Abstract
Senior citizen management has become a major challenge to many countries in the world. In Taiwan the problem is even worse due to a rapid increase in the number of elderly citizens which are outstretching the currently available management services. With the worrying growing trend over the years there is a need to develop a mechanism of predicting the demand for senior citizen management in Taiwan. This study therefore has focused on the available data to come up with a method of forecasting the demand for senior citizen management in Taiwan. To accomplish this, the study has heavily relied on the available demographic data to formulate a framework that monitors the citizens’ age with the aim of estimating those who will be joining the senior citizens category per year. This framework however will rely on policies formulated by the state to standardize the procedures in all parts of the country. It also requires the cooperation of various senior citizen management agencies that are currently operating in Taiwan. Implementation of this project will lead to better living conditions for the vast numbers of senior citizens of Taiwan.
Introduction
The issue of senior citizen management has proved to be challenge for all nations in the world. With improved “life expectancy brought about by improved healthcare the number of people aged 65 years and above is rising steadily to account for a bigger percentage” that is overwhelming the care givers. (Wambui, 2002) The population of Taiwan is growing at a very low rate (0.2%) this means that the number of the aged individuals is increasing to make up a large proportion of the country’s population. “According to the statistics available, the number of people above 65 years of Age in Taiwan has reached 1,490,801, since the year 1993 and this number accounts for 7 of the total population of Taiwan. The country has even been described by the United Nations as an aging nation.” (Kahn, 2000)The aging of Taiwan is a consequence of successful public health policies to reduce fertility and mortality. The sharp increase in the number of elderly Taiwanese citizens has been accompanied by social and economic change that puts pressure on traditional patterns of co residence and other methods for providing for the elderly. Just like many other Asian countries Taiwan has undergone a shift from agrarian to a service economy. However, as compared to the Western nations, Taiwan has not put in place proper mechanisms to provide for the economic, social, and psychological well being of the elderly. The senior citizen management service facilities have been overstretched by the large number of people who are joining the bracket of senior citizens. The policy makers have continued to encourage the roles of family in caring for the elderly and have designed public support initiative to explicitly complement filial responsibilities. “The institutional mechanisms are becoming inadequate for the growing proportion of the elderly citizens.” (Gould, 1999) This paper therefore seeks to develop an interval forecasting method for predicting the undulated demand for senior citizen management in Taiwan. This method of forecasting the demand for the senior citizen management will go a long way in ensuring proper care of the country’s ever increasing senior citizens.
Literature review
“Taiwan is located between Japan and Philippines, off the south-eastern coast of China.” (Kahn, 2000) Two thirds of the island is covered by a mountain range. A large proportion of the people of Taiwan are “descendants of Han Chinese settlers.” (Gould, 1999)The Taiwanese people inhabit the west coast while the aborigines inhabit the mountainous east coast. In spite of the cultural differences the people of Taiwan live together peacefully.
Demographic information
“In the year 2000, the population of Taiwan was estimated to be 22,257000. The number of people of age 14 and below comprised 22% while those in the age bracket of 15 – 64 years comprised 70%.” (Gould, 1999)The earliest data available indicates that the island population “stood at 3.12 million in 1905 and the figure rose to 6.02 million by the year 1945. In the following years the population growth rate averaged 3.84 percent.” (Kahn, 2000) This prompted the Government to “implement strict population control measures such as family planning. By 1997, the population growth rate had dropped to 1 percent.” (Gould, 1999) “The life expectancy of the Taiwanese people has been maintained at an average of 77 years for a long time.” (Life expectancy at birth:Total population, 2010) Recent statistics indicate that the figure is closing up to 80 years. This means that Taiwan has a high number of aged individuals as compared to countries with shorter life expectancy
Life expectancy at birth: total population: 77.96 years
(Life expectancy at birth:Total population, 2010)
Taiwan’s population growth currently stands at o.227% this implies that the country has more adults moving into old age than there are children being born to replace them. According to the demographic data available the country has maintained its growth rate a approximately 0.2% since 2003. The statistics available indicate that there has been a slight variation in the population numbers of the Taiwanese citizens since 2003 to date; the range has been maintained between 22,603,001 and 23,036,087 with some instances of negative growth. The population stands at 22,974,347 as of July, 2009.
