Can AIO be a solution for Taiwan’s LTC problem?

Long-term care is a hot topic these days due to the rapid aging demography. In the conference last year (2015) in November, I presented the following chart in the annual conference of Political Societal and Regional Change at  University of Helsinki. It is quiet obvious how urgent we need a good long-term care system all over the world.

rapid aging-Gao-2015.001

I made this comparative chart to underline the importance of long-term care. It is not a problem that only happens in one place, but all over the place.

With more aged and possibly disabled people, Taiwan needs more care givers. It is commonly seen that those who take care of the disabled/aged people are not from outside, but the family members (and 70% of care givers — wife, daughter, sister, daughter in law, niece, you name it–are female, if we are looking at those who are economically disadvantaged). For those families that are a bit more affluent, they tend to employ foreign care givers (mostly from south-east Asia). Only minority of the disabled and/or aged people stay in long-term care institutes. In Taiwan, among 700,000 disabled people, 65% (455,000 persons) are cared by their family members; 28% (200,000 persons) are cared by the foreign care givers and only 4% are cared in the long-term care institutions (PNN news 2013/12/21).

There is simply not enough public resources to support any kind of universal long-term care system. While the new president Tsai is not in the office yet (she’ll be in office 20/5/2016), nobody really knows what kind of long-term care system will be constructed and what kind of financing system will be applied to support the long-term care system. The public sector is considering a new approach from Denmark: AIO.

AIO stands for ‘All In One’. It is allegedly coming from Denmark (Kongens Enghave in particular) and introduced into Taiwan by a nationwide foundation that provide services for the elderly. Under the banner of ‘nordic elderly care’, this foundation is arguing how wonderful it is to have this AIO service for two main reasons. First, the elderly people are able to stay in the communities and have full access to the services. Second, young people have incentives to join as care givers because they are provided with stable monthly salary. The foundation argues that this exceptional AIO model has been really successful to create localized long-term care services since 2013.

I don’t think there is something that distinctively called “AIO”. What the foundation introduced, I suspect, is something similar to “home- and community-based long-term care” (HCBC, see Stuart and Weinrich 2001). HCBC is like essential piece in the Danish long-term care (LTC) system for the elderly and people with disability. The ultimate goal is to keep the elderly and the people with disability manage on their own at their own home as long as possible. Finland is now adapting similar measure to keep aged/disabled people at home, largely for budgetary considerations. Denmark has also faced this budgetary consideration, most notably can be seen from the introduction of Free Choice (frit valg) in long-term care. Under this free choice reform, private providers are allowed to enter the market while local authorities should give quality standards and/or price requirements according to the special need of each municipality (see OECD’s LTC info on Denmark). I agree that the local authorities should always set the absolute minimum standard, especially considering LTC. However, it is disillusioning to see how little role the Taiwanese government is willing to play in LTC system. Therefore,  I don’t know to what extent the Danish model can be transplanted to Taiwan–HCBC or AIO or whatever name they call it– given that Taiwan’s government has no desire nor experience in being responsible for administrating private providers (esp. that are providing what should be provided publically).

The foundation is introducing a part of Danish public-funded LTC services as their semi-private product. I can’t wait to learn more about what they offer in details and examine to what extent it actually helps to pluralize LTC models from grassroots.


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