Long-term Care In Taiwan Research Articles

The Development of Community Long-Term Care in Taiwan and the United Kingdom: An Analysis in Terms of a Welfare Pluralist Perspective

<p>當前臺灣長期照顧是從社區照顧關懷據點模式發展為長照1.0及2.0，與英國西元2000年之前的社區照顧發展過程相仿。本研究旨在探討英國和臺灣社區長期照顧的福利多元主義模式發展歷程。其研究方法係採用解釋性比較研究，在較複雜的體系內，探討部份政策改變的效果。研究發現，英國在機構照顧、社區內照顧之後，由1980s由社區來照顧至1993以後在社區範圍內的照顧階段，與臺灣2005之後兩階段相似。顯示臺灣從英國之模式中有所借鑒，使相關的預算支出獲得相當的控制。本研究建議高齡化國家初期以社區照顧據點自助、社區式長期照顧公助和機構式補助為主，中期則採取社區長期照顧和機構長期照顧的公助相輔相成之方式，而超高齡國家則需以長照保險發展共助來穩定財源。</p> <p> </p><p>This study focuses on community care in Taiwan and the United Kingdom. The comparative analysis was applied to explore the development process of community-based LTC in the United Kingdom and Taiwan from a welfare pluralism perspective. The study found that the United Kingdom and Taiwan have experienced similar policy ideas and practice shifts, that is, from “Care by the Community” to “Care within the Community”. In the time of change, the United Kingdom took place in 1993 and Taiwan in 2005. This study suggests that the national long-term care service strategies should be adjusted according to the degree of population aging. In the early stage, self-help community care bases and community care are mainly used, combined with institutional subsidies. In the medium term, community care, and institutional care provided by the government will be adopted. When reaching the super-advanced age, long-term care insurance will be needed to stabilize financial resources.</p> <p> </p>

Sexual harassment prevention program for Indonesian nursing aides: a mixed-methods study

Available evidence suggests that sexual harassment is widespread among Indonesian nurse aids working overseas, however little research has been done on the topic. This study investigated the effectiveness of sexual harassment prevention program for Indonesian foreign nursing aides working in long term care in Taiwan. Average work experience was 54.8 months and 93% of participants were female. We used mixed methods followed by a focus group. Quantitative data were analyzed using Wilcoxon signed rank test. Most participants had higher post-test scores, indicating a significant positive change in their awareness about sexual harassment (effect size <em>r</em>=0.84). More work experience correlated with less sexual harassment and greater job satisfaction. Content analysis was used to analyze qualitative data. Four themes emerged from the discussion: harassment may not be intentional, perpetrators are male patients, communicating in an effective and timely manner is important, and personal safety on the job is a concern. Although sexual harassment prevention programs are important for nurse aides, these programs should also include patients, their families, and staff members at long term care facilities. Further recommend the Indonesian Economic and Trade Office in Taiwan collaborate with private agencies to provide legal protection and training programs on these issues.

Assessing Quality of Life with Community Dwelling Elderly Adults: A Mass Survey in Taiwan.

With the growing life expectancy for older adults, this study aims to examine the correlation among sociodemographic characteristics and the combined effect of QoL-related domains including physical health, psychological health, social relationships, and environmental factors with the overall QoL level of older adults in Taiwan. The WHOQOL-BREF Taiwanese Version questionnaire was adopted and conducted using a randomized telephone interview system from community household elders. In total, 1078 participants aged 65 years and older were recruited. A multiple regression model was used to examine the statistical significance between the overall QoL score as the dependent variable and the sociodemographic characteristics, and 26 items of QoL-related questionnaires as the independent variables. Categories including female, aged 85 years and above, higher education level, and better financial situation had significantly higher overall QoL level. Except the physical health domain and six items, the correlations among all other domains and their including items of questionnaires with overall QoL level were significant. The Taiwanese WHOQOL-BREF questionnaire can be used to examine the overall QoL level of elders in Taiwan. Nevertheless, the robust systems of universal health care and long-term care in Taiwan may have led to the no significance of the six items.

Analysis of Older Adults under Home Care in Taiwan's Ageing Society.

As of January 2022, 16.91% of Taiwan's population was over the age of 65, and a 2017 study indicated that 94.2% of patients who required long-term care in Taiwan received home care. This study produced a “post-home care patient information survey” to understand the characteristics of home care patients and the volume and results of home care and investigate the relationships between them. Different diagnoses were found to have no significant effect on the volume or results of home care. Positive correlations were found between the services patients required and the volume of home care and specific results. Volume and specific results were also positively correlated. The termination of home care was primarily due to medical needs (98.6%). As the Taiwanese population ages, home care must be improved, and the conditions for which patients can receive home care should be expanded. Care services should replace diagnoses in determining benefit standards for home care payments.