The table below shows the population growth for the past two years and the international ranking of the country.
Population growth rate: 0.227%
(Taiwan population Growth, 2010)
The table below shows the population growth trends of Taiwan since 2003.
(Taiwan population, 2010)
The distribution of the Taiwanese population according to age shows that majority of the Taiwanese are aged between 15 64 years which contributes 8,416,300 males and8, 267,675 females comprising 72.6 percent of the total population. The age group of between 0-14 years contributes 16.7percent, 1,996,905 males and 1,844611 females. “The age of 65 years and over contributes 10.7 percent of the total population, 1,183,382 males and 1,265,474 females.” (Taiwan age structure, 2010)
The mortality rate of the Taiwanese population has been undulating throughout the years; recent statistics indicate that the “mortality rate stands at 6.76 deaths/1,000 people as of July 2009.” The following table shows how the mortality rate has varied since 2003.
(Taiwan death rate (Taiwan Demogaphics), 2010)
Major causes of death in Taiwan
The major causes of death in Taiwan includes; malignant neoplasm, heat diseases and cerebrovascular diseases. According to a research conducted in 2007, the top ten leading courses of mortality per 100,000 people per annum in Taiwan were
- Malignant neoplasm accounting for 175.9 deaths per 100,000 people.
- Heart diseases accounting for 56.7 deaths per 100,000 people.
- Cerebrovascular diseases, accounting for 56.2 deaths per 100,000 people.
- Diabetes mellitus, accounting for 44.6 deaths per 100,000 people.
- Accidents accounting for 31.1 deaths per 100,000 people
- Pneumonia, accounting for 25.7 deaths per 100,000 people.
- Chronic liver disease and cirrhosis accounting for 22.5 deaths per 100,000 people.
- Nephritis, nephritic syndrome, and nephrosis accounting for 22.2 deaths per 100,000 people.
- Suicide, accounting for 17.2 deaths per 100,000 people
- Hypertensive diseases, accounting for 8.6 deaths per 100,000 people.
( Government Entry Point ( Major health problems and promotions), 2010)
In order to understand the concept of undulating demand in the senior citizen management services it is imperative to get the figures of deaths of the individuals aged 65 years and above. “Heart diseases and cancer have been ranked as the two leading cause of mortality in senior citizens.” (Gould, 1999) These two conditions account for half of all death cases of senior citizens worldwide. (Leading causes of death for persons age 5 years and older by sex, 2002)
Taiwan has witnessed a decline in fertility over the last 30 years; this implies that the proportion of the elderly is rising. It is projected that the proportion of the elderly is projected to double over the next three to four decades. By around the year, 2040, more than one in every four Taiwanese will be aged 60 years or older. This situation calls for research on helpful planning and policy development to deal with the rapid advancement of the changes in the age structure.
Caring of an aging parent is a responsibility that nobody is well equipped to undertake. “The gradual change in life brought about by aging is never anticipated” to cause problems in the later years. (Cohen, 1994) As children, we always depend on our parents for everything, the aim is to help us grow well and depend on ourselves. No one ever imagines of ever coming back to give back to an aging parent. Should I be confronted with a need to care for an aging parent, then the following steps describes what I will do. I will first consult with the parent to make a plan on how best I can support him/her. I will then get a house help to monitor my parent, especially when undertaking risky activities such as driving. The house help will also be equipped to ensure that my aging parent is having proper healthy life, through diet, medication and exercises. I will setup a network of people to monitor the situation and build a fund to take care of any problem escalation
Care for the Senior Citizens in Taiwan
“Senior citizens welfare in Taiwan was established in 1980 and was amended ones in 1997.” (Wen, 2010) The Taiwanese constitution states that the “Social security should include employment policy, social insurance, social relief, medical services, national health insurance, and women, disabled, and aboriginal Taiwanese welfare policies.” (Wen, 2010)
“The intensive healthcare service project” established in 1998 offers wide ranging services for the elderly people in the Taiwanese Communities. (Wen, 2010) The services offered include; “homecare service, day-care centres, medical services, and elderly residential plans”. (Wen, 2010) The Taiwanese elderly care services have been rocked by poor quality management. This has been occasioned by the fact that some “private welfare agencies are providing services as charity.” Secondly, nursing homes amounting to 328 are still operating as illegal entities. Thirdly, the agencies are operating without “standard assessment and monitoring systems.” (Wen, 2010)
Existing welfare services
Home care
This service is offered in many counties around the country, it entails the provision of care services to the elderly members of the society in their homes. The services are offered by assigned individuals who may be doing it voluntarily or as workers of the senior citizen welfare agencies.
