A severe shortage of hospice services in hospitals and health centers across the nation could have a severe impact on the elderly and terminally ill patients, the Taiwan Healthcare Reform Foundation said yesterday.
“Nearly 86 percent of respondents to a survey conducted last month by the foundation said they would prefer painless hospice care at home or in local communities, rather than being kept alive by a ventilator. However, whether that hope will be dashed may hinge entirely on where they live,” foundation chairwoman Liu Mei-chun (劉梅君) told a news conference in Taipei.
Liu said that while it is common knowledge that the nation is rapidly becoming a “super-aged society,” in an evaluation of the availability, accessibility and policy of hospice care services, just two out of 19 cities and counties scored more than 41 out of 50 points — the minimum requirement for a five-star rating by the foundation.
In addition to the two five-starred administrative regions, Greater Taoyuan and Yilan County, five regions earned four stars: Greater Taichung, Chiayi and Hsinchu cities, and Changhua and Hualien counties, Liu said.
“It is worth noting that Taipei, despite being equipped with relatively abundant end-stage palliative care resources, scored just 30 on the test and was given a three-star rating, as its relatively large elderly population of 360,000 people has resulted in a high demand for end-of-life care,” Liu said, adding that Yulin County was rated the lowest, because it was lacking in all aspects of palliative care.
Another pressing problem is the wide gap in hospice care resources between cities and counties, Liu said, citing statistics that showed each hospice care facility in Chiayi City is responsible for an average of 189 cancer patients, for example, compared with 977 per facility in Yunlin County and an average of 364 per facility nationwide.
“In addition, about eight hospice palliative care beds are available per 100,000 residents in Hualien County, while people living in Nantou County have no such facilities at all,” Liu said.
More troubling, Liu said, is that nine out of the nation’s 50 “sub-medical regions” — population centers within larger medical service areas — were found to be without palliative care, lacking hospice beds, community services or home care options, Liu said.
Three are in Taitung County, two in Pingtung County and one each in Miaoli, Nantou, Yulin and Hualien counties, she added.
Foundation deputy executive director Phoebe Chen (陳芙媺) said its researchers have determined the root causes of the problems, which include indifference from local government leadership and reluctance among hospitals to promote hospice care because it is less lucrative than other hospital services.
“So far, only the governments of Taoyuan, Changhua, New Taipei City and Nantou have endeavored to promote community-based palliative care, while others rely solely on the services provided by the National Health Insurance program and have done little to build a hospice care network,” Chen said.
Despite the Ministry of Health and Welfare’s oft-touted efforts in facilitating hospice care, Chen said that just three of the nation’s 27 ministry-affiliated hospitals have palliative care beds, which are also absent in established cancer-oriented medical institutions such as Taipei’s Shin Kong Wu Ho-Su Memorial Hospital and the Far Eastern Memorial Hospital in New Taipei City.
The foundation urged local governments and the ministry to prioritize the provision of palliative care.
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