Role Function and Policy Prospects of Long-Term Care Nurses in Taiwan: Evidence-Based Policy Recommendations of Professional Nursing Organizations

Professional nursing organizations represent an important channel for the nursing profession to influence health policy, represent and protect the interests of nurses, and advocate for the further development of the profession. Facing the rapidly increasing aging population and emerging needs of long-term care in Taiwan, the Taiwan Nurses Association launched an integrated project to propose policy advice on the development of nursing in long-term care. In this paper, the relevant findings in the domestic and foreign literature are summarized to better define the role function and core competence of long-term care nurses. In addition, the current tasks, perceived competence, and training needs of nurses working in long term care settings are presented, and the consensus on various advocacy strategies are summarized. The findings presented in this study may be referenced when developing evidence-based policy recommendations related to education, practice, legal / regulatory amendments, and professional organizations.

Determinants of long-term care service use by persons with dementia: A national dementia registry study conducted in Taiwan.

This study investigated the determinants and use of Taiwan's long-term care (LTC) Plan Version 2.0 (LTC 2.0) services by persons with dementia (PWDs) and their caregivers. In total, 1268 PWD-caregiver dyads were enrolled for analysis from a national dementia registry. Andersen's Behavioral Model of Health Services Use was used to investigate the association of LTC service use with several factors, namely the demographic data of PWDs and their caregivers, migrant caregiver employment, monthly household income, caregiver burden as determined by the Zarit Burden Interview (ZBI), Mini-Mental State Examination score, Clinical Dementia Rating scores, neuropsychiatric inventory scores for the behavioral and psychological symptoms of dementia, and PWDs' activities of daily living (ADLs). Among the studied family caregivers, 81.4% did not use LTC resources. A multivariable logistic analysis revealed that aberrant motor behaviors (odd ratio [OR]=1.31, 95% confidence interval [CI]=1.10-1.56, p=0.003), dysfunction in ADLs (OR=1.06, 95% CI=1.02-1.10, p=0.002), higher ZBI scores (OR=1.02, 95% CI=1.01-1.03, p=0.004), not residing with family members (OR=1.88, 95% CI=1.32-2.66, p<0.001), and not employing a migrant caregiver (OR=4.41, 95% CI=2.59-7.51, p<0.001) were the factors most significantly associated with LTC service use. Factors such as whether PWDs live alone, specific neuropsychiatric symptoms, and impaired function should be considered in future policy amendments to provide required activities and care resources for PWDs and their caregivers.

Community-Based Long-Term Care in Taiwan: The Service Experiences of Tier B Centers

This qualitative study explored the community-based long-term care in Taiwan, examining the service experiences of Taiwan’s Tier B centers. Semi-structured interviews were conducted with seven Tier B service centers managers. The interview transcripts were analyzed by comparing the participants’ responses to find similarities and inducted into three themes. It was found that the adversities encountered include frequent policy revisions, the lack of systematized training programs, the high turnover rate among service providers, as well as differing perceptions between family members and service providers. They tried to solve problems and suggested policy improvement, including establishing platforms for government-citizen dialogue as well as creating supervision and evaluation mechanisms. Consequently, Tier B service centers benefit the community and the long-term care industry as elderly people can age in place and reduce families’ caregiving burden. Also, the practical experiences provide the real situation of differences between policies, training, and social service promotion. For future research, it is suggested to use this study’s results as a blueprint and conduct a questionnaire survey on all Tier B service centers in the country to understand the overall service outcomes. And propose suggestions for policy revision and formulating training programs for service providers.