Day care
In the day care centres, the senior citizens are taken to the centres on daily basis for them to be closely monitored and cared for during the day. The senior citizens are brought to the centres by their family members who proceed to pay the services
Voluntary service
Voluntary services are offered by voluntary groups which provide free senior citizen care services. The voluntary services are mostly offered in the homes of the senior citizens though there are care centres operated as charity homes by several agencies.
Education programs for senior citizens
In the educational programs, the senior citizens are taught how to cope with there situations. This includes counselling services and education on skills aimed at helping the elderly to be self reliant.
Senior citizens centres for recreation
These centres provide recreation facilities to the senior citizens to have a break from the usual boring life they live. The recreational facilities are meant to boost the mental and physical health of the senior citizens.
Senior clubs
The senior clubs are organizations which consist of networks of senior citizens; the purpose of the senior clubs is to provide support and fellowships to the senor citizens.
Hot line for protection services to the elderly
This is emergency lines that are used by the senior citizens in case of any impeding danger due to health complications or assault from the environment.
Physical Examination
These are physical heath checkups to examine the elderly citizens for health problems or fitness. Mostly examines the old age diseases among others.
Health eating services for senior citizens
This are services offered to provide the senior citizens with health diet that is specially designed for their age and condition.
Other services offered for senior citizens in Taiwan includes the following; Provision of residential service for senior citizens, Provision of Accommodation services for senior citizens, Nursing home for the elderly citizens, Provision of community shelters, Provision of residential setting for the elderly.
Research model
“The research model utilized in the study was based on descriptive research where data was collected to describe the current aging situation in Taiwan.” (Champy, 1994) This was done so as to establish how this could be used for development of effective ways of managing the senior citizens of Taiwan. The research made use of the demographic data available on Taiwan in order to effectively develop an interval forecasting method for predicting the undulated demand for senior citizen management in Taiwan. The important data considered in the study included; the population growth rate, the current population, the estimated number of individuals in each age category, the mortality rates, the major causes of mortality in the country. This data was used to predict future trends in the age structures with the aim of designing effective ways of dealing with the rising proportion of senior citizens in Taiwan. The age structure is the most important determinant of the future number of senior citizens in Taiwan.
The following table indicates how the various demographic data can be arranged in logical manner to used effectively to develop an interval forecasting method for predicting the undulated demand for senior citizen management in Taiwan
The demographic data about the patients was used to create an estimate of the number of individuals joining the category of senior citizens per annum. This will require support from the necessary policy formulation to oversee the implementation.
Methodology
“The demographic data provided was analysed to predict the” growing number of senior citizens in Taiwan.(Walliman, 2006) This data shows that the current growth rate of the Taiwanese population stands at 0.227%, this implies that the number of children being born are very few. Consequently, the number of adults in the population is rising to form a big percentage of the total population and is constantly feeding the senior citizens category. With a life expectancy of 77.96 years, there is a problem posed by large number of senior citizens for whom adequate provision of care services is proving difficult. Currently the country is already faced with over 10 percent of individuals of 65 years and above. The following category of age bracket 15 – 64 years accounts for 70% of the population with the 0 to 14 years making only 22% of the total population. Thus, there is need to develop a strategy to forecast the rising numbers of the elderly citizens and plan for their management. This will be achieved by using the available data to monitor the number of individuals entering the category of senior citizens. Using the data available on the number of citizens in the different age brackets or specific age of individuals an estimate of people joining the elderly every year can be made. To determine the extra required services for new individuals the number of those who have passed away will be subtracted from the estimate. Though the method will not be perfect but can alleviate the current situation of unprecedented increase in the number of elderly individuals. The planning can be better performed at regional level rather than a single plan for the whole nation. This is due to the fact that it will be easier to monitor and care of elderly individuals at regional level rather than have a grand plan for the whole nation which may be prone to errors due to poor management. For this plan to work there needs to be proper resource allocation to cater for increasing cases of the elderly. The resources can be used to build care centres in every region to cater for the increasing demand for elderly care services. The plan can be successfully implemented through policy formulation to shift from the current emphasis on co residence or family dependent senior citizen management. The forecasts will rely heavily on the demographic data to determine the annual demand for senior citizen management in Taiwan. However, an electronic monitoring system can be developed where by all demographic data will be collected and stored for the purpose of monitoring the population growth and aging process. This data may include the ages of all the individual citizens of Taiwan. For this kind of approach to work the government will be required to allocate enough resources for a country wide demographic data collection exercise.
