Abstracts & Papers in Stream 2

Reform of Veteran Care Homes in Taiwan: From Charity to Quality Care

There are currently 18 Veteran Care Homes in Taiwan. After the 1949 defeat of the KMT government, large number of soldiers migrated from China to Taiwan. Various ways were initiated to help the re-settlement of these soldiers, such as factories, farms, and occupation training facilities, to keep these soldiers from further uproar. In 1953, four Care Homes were established for the disabled and the old veterans. For about 50 years, a political overcoat had been cast upon the Veteran Care Homes and care in these big institutions was considered charity by the KMD government. Large scaled institutional care also excluded the old and disabled veterans from the society. However, as the ageing of the WWII soldiers continues, the original residents in these Homes have gradually expired, which created a tremendous treat to the survival of these Homes. In the mean time, democratization has strengthened the welfare rights and consumer rights of the remained veterans. In order to face the multiple challenges and to compete in the care service market, the Veteran Care Homes have gone through a series of reforms since 2000, earmarked by three times of comprehensive evaluations. This paper will introduce the history and the reform of the Veteran Care Homes in the 21st century and report on how the Veteran Care Homes have transformed their culture from charity to quality care. Data collected from the three comprehensive evaluations will be analyzed in six areas: organizational administration and management, life care and professional services, service facilities and safety measures, protection for resident rights, reforms and improvements, and bonus questions. Indicators used in the evaluations were originally designed by the Central Governemt to evaluate the non-veteran public and private elderly care homes.

Full paper download: Yang P_veterans care homes.pdf

At the end of 2007, the population structure of Japan has entered the super-aged society, ratio of the aged exceeded 20%. Also, Japan will face increasing aged population until 2040 according to the Latest Population Statistics. Due to the outflow of young generations in small municipalities, the aging in these small municipalities is more rapidly. Facing the rapid aging population, the Japanese government has regarded community welfare as an important issue. The issue is to find a way to enrich the welfare system for elderly, and construct a sustainable community welfare network. As a part of decentralization, Japanese government carried out a reform in the taxation system which is called the trinity reform in 2004. There are three major affairs: 1.abolish or reduce national treasury subsidies; 2.transfer tax resources to local governments; 3.reduce local allocation tax. The second affair of the trinity reform, transfer of tax resources to local government, was carried out at a later stage. Due to this decision, the tax allocation of local governments was reduced by 3.4 trillion yen during the 4 years of this reform (2004-2007). Under these circumstances, I focus on the progress of the aging from a different angle in this research. After considering whether "Making a Town of Welfare" is correlating with economic ripple effect, the aim of the research is to determine the following two points. First, search for the ideal method of carrying out sustainable community welfare in small municipalities. Second, search for the key elements in order to tie completeness of welfare system to increase self-financing resource.

Full paper download: Hsu M_community welfare and securing source.pdf

The ethics of the Chinese medical profession has been guided by and fashioned in accordance with the Chinese Communist Party's ideology since the establishment of the People's Republic of China (PRC) in 1949. It has been an ideological demand for doctors to serve the people unselfishly. Role models, represented by Dr Norman Bethune, have been promoted for medical professionals to follow and emulate. In the pre-reform era, public ownership of means of production and resources and command economy were established to facilitate the ideological commitment to serving the people in health care, as well as in other spheres. Since 1978, Chinese economy has undergone profound changes brought about by market-oriented reforms in almost every economic domain, including health care. In the meantime, however, the guiding principles for professional ethics of medicine continue to be those inherited from the command economy, featuring an emphasis on serving the people selflessly. Consequently, the market-oriented health care reform has created a dilemma that has long confused the medical profession, misled health policymaking, and partially caused the public outcry over the health reform. This paper examines the ideological core of the ethics of the Chinese medical profession formulated in the pre-reform era and the dilemma it has caused in the reform-era.

Full paper download: Yang J_communist ideology and professional ethics.pdf

The purpose of this paper is to analyze the Japanese aspects of the international migration of health care workers, also known as the "globalization of care", through introducing the circumstances of foreign nationals who are engaged in care work or care worker education in Japan. Due to population aging and low birth rates, Japan is expected to face labour shortages in the future; the long term care labour market in particular is drawing attention. According to official government policy, these future shortages are expected to be dealt with by activating domestic labour sources. That is one reason why there is no visa for care workers available in Japan at this point.

Despite the fact that there is no visa available, there are some ways for foreigners to enter this market, and there are three clearly distinguishable groups already doing so, or scheduled to do so in the near future. One group consists of foreign students in welfare education at universities. The members of the second group are mostly Filipina residents with visas without work limitations (marriage etc.) and 2nd degree Home Helper licenses. The third group includes Certified Care Worker candidates from Indonesia and the Philippines. This paper, after giving an overall introduction to the current Japanese long-term care labour market, immigration policy and these three groups mentioned above, analyzes the various attitudes towards foreign care labour, based on an interview survey conducted in 2007 from October to November among the most important domestic stakeholders. Finally, on the basis of this survey, it summarizes the most important questions and problems concerning the future possibility of introducing foreign care workers to the Japanese long-term care market, and points out the possibly necessary support for the migrant groups educated in Japan and already present in the market, so that they can contribute to Japanese long-term care as much as possible. Finally, necessary topics for future research are also indicated.

Full paper download: Virag V_foreign nationals in long term care.pdf

The long term care insurance conduced an epoch-making change to the elderly person welfare policy of the local government. The Takanosu-cho in Akita Prefecture had attracted attention with its "advanced welfare municipality" before the long term care insurance. However, the conflict of the citizens who demanded original service of the local government that exceeded the long term care insurance and the ones who requested only service in the long term care insurance occurred. As a result, the head of the local government was alternated and the welfare policy was changed radically. Why did the advanced welfare policy in the 1990's change in the 2000's? First, there was a conflict between the welfare policy of a central government and that of the local government after financial crisis. Second, there was a limit in the autonomy of the local government in the long term care insurance management. Third, the consensus building between the citizens about the burden of paying tax and the welfare service supply failed.

Full paper download: Park H_long term care insurance management.pdf

Financial Insufficiency and Abuse of the Elderly

Extreme individualism and egoism derived from intense industrialization as well as the trend towards nuclear families has led to the weakening of the social position of the elderly. Abuse of the elderly in the form of diminishing support and respect grows more serious day by day. Because it is no longer merely a family matter, now is the time for society and the government to address this issue. This study, therefore, focuses on the detailed causes of the abuse of the elderly and especially how their financial situations can influence the degree and level of their abuse. The main causes of the abuse of the elderly are as follows: self-induced personal reasons, an abuser-related cause inducing mistreatment, an interaction cause between abusers and the elderly, a living environment-related cause, a socio-cultural cause, and a socio-political cause. Apparently, there are no existing studies on this specific issue; however, documented references and data from Internet searches led me to determine that the most serious cause leading to abuse of the elderly is their lack of economic power. The strongest cause of the abuse of the elderly is directly related to how much they have; the more they have, the less the abuse ratio is. Also, their financial situations and the number of times they meet their sons and daughters directly affects the elders' living standards and abuse risks. Recently even something like a modern-version of "Korea-jang" has happened, and it shows that the support level of sons and daughters greatly depends on their parents' assets. Since now the most important thing in society is money, the main cause of elder abuse is definitely the elders' lack of economic power.

Full paper download: Yoon H_financial insufficiency and abuse.pdf