Factors Affecting Willingness of Direct Care Workers to Engage in Elderly Care

Direct care workers are the main workforce in long-term care in Taiwan. However, few direct care workers desire to enter or stay in this field. This study aims to explore the factors influencing direct care workers’ elderly care willingness. A cross-sectional design was used in the present study. Stratified random sampling was utilized to select samples from a southern city in Taiwan. Overall, 207 participants completed the questionnaire, including providing demographic data and answering all questions on the Older People Scale and the Willingness Toward Elderly Care Scale. An independent sample t-test, one-way analysis of variance (ANOVA), Pearson’s correlation coefficient, and multiple regression analyses were used to examine the associations among the study variables. Direct care workers’ elderly care willingness was significantly influenced by junior high school (β = .023, p = .047), hourly wage (β = .148, p = .037), and appearance and physical attitude toward older adults (β = .302, p = .002). These factors explained 15.4% of elderly care willingness. In conclusion, it is critical to cultivate positive attitudes toward older adults and nurture the appropriate understanding of aging to avoid stereotypes and enhance the willingness of direct care workers to care for older adults. Furthermore, providing a more flexible schedule and additional opportunities to receive better compensation will increase the care willingness of direct care workers. It is suggested that the on-the-job training about caring for older people that aims to develop positive attitudes toward older adults and awareness of age stereotypes are required. These findings provide critical information for the retention and recruitment of the workforce to care for older adults.

Degrees of Shortage and Uncovered Ratios for Long-Term Care in Taiwan's Regions: Evidence from Dynamic DEA.

The government is facing the country’s aging population and low birth rate have led to a severe shortage of its healthcare workforce in Taiwan after 2003. In order to explore the status of the country’s degree of long-term care shortage and uncovered ratio, this research uses the Push-Pull-Mooring (PPM) theory to explain long-term care efficiency during 2010–2019 in each city and county. We collect longitudinal-sectional data for 2010–2019 from the Ministry of Health and Welfare’s Department of Statistics for 22 administrative regions in Taiwan in each year and employ dynamic data envelopment analysis (DEA) to evaluate the overall technical efficiency and the disaggregate output insufficiency to explain the research results. The main findings are as follows: (1) Cities near the capital Taipei have the highest degree of shortages in long-term caregivers and high uncovered ratios of people who need long-term care. (2) Presently, there is no demand to increase the number of long-term care institutions in Taiwan. (3) The government should introduce new long-term care certificates through national examinations in order to develop a stronger professional workforce in this field.

Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

The Lived Experiences of Indonesian Nurses Who Worked as Care Workers in Taiwan.

Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan. This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan. Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data. Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry. Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.

Using the Importance–Satisfaction Model and Service Quality Performance Matrix to Improve Long-Term Care Service Quality in Taiwan

The present study integrates the importance–satisfaction (I-S) model and service quality performance matrix (SQPM) to examine long-term care (LTC) service demands and satisfaction improvement. Many scholars have used a single model to explore project improvement. Each model has advantages, but we think they are too subjective and suggest that it is best to integrate models to determine what should be improved. We established quality attributes of service demands based on more than two sessions of discussions and expert consultations with LTC service users (older adults). The final questionnaire was divided into three parts: a demand survey, satisfaction survey, and demographics survey, and 292 valid questionnaires were collected. The questionnaire items were summarized with means and standard deviations. In this study, if only the I-S model was used to examine LTC in Taiwan, then seven service elements of the system would need to be improved. However, if only the SQPM method was used, then 16 service elements would need to be improved. Only seven service elements were identified by both methods. When time and resources are limited, it is not feasible to take comprehensiveness into account. When many projects must be improved and it is impossible to implement them at the same time, improvement priorities need to be developed. Taiwan lacks sufficient LTC resources, so it is impossible to provide enough resources for all those who need care. To use resources efficiently, the I-S model and SQPM were integrated in this study to identify areas for improvement.

An Exploration of Factors Related to Quality of Life in Indonesian Care Workers in Home-Based Care Settings.

ABSTRACTBackgroundIndonesians constituted 79% of foreign care workers for long-term care in Taiwan in 2015. Therefore, it is crucial to explore the effect of work stress and quality of life (QoL) on this population.PurposeThis study aims to explore stress levels, social support requirements, and perceived QoL among Indonesian care workers (ICWs) who work in home care settings.MethodsA cross-sectional design was used. Data were collected between 2014 and 2016 from a convenience sample of ICWs working in eastern Taiwan using a self-administered questionnaire that comprised the Stress Perception Scale (SPS), Social Support Scale (SSS), and World Health Organization Quality of Life-Brief scale. One hundred fifty-seven valid questionnaires were collected. The response rate was 80.51%. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis.ResultsThe results found that the average SPS of the sample was 70.50, with low QoL scores and requirements for more social support. In addition, significant and positive correlations were found between QoL and SPS, SSS, duration of patient care, and hours of care per week. Stepwise regression analysis showed that the most predictive variables for QoL were time spent caring, preservice training, psychological stress, and emotional support, which together accounted for 60.9% of the total variance.Conclusions/Implications for PracticeThis study facilitated understanding of the stress on ICWs and the impact of social support on their QoL. The findings suggest that new immigrants in Taiwan should be introduced to foreign care workers or nursing attendants. Moreover, long-term-care-related teachers should work with home care institutions or agencies to develop a teaching model for innovative care skills to relieve the perceived stress of ICWs.