The steps to be followed to realize a forecasting method of the demand of senior citizen management are outlined in the figure below.
Results and Discussion
The issue of caring for aging citizens has plagued the world for a long time now. The changes in the social structures which are occasioned by technological advancement and urbanisation have left many aging parents with no one to turn to. The traditional practice of co residence whereby the younger family members lived together with their aging parents is long gone. In the contemporary society many family members have moved to cities to settle and work their leaving their aging parents to fend for themselves. Due to this there has been an increasing demand for external care services to be offered to the aging parents. In Taiwan, the services have not been adequate to cater for the rising population of senior citizens. The problems faced have either been due to poor resource allocation or poor managerial function in forecasting the demand for the senior citizen management services. As a result there has been need to develop a method to forecast the undulating demand for senior citizen management services. This in effect will go a long way in creating the required mechanisms to deal with the rise in the numbers of senior citizens. “The forecasting method for demand of senior citizen management and development of proper infrastructural framework” will effectively reduce the current problems.(Mugenda, 2003) The issue of overwhelming numbers of senior citizens in Taiwan is creating a big challenge to the care givers due to unpreparedness to handle such a magnitude of elderly citizens. The state has encouraged the traditional way where by the elderly are taken care of within the family rings by other family members. This has however proved difficult due to the shift from agricultural to the manufacturing sectors. Many family members have shifted base to work in cities and towns leaving their aging parents in the country side. This calls for policy change by the state to concentrate on developing a state run senior citizen management framework. The policy formulation will be able to streamline the services offered at the existing care centres. The existing senior citizens welfare has failed to improve the living conditions of the senior citizens due to poor monitoring systems. The services currently offered include; “homecare service, day-care centres, medical services, and elderly residential plans.” (Wambui, 2002) This services need to be capacitated to take care of the increasing numbers of senior citizens. In the past the country has failed to provide proper care to its elderly by living the task to family members and rogue agencies which are fleecing the aged. Poor fertility rates are occasioned by the intervention family planning program. The interventions were carried out by the Government to reduce fast population growth which was impacting negatively on the economy.
Conclusion
The issue of senior citizen management has proved challenging to many countries the world over. This is due to the complexity involved in the provision of care services to the senior citizens. Some are taken care of by family members while others are left to fend for themselves. The difficulty lies in identifying the people who have no family members and therefore need assistance. With proper mechanisms in place it will be easy to identify these people and plan adequately for their care.
With a stagnant population growth, Taiwan is at a higher risk of problems caused by high numbers of senior citizens. The current statistics shows the senior citizens contribute 10% of the total population and the figure is projected to double in forty years. Therefore there is a need to adequately prepare for the consequences of an increase in the percentage of senior citizens in the country. The forecasting for the demand of senior citizen management services will go hand in hand with the development of facilities to offer the service. This implies that the state will allocate a lot of funds towards this worthy course. However, the state needs to put mechanisms in place to change the current state of affairs. There should be intensive campaigns to encourage the people of Taiwan to give birth to more children. This is because soon the situation will be overwhelming as the majority of the citizens will be old and therefore not able to provide the manpower required to run economic activities in the country. Worse still, there won’t be enough people to run intensive care services for the elderly. Consequently, the state will use more resources for outsourcing labour and skill to run the country’s economy. The solution outlined in this paper is only intended to safeguard the country on a short term basis.
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