The Cabinet’s Task force on long-term care insurance task force held its first meeting on June 29 to report the preliminary results of its preparations. As expected, and just as at the Council for Economic Planning and Development’s preliminary planning meeting, the Cabinet’s task force — none of whom are disabled — ignored the needs of the disabled, disappointing the disabled and their families.
The council made two suggestions: a national insurance plan and compulsory insurance for those older than 40. Adopting the latter would exclude many people who are younger than 40 but still need long-term care. As for the national insurance, the council estimates it would only add another 24,000 disabled people.
During the first quarter of this year, however, there were more than 16,000 physically and mentally handicapped patients living in institutions that provide full-time care, day care or nightly accommodation. Many more were cared for by family or foreign caretakers. An estimated 9,300 patients under the age of 44 with grave physical or mental disabilities needed long-term care last year. No matter how you look at it, the numbers exceed the council’s estimates.
We do not know the origins of these figures that so heavily underestimate needs, but we guess that they are based on the number of physically disabled. In other words, the mentally disabled, including those with intellectual disabilities, autism, Alzheimer’s disease or psychiatric disorders are not considered to need long-term care. This view is, of course, based on financial concerns.
However, many parents of mentally handicapped patients cannot sustain the pressures of long-term care, and some worry that they won’t be able to continue. The thought of an elderly parent dying while still caring for their child is tragic, and if long-term care insurance cannot help these families that need it most, it is nothing more than a nice name.
A proposal to pay for care according to the level of service offers three levels. The highest one is the still inadequate 150 hours per month. Someone with a spinal cord injury, muscular dystrophy, spinocerebellar atrophy, motor neuron disease or Alzheimer’s disease requires around-the-clock attention. At 150 hours of care per month the long-term care insurance would pay for just five hours per day. Families would have to pay one-tenth of that and then pay for the remaining 19 hours of daily care. Most families cannot affort the estimated NT$200 per hour cost of care, so in the end they will hire a foreign caretaker. Long-term care insurance thus becomes a respite care service using foreign caretakers.
Even more worrying is that institutions offering accommodation for the physically and mentally disabled are maintaining the level of their care because the Ministry of the Interior uses subsidies as a policy tool, restricts fees and makes regular reviews. If these institutions are to provide the services under the long-term care insurance scheme, and if there are no more subsidies for specialists, operational costs will shoot up, forcing non-profit groups to start operating for profit. That will affect the quality of care and the physically and mentally disabled will be the first to suffer.
The Cabinet needs to make long-term care insurance a priority with substance instead of delivering an inadequate program just to say it is implementing one of President Ma Ying-jeou’s (馬英九) election promises. It should respond to the needs of the public and deliver on the promise of a government that serves the people for the sake of all those who want a dignified life. The creation of a long-term care insurance plan devoid of content will only disappoint everyone.