Aging in place: The direction of Taiwan long-term care policy in the 21^st century

In the 21^st century, long-term care has presented serious challenges to public policy as the elderly population in Taiwan increases rapidly. Many developed countries have used "Aging in Place" as the guiding principle for devising elderly care policy. Aging naturally in the community has been a key ingredient in maintaining independence, self-respect, privacy and quality of life. Thus, to be consistent with the concept of community-based care, many countries have started a reform in long-term care resource development, service provision, management, and financial schemes, regardless of political systems. The focus is to develop supportive services locally with the intention of helping the elderly stay in the local community for as long as possible. Contrary to the developed countries, supportive services to help the elderly staying at home are seriously lacking in Taiwan. Two three-year projects, funded by the Executive Yuan in 1998, have led to the dramatic growth of institutions, while community-based care resources remained scarce. Such trend is in the exact opposite direction of "Aging in Place" principle. If continues, it is expected the society will have to pay for the high cost of institutional-based care, and many elderly will be deprived of the opportunity to age naturally in the community. Therefore, the elderly care policy in Taiwan needs some adjustments. To be consist with "Aging in Place" principle and to achieve the goal of staying in the community, reforms and researches are needed in the following areas: (1) Perform need assessment for elderly care in the community level, in order to project resource development, (2) Develop various long-term care resources locally to serve local residents, (3) Integrate service network and to improve efficiency of services, (4) Encourage home care and other supportive services to prolong time spent in the community, and to reduce the use of institutional care, and (5) Devise a financing scheme consistent with the development of community-based long-term care system.