Over the Dragon Boat Festival long weekend, apart from spending time with my wife and parents, most of my time was devoted to arranging things for my former university professor, who lives alone, but is in the hospital with cancer.
One weekend morning two weeks before the festival, the professor fainted at home. He remained unconscious until the evening, when he managed to summon all his remaining strength to pick up his cellphone and call my wife. My wife rushed to the professor’s home and asked the fire brigade to break down his door, rescue him and take him to the hospital for emergency treatment.
He received treatment as an inpatient, but then had to leave because of how the National Health Insurance system works. However, just a few days after returning home, he was taken back to the emergency room because he was feeling unwell.
The frustrating thing is the lack of communication between the medical centers, the hospital social workers and physicians, and the ward nurses, allowing a sick patient with no one at home to care for him to leave the hospital and then have to go back after a short time. It is sad to see solitary elders being tormented like this.
Increasingly, elderly people in Taiwan are living alone. President Tsai Ing-wen (蔡英文) has said that she wants to bolster the social safety net, but the safety net does not give full protection to elderly people who live alone.
Tsai and her administration are proud to be promoting “long-term care services,” but older people are left to apply of their own accord, while the services available are limited and of uneven quality.
There is a program of care visits for solitary elders, but the service items offered are limited. The same can be said of the National Health Insurance Administration’s (NHIA) Integrated Home Care Project, which has many restrictions on the available medical services. With each ministry doing as it sees fit, an increasing number of people are likely to die at home alone.
People tend to become less adaptable to new environments as they get older. This causes many elderly people to be unwilling to leave their original homes. They will always be so, no matter how many old people’s homes or long-term care facilities are built.
Other factors leading to the growing numbers of elderly people living alone are that more of them are unmarried or divorced, and that people have fewer children than they used to. The prevailing social trend encourages people to work hard to earn money and save it for their retirement, but this might lead them to neglect relationships with relatives, and result in their becoming isolated.
Ministry of Health and Welfare statistics show that 45,035 elderly people in Taiwan last year were registered as living alone. However, the ministry’s Report of the Senior Citizen Condition Survey 2017 shows that there were nearly 3.22 million people aged 65 or over, 8.94 percent of whom were living alone. To this can be added the 20.38 percent who only live with their spouse and the 1.38 percent whose only live-in companion is a foreign care worker.
This adds up to about 30.7 percent of elderly people living alone, not to mention the 0.88 percent — more than 20,000 — who live in institutions, making it clear that those registered as living alone, who the government is concerned about, account for less than 20 percent of the real number of seniors living at home.
Elderly people who live alone need companionship and healthcare, but they above all need medical treatment when they are sick. The ministry’s 2017 report shows that 64.88 percent of elderly people said they suffered from chronic illnesses, while 28.16 percent said they had difficulty with what are called activities of daily living and instrumental activities of daily living.
Older people might have difficulty going out to visit a doctor, and those who live alone are even more disadvantaged with regard to medical treatment. Besides, many elderly people have been sent to institutions, but institutions are not included in the Integrated Home Care Project. This is another factor that makes seniors who live in institutions disadvantaged with regard to medical care. Medical services that reach out to elderly people in their homes should also extend to institutions, if that is where they live.
Tsai is unmarried, and many unmarried people can expect to end up living alone when they become old. Has Tsai seen the problems that elderly people face when they live on their own? These problems are not just about social welfare and long-term care.
The fundamental question is one of healthcare. Physicians should be encouraged to provide at-home treatment and integrate across medical disciplines. Home medical care services should be included when implementing the care visit plan for elderly people who live alone.
They should also be included in long-term care services and the social safety net. The NHIA should broaden its definition of which elderly people qualify to receive at-home integrated treatment services.
Borough wardens, neighbors, social workers at social service centers, community nurses at public health centers and hospitals physicians all know elderly people who live alone, and they should encourage those seniors to use home-based medical treatment and receive regular visits from doctors specialized in family medicine, who can help them consolidate their medicines and connect with specialist services. By caring for elderly people in the last mile of their lives, the nation can achieve the aim of providing them with hospice services at home or in familiar surroundings.
Lo Pin-shan is deputy secretary-general of the Taiwan Society of Home Health Care.
Translated by Julian Clegg
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