The Hospice Foundation of Taiwan on Tuesday said that 73.5 percent of respondents to a survey it conducted supported hospice care. That number was a significant increase from the 43.3 percent who answered similarly in a survey 10 years ago, it said.
Hospice care will become increasingly important as the population ages and the number of people with chronic or severe conditions grows. However, an increasingly aged population also means that the burden on the healthcare system will grow, and the number of qualified doctors and nurses might become insufficient.
Palliative care requires specific training and those in hospice are usually bedridden for months, putting even more stress on the healthcare system. While palliative care is important to improve quality of life during a person’s final days, the healthcare system’s preparedness to provide hospice care is of greater importance than the public’s acceptance of the idea.
The National Development Council in August said that by 2025 Taiwan would be a super-aged society, meaning that one in five people would be 65 or older. Taiwan’s working-age population — those aged 15 to 64 — has been declining since 2015. Within five years not only will there be greater medical need, but also fewer people to serve those needs.
A study in October last year said that due to dietary habits, overwork and lack of sleep, the number of people with diabetes has risen, and a study by the Health Promotion Administration in August showed that the number of people aged 40 to 64 with the “three highs” — blood pressure, blood lipids and blood sugar — was also on the rise. Added to that, the number of cases of cancer — for decades the No. 1 cause of death in Taiwan — is also increasing.
All of these are related: People work more because salaries are low and companies generally require overtime; they are unhealthy because they are overworked; and because they are overworked they put off having children — who they often feel they cannot afford.
An aging population and a low birthrate are not solely problems for educators and obstetricians, they are issues that the economy needs to face and which also affect national defense.
Hospice care will be important in the short term, but the government needs a plan to increase salaries, reduce work hours and punish companies that force overtime on employees — directly or indirectly — to encourage childbirth.
With those goals in mind, it can make headway in reducing the occurrence of chronic and terminal illnesses, and reduce the stress on young people so that they can focus on their family.
In the interim, the government could encourage those interested in a career in the health sector to consider palliative care and, if demand outstrips supply, it could consider offering work opportunities to specialists from other countries.
However, this solution might prove difficult, as Chinese-language proficiency would be a must. Smart technology might assist in a hospice environment, but this cannot replace the human element for palliative care — of which the psychological and spiritual aspects are as important as conventional medicine.
Moreover, some older Taiwanese are more comfortable speaking Hoklo (commonly known as Taiwanese) or even Japanese than Mandarin, so hospice personnel must be comfortable with those languages. Patients also adhere to belief systems such as Buddhism, Taoism, Christianity or folk traditions. Aborigines have linguistic and spiritual requirements that only someone from their community would be able to properly fulfill.
It is a positive development that awareness about hospice care is growing in Taiwan so that it can comfort people as they face death. However, the government must also tackle more fundamental issues in the country to make the healthcare system sustainable.
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