Recent reports of dire situations faced by poor senior citizens living alone have highlighted the inadequacies of the government’s welfare program and a critical lack of home-care services, welfare workers say.
The Huangshan Social Welfare Foundation has highlighted several cases of needy, but underserved Taipei residents, including an 87-year-old grandmother surnamed Tsai (蔡), who lives alone in the Songshan District (松山). She has heart problems and diabetes and is largely restricted to either her bed or a chair that is next to it. She also uses a catheter and a urine drainage bag.
According Tseng Pei-ling (曾沛鈴), head of the foundation’s Songshan chapter, the government’s assistance program provides a caregiver to visit Tsai for two hours a day on weekdays.
“On a weekday visit, the caregiver provides a towel bath, cooks a meal, changes the urine drainage bag and other chores. Two hours each day is not enough for Tsai’s case,” Tseng said.
“Weekends are a big problem. The caregiver who comes on Mondays often finds food for two days’ meals has been gnawed on by rats, and the urine drainage bags overflowing,” Tseng said.
Tsai’s daughter provides some occasional financial support to her mother, so Tsai is not eligible for the government subsidy to low-income households, Tseng said.
“Due to this, Tsai gets a very small subsidy for elderly home care. If she applies for extra hours, then she has to pay the full cost for the service,” Tseng said. “However, we do not have enough caregivers, so even if someone has the money to apply for one, a caregiver may not be available.”
A 70-year-old man surnamed Chang (張) in Tatung District (大同) faces similar problems. Divorced some years ago and once homeless, Chang now lives alone in a small room.
Chang is no longer in contact with his son, who has a steady income. However, because his son is employed, Chang lost his government welfare subsidy this year, and now he gets by on the meager income from doing odd jobs.
An elderly man surnamed Ke (葛) was university educated and once made a decent living using his English and German-language skills. However, as a younger man he drank and gambled, and eventually his marriage broke down. His wife won custody of their son and daughter.
Ke has not had any contact with his children for years, but because his son has an income and property, Ke’s low-income subsidy was canceled by the city government, leaving him penniless and in debt.
The city government provides a subsidy of NT$230 (US$7.70) an hour for elderly home care, but the full amount is only available to low-income households. People in the medium-to-low-income range have to pay 10 percent of the cost, while regular households pay 30 percent.
For people with a minor level of physical or mental disability, the city subsidizes 20 hours of care per month. The hours go up according to the level of disability — 60 hours for medium level and 90 hours for a high level.
If more hours of care are needed beyond what the subsidies cover, the clients must pay for them themselves, which most of them cannot afford.
Chen Shu-chuan (陳淑娟), head of the city’s Division of Welfare Services for Senior Citizens, says Taipei residents can apply for a status review if they are in a situation where they are not in contact with family members and receive no support from them, yet are regarded as ineligible for a subsidy because they have living relatives.
“Under Article 3 in the Public Assistance Act (社會救助法), they can file a request for a review of their case. The city’s Department of Social Welfare will send an officer on a home visit to assess the situation,” Chen said.
There have been 40 cases of elderly people having their welfare subsidy restored on appeal, after their relatives’ income is precluded.
However, Chen said there are not enough caregivers available.
“We have contracts right now with 18 private companies for a total of 600 caregivers, but we have about 3,000 elderly in the city needing the service,” Chen said.
Of the NT$230 hourly subsidy, about NT$180 is used to pay the caregiver, while the rest covers the private company’s administration and management expenses.
The city government has an annual budget of about NT$200 million for at-home care for elderly residents. The Ministry of Health and Welfare provides NT$110 million of the budget and the city makes up the rest.
Premier Jiang Yi-huah (江宜樺) said in May that the central government would raise the subsidy for elderly home-care service from NT$180 per hour to NT$200 and caregivers’ hourly wages would be raised from NT$150 to NT$170.
“Caregivers in Taipei have always had a higher hourly rate than what the central government’s budget provides for. However, we hope to change to a monthly wage structure, so the caregivers can also take time off for personal reasons, and take maternity leave if necessary,” Chen said.
“The new policy will also see a higher hourly pay rate and will allow caregivers to take time off from work for job training while still being paid. Caregivers are now protected under the Labor Standards Act (勞動基準法), so we hope to attract more people to enter the elderly home-care sector,” she said.
Additional reporting by Tsai Ya-hua and Lin Hui-chin
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