Cargando…

From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country

BACKGROUND: Taiwan, one of the fastest-aging countries in the world, started implementing version 1.0 of its long-term care (LTC) plan in 2008. In 2017, LTC Plan 2.0 began a new era with its goal to integrate Taiwan’s fragmented LTC service system. LTC Plan 2.0 also aims to establish an integrated c...

Descripción completa

Detalles Bibliográficos
Autores principales: Chiu, Tzu-Ying, Yu, Hsiao-Wei, Goto, Rei, Lai, Wen-Lin, Li, Hsi-Chang, Tsai, En-Tien, Chen, Ya-Mei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555737/
https://www.ncbi.nlm.nih.gov/pubmed/31174477
http://dx.doi.org/10.1186/s12877-019-1172-5
_version_ 1783425200021307392
author Chiu, Tzu-Ying
Yu, Hsiao-Wei
Goto, Rei
Lai, Wen-Lin
Li, Hsi-Chang
Tsai, En-Tien
Chen, Ya-Mei
author_facet Chiu, Tzu-Ying
Yu, Hsiao-Wei
Goto, Rei
Lai, Wen-Lin
Li, Hsi-Chang
Tsai, En-Tien
Chen, Ya-Mei
author_sort Chiu, Tzu-Ying
collection PubMed
description BACKGROUND: Taiwan, one of the fastest-aging countries in the world, started implementing version 1.0 of its long-term care (LTC) plan in 2008. In 2017, LTC Plan 2.0 began a new era with its goal to integrate Taiwan’s fragmented LTC service system. LTC Plan 2.0 also aims to establish an integrated community-based LTC system incorporating both health care and disability prevention. This three-tier model consists of the following: two LTC services with a day-care center as their base and case management (Tier A), a day-care center and a single LTC service (Tier B), and LTC stations that provide primary prevention services and respite services for frail community-dwelling older adults to prevent further disabilities (Tier C). A defined cluster of agencies in a local area works together as a Tier ABC team. LTC Plan 2.0 is a new policy for Taiwan, and hence it is important to understand the agencies’ initial difficulties with implementation and identify future challenges to help further policy development. METHODS: This preliminary study explored the challenges to implementing LTC 2.0 through in-depth interviews based on Evashwick’s integration mechanisms with representatives from three service teams. We interviewed three chief executive officers and three case managers. RESULTS: We found that the LTC Plan 2.0 mechanisms for service integration have been insufficiently implemented. Recommendations include (1) Build up the trust between agencies and government, avoid duplication of LTC services within Tier ABC team, and encourage agencies within a team to create a shared administrative system with the same mission and vision. (2) Clarify the roles and responsibilities of government care managers and agency case managers. (3) Provide an integrated information system and create an official platform for sharing client records across different agencies and caregivers. (4) Establish a tool and platform to track the budget and payment across different levels of service as soon as possible. CONCLUSION: There is an increased demand for LTC services in Taiwan because of its rapidly aging population. Our findings shed some light on the challenges to developing integrated LTC services and thus may help both policymakers and service providers find ways to overcome these challenges.
format Online
Article
Text
id pubmed-6555737
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-65557372019-06-10 From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country Chiu, Tzu-Ying Yu, Hsiao-Wei Goto, Rei Lai, Wen-Lin Li, Hsi-Chang Tsai, En-Tien Chen, Ya-Mei BMC Geriatr Research Article BACKGROUND: Taiwan, one of the fastest-aging countries in the world, started implementing version 1.0 of its long-term care (LTC) plan in 2008. In 2017, LTC Plan 2.0 began a new era with its goal to integrate Taiwan’s fragmented LTC service system. LTC Plan 2.0 also aims to establish an integrated community-based LTC system incorporating both health care and disability prevention. This three-tier model consists of the following: two LTC services with a day-care center as their base and case management (Tier A), a day-care center and a single LTC service (Tier B), and LTC stations that provide primary prevention services and respite services for frail community-dwelling older adults to prevent further disabilities (Tier C). A defined cluster of agencies in a local area works together as a Tier ABC team. LTC Plan 2.0 is a new policy for Taiwan, and hence it is important to understand the agencies’ initial difficulties with implementation and identify future challenges to help further policy development. METHODS: This preliminary study explored the challenges to implementing LTC 2.0 through in-depth interviews based on Evashwick’s integration mechanisms with representatives from three service teams. We interviewed three chief executive officers and three case managers. RESULTS: We found that the LTC Plan 2.0 mechanisms for service integration have been insufficiently implemented. Recommendations include (1) Build up the trust between agencies and government, avoid duplication of LTC services within Tier ABC team, and encourage agencies within a team to create a shared administrative system with the same mission and vision. (2) Clarify the roles and responsibilities of government care managers and agency case managers. (3) Provide an integrated information system and create an official platform for sharing client records across different agencies and caregivers. (4) Establish a tool and platform to track the budget and payment across different levels of service as soon as possible. CONCLUSION: There is an increased demand for LTC services in Taiwan because of its rapidly aging population. Our findings shed some light on the challenges to developing integrated LTC services and thus may help both policymakers and service providers find ways to overcome these challenges. BioMed Central 2019-06-07 /pmc/articles/PMC6555737/ /pubmed/31174477 http://dx.doi.org/10.1186/s12877-019-1172-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chiu, Tzu-Ying
Yu, Hsiao-Wei
Goto, Rei
Lai, Wen-Lin
Li, Hsi-Chang
Tsai, En-Tien
Chen, Ya-Mei
From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title_full From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title_fullStr From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title_full_unstemmed From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title_short From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
title_sort from fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555737/
https://www.ncbi.nlm.nih.gov/pubmed/31174477
http://dx.doi.org/10.1186/s12877-019-1172-5
work_keys_str_mv AT chiutzuying fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT yuhsiaowei fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT gotorei fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT laiwenlin fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT lihsichang fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT tsaientien fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry
AT chenyamei fromfragmentationtowardintegrationapreliminarystudyofanewlongtermcarepolicyinafastagingcountry