Lessons learned from the evolution of long-term care programs in Japan and the implications for Taiwan's long-term care system development

Lessons learned from the evolution of long-term care programs in Japan and the implications for Taiwan's long-term care system development

LTC 2.0: The 2017 reform of home- and community-based long-term care in Taiwan

Taiwan planned to establish a social insurance-based long-term care system in 2016. However, due to the change in political parties that year, it was decided that Taiwan’s long-term care policy would remain a tax-based financing scheme. The new policy focuses on providing home- and community-based service (HCBS); a three-layer HCBS service network within towns and districts was set to provide the 17 types of services in the HCBS spectrum, including preventive care. The reform was criticized as being too restrictive and lacking flexibility. However, the HCBS service spectrum has been widened, the target group has been enlarged, and thus HCBS utilization has increased. A rolling amendment has continued into 2018: the HCBS system requirement has been eased, and a new capitalized fee-for-service payment system has been launched. This paper discusses the analysis of the policy reform.

Oral Care for Clients in Long-Term Care

Oral health impacts the physical and psychological comfort and the quality of life of clients in long-term care. The programs to prevent or delay disability care advocated under Taiwan's Long-Term Care Plan 2.0 address oral health care, highlighting the importance of oral health care for clients in long-term care. This article discusses three concepts of oral health care for clients who are in long-term care. These include: the relationship between oral conditions and general health, oral care and dysphagia, and oral health and hydration. In addition, oral health care strategies for long-term care facilities are discussed. It is hoped that this article will encourage long-term care practitioners to pay close attention to the issue of oral health and to implement appropriate oral health care for their long-term-care clients.

Long-term care system in Taiwan: the 2017 major reform and its challenges

AbstractThis paper reviews the past development of the publicly funded long-term care (LTC) system and aims to advance further discussion of LTC in Taiwan. The Ten-year Long-Term Care Plan 2.0 introduced in 2017 calls for a major reform of a publicly funded LTC system in Taiwan. The reform expands on the previous universal tax-based LTC system, allowing for more comprehensive and accessible subsidies on LTC services. This paper provides a brief overview of the political context of the reform and an introduction to the legal basis, financing and delivery mechanisms of the reform plan. To this end, as a preliminary evaluation, this paper identifies major institutional and socio-cultural tensions that could challenge the implementation of the plan. Institutional tensions include the dominant foreign worker caring model, which relies on approximately 220,000 foreign workers to provide LTC services, and the discontinuity between health and social care governance, which leads to a discontinuity between curative and LTC care. Socio-cultural tensions focus on conflicting values in the allocation of responsibility of care and in the understanding of disability between universal social citizenship in the modern state and traditional Confucian ethics. Policy implications of these tensions for the LTC system are then discussed.

Exploring the home services utilization and its influencing factors for case closures in Taiwan long-term care system

目標：居家服務於長期照護中相當普遍，而發展以人為本的社區式服務，必須透過縱向資料的累積來了解高齡者之個人特性、服務使用與留住社區之能力。本研究目的在檢視南部某都市的居家服務利用情形、結案原因以及相關影響因素。方法：以南部某都市照顧管理資訊系統（LTC-CM）資料庫2011年至2015年為止曾核定使用居家服務之身心障礙者及老人現況資料進行分析，第一次需求評估中（T0）共有9,889名個案接受服務。Cox回歸分析應用於檢視服務利用兩年內結案原因分析，來找出潛在影響因子。結果：研究期間結案的比例偏高，其中死亡佔20%，離開服務佔41%（主因為個案之家庭網絡尋求其他照顧資源）。扣除死亡後結案的影響因子為一般戶、照顧者負荷較大、中度智力缺損者較易結案。結論：本研究結果實證居家服務的高結案率，建議除服務提供外，應重視個案的服務利用狀況與結案原因，建議未來進一步探討不續用服務者其產生服務缺口的原因。

The Effectiveness and Related Factors of Taiwan's Long-Term Care Professional Manpower Training (Level I Common Curriculum)

The Effectiveness and Related Factors of Taiwan's Long-Term Care Professional Manpower Training (Level I Common Curriculum)

641 Meet the needs of sexual desire, sexual satisfaction in long term care in Taiwan

641 Meet the needs of sexual desire, sexual satisfaction in long term care in Taiwan