The new 10-year “long-term care services program 2.0” plan is being promoted by the government as a high-quality, inexpensive and universal system that can channel the energy of local communities.
It is hoped that it will enable older people to live out their lives in their communities by receiving long-term care there. Building a system of local services that are able to deliver localized, universal and accessible care is a challenge facing local governments nationwide.
There are already successful examples of making use of unused buildings on school and college campuses for the development of long-term care programs and combined day care centers for the young and older people, which have received praise and attracted attention at a high level in government circles.
These types of programs are seen as important for three reasons.
First, combined day care centers are both feasible and respond to needs.
Second, as Taiwan adjusts to the twin effects of an aging society and a declining birthrate, using school buildings is a good way to save resources.
Third, delineating school districts accords with the principle of developing localized long-term care.
However, at present, turning school buildings into care centers for older people is not yet widespread due to several problems.
First, land used by educational institutions and social welfare services is zoned. This means many of these institutions need to apply for permission to add a usage category to the land that they occupy.
Second, some buildings are extremely old, and the required usage permits do not exist for them. While there is a method to apply for a supplementary permit, the process is extremely bureaucratic and time consuming.
Third, building management and fire protection regulations mean that turning school buildings into care centers would be problematic for the majority of possible sites. Regulations governing a number of municipal sites mean that changes can be avoided if the site area falls below a given size.
However, if the area is too small, it would not be suitable for use as a day care center, or the number of people it can take on would have to be reduced. Reduced numbers would mean increased operating costs. In addition, upgrading facilities to meet fire regulations would entail jumping through many hoops of bureaucracy.
Fourth, in addition to ensuring that facilities conform to regulations, some people are not yet ready to accept care facilities for older people on school campuses. Problems that would need to be overcome include the opening up of campuses to the public and potential objections from families.
Since people have yet to get used to the concept of an aging society, and due to concerns over safety, not everyone is willing to cooperate at this stage, and this is a challenge that will need to be overcome for there to be a more flexible use of space.
To foster a spirit of communitarianism to allow long-term localized care to become a reality, it has been suggested that unused buildings on elementary and junior-high school campuses be given a prioritized legal status.
The Ministry of Education and the Executive Yuan have strategies in place to promote the reuse of unused buildings on school campuses, but they carry insufficient legal weight and do not ease regulations on building management and fire prevention, which can be used as a first line of attack to scupper plans by those opposed to the schemes.
However, there are specific proposals that would deal with these problems.
First, regulations governing standards on campus facilities could be amended to additionally stipulate facilities for combined day care centers and retirement homes, which would form one of the categories of facilities to be provided by educational institutions.
New buildings should be designed to set aside additional space, while old buildings can be renovated to make space as required. The idea is that they would operate like a type of classroom within their own distinct department.
Second, since care centers would form part of on-campus facilities, building management and fire regulations requirements could be made the same as those already in place for educational institutions. Classrooms that are considered safe for children should in theory also be safe for older people.
Third, facilities for combined day care centers and retirement homes should be designed with all-purpose disabled access in mind, so that older people, pregnant women and those with disabilities all have equal access to community campus life.
Lue Jen-der is director of the Taichung City Government’s Social Affairs Bureau. Cheng Ching-hsia is an associate professor at National Chung Cheng University’s Department of Social Welfare. Su Shu-chen is a doctoral student at the university.
Translated by Edward Jones
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