According to reports, the largest setback in the Long-term Care 3.0 program is the shortage of residential beds for people with dementia. In metropolitan areas, beds are extremely difficult to secure. There shortages in 11 counties and cities and the situation in the six municipalities is even more severe.
Although the Ministry of Health and Welfare indicated plans to invest NT$2 billion (US$62.47 million) for 900 beds and to provide incentives for resource-scarce areas to increase capacity, the high initial costs, difficulty in securing sites and challenges associated with workforce training mean that tangible results are unlikely to be seen in the short term.
Setting aside older people with dementia, those without dementia or disabilities also face major challenges in housing and mobility due to aging and physical decline. Many of Taiwan’s four and five-story walk-up buildings were constructed during the economic boom of the 1960s and 1970s, when developers rushed to build. Little thought was given at the time to the fact that 40 years later, people and the buildings would be much older. As a result, elevators were not installed, leading to the present issue — aging buildings are trapping older people. They are unable to climb stairs and are effectively confined to their old apartments, forced to limit outings and remain at home.
Some people might ask why older people do not just sell their aging urban walk-up units and buy one in new buildings with elevators, which are often in the suburbs. However, most older people hope to grow old in the communities familiar to them, where some of them have lived for more than four decades. Urban areas also have more hospitals and clinics, better for meeting their medical needs, and public transportation is much more convenient. However, installing elevators in older urban buildings is difficult, and urban renewal projects rarely allow a one-for-one property exchange — homeowners typically have to pay developers a substantial added sum. Most middle-class older people simply cannot afford to use their retirement savings to move into a new urban building. As a result, many older people have effectively become “house refugees,” facing constant mobility challenges due to the lack of elevators.
Older people with dementia have an even greater need for familiar environments and care models such as group homes, which could help slow the progression of the disease. Family members could also visit and assist with caregiving in the community, helping prevent one’s condition from placing an overwhelming financial burden on the entire family.
The only plausible solution to this problem is for the government to build senior housing and group homes with dementia care beds in every community. Older people or families of those with dementia could use their apartments as collateral or exchange them for a spot in social housing designed for older people or those with dementia — buildings equipped not only with elevators, but also with facilities that meet the needs of older people living and dementia care.
A community-based social housing model for older people and those with dementia is a policy that the government should urgently invest in. As the nation’s population ages, many urban areas already have idle schools, military camps or other public buildings that are not being utilized properly. Rather than continually focusing on land sales or urban redevelopment, the government should prioritize establishing more social housing dedicated to older people and those with dementia.
Wang Hsi-chang is a retired librarian.
Translated by Kyra Gustavsen
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