Long-term care 2.0 plan for greater peace of mind

  • Date: 2018-03-06

I. Background

With a fast-growing elderly population, Taiwan is expected to join the ranks of aged societies in 2018 when its population aged 65 and above reaches 14.5 percent, and further become a super-aged society in 2026 when that figure will hit 20.6 percent. For individuals in this segment, aging is often accompanied by chronic illness and functional impairments that can place family members under increasing strain, at a time when family care is on the decline. To meet the growing needs for long-term care while alleviating the stress on families, the Executive Yuan approved the long-term care 2.0 plan on September 29, 2016 and began implementation on January 1, 2017.

II. Why the need for long-term care 2.0?

The first iteration of the 10-year long-term care plan introduced in 2007 had already expanded the nation’s service capacities considerably. Service demands have since become more diverse, however, creating a pressing need for new and innovative types of care service models. The 2.0 plan emphasizes preventive care early on to minimize the number of years lived with disability, and integrates home hospice care with other home-based treatments for the later stages of life. These services are designed to provide a diverse and continuous long-term care system to meet the full spectrum of needs of the care recipient.

III. How is long-term care 2.0 better?

A. Three-tier, community-based system to promote aging in place
Integrates the resources of long-term care service units at all levels
The 2.0 plan created a three-tier system consisting of community-based integrated service centers (Tier A “flagship stores”), combined service centers (Tier B “specialty stores”), and long-term care stations distributed in residential alleys and lanes (Tier C “grocery stores”). Health care, long-term care, home-based services, preventive care, and support for daily activities are all linked together in this system.
A dense network to service all needs
Anyone with a need for long-term care can access this entire service network through any of the Tier A, B, or C centers. The plan’s goal is to establish at least 469, 829 and 2,529 centers at the A, B and C levels in communities across the nation by the end of 2020.

B. Expands service capabilities
Extends coverage to more users
In addition to individuals aged 65 or over, the plan covers people with dementia aged 50 or over, members of all indigenous communities aged 55 or over, and individuals of any age affected by mental or physical disabilities. This will more than double the number of beneficiaries from 511,000 to over 1.28 million.
Increases the number of service items offered
New service items added under the 2.0 plan include care for dementia patients, integrated services for indigenous communities, small-scale multifunctional services, services for caregivers, community-based preventive care, preventive care to delay disability onset, hospital discharge planning and home-based treatments. From the front end to the back end, these services include early preventive care to minimize and delay the onset of disabilities as well as hospice care to provide comprehensive, compassionate and dignified care for those most in need.

C. Easy-to-find, easy-to-access services
One-stop shop
County and city governments will strengthen their long-term care management centers to provide convenient services for local residents. The centers serve as one-stop shops for processing applications, evaluating patient needs and helping families develop care plans. Ninety centers and branch offices have been set up in 22 counties and cities across the nation so far.
“1966” hotline
The “1966” long-term care hotline was activated in November 2017. Callers may request case managers from long-term care management centers to visit their homes for individual evaluations.

D. New subsidy system for more customized care plans
Four categories of integrated services to choose from
A new schedule of government subsidies to care providers and care recipients took effect January 1, 2018, consolidating 10 categories of services into four: care and professional services, transport services, assistive services and barrier-free home modifications, and respite care. Whereas in the past many people selected and requested services on their own without understanding what each service entailed, the new subsidy system allows long-term care management centers or professional case managers to create customized plans tailored to the diverse needs of each patient.
More responsive to different levels of disability
The 2.0 plan created a finer classification of disability that uses more evaluation criteria and includes different types of long-term disabilities. The old system looked only at one criterion (ability to perform activities of daily living) to assess the patient’s degree of disability (mild, moderate or severe), while the new system employs more evaluation items (instrumental activities of daily living, emotional or behavioral factors, etc.) to accommodate different types of long-term disability patients. The new system also stratifies the disabilities into levels 2 through 8 to be more responsive to the specific needs of each patient.
A service-based approach for greater efficiency
In calculating subsidies for care recipients, the old long-term care system used the number of care hours while the new system uses the services provided to the recipient (grouped into combinations of services). The cost of each combination reflects the difficulty of the services to be performed, which encourages long-term care providers to deliver services in a more efficient and effective manner. Subsidies for care providers, meanwhile, are increased for special situations to encourage care workers to take on the more challenging cases. The new subsidy system also simplified paperwork for care-providing institutions, resulting in a more efficient reimbursement process.

IV. Earmarked tax revenues to fund long-term care system
As long-term care grows in demand and capacity, so will the funds needed to finance the overall system. To create new and steady revenue sources, the government raised tobacco, estate and gift taxes and amended the Long-term Care Services Act in 2017 to designate the increased tax revenue from these adjustments as additional sources to fund long-term care. Over the next two years, the Ministry of Health and Welfare will review the entire long-term care financing structure and study the feasibility of tapping other tax revenues or creating a national long-term care insurance system to ensure that Taiwan’s growing long-term care system has the funding required to operate sustainably.

V. Conclusion
Built around neighborhoods and local communities, the long-term care 2.0 plan integrates community care, health care and preventive health resources to create a quality, affordable and accessible long-term care system. The goal of this system is to provide dignified and humane care to people with long-term conditions, and nurture a society that values respect and compassion for its elderly members.