Service Banks--A New Solution to an Aging Problem

In an age when money rules, it seems you've got to shell out for anything. Services are no exception. But some people need services and have no money to pay for them, and some kinds of services money won't buy. What is to be done? Don't worry, the "service bank" solves this problem.

With the help of volunteers, old people who have been bedridden for long periods get a chance to go outside for a breath of fresh air.

Service, like money, can be saved. People in the prime of life can first serve others, having these hours credited to their accounts at the service bank, and then later when they need service themselves they can go to the bank and make a withdrawal.

The things that old folk fear most are poverty, illness and loneliness. And these three dark horsemen often ride together.

Such an ideal system is already being tried by people in Taiwan.

Every Sunday morning, Wang Wen-shen, who works in insurance, leaves the house in casual clothes. He's not going on an outing or to get some exercise, but rather is going to struggle with a 65-year-old stroke victim.

Using "struggle" to describe Wang's work isn't the least bit an exaggeration. From helping his elderly charge to bathe, cut his hair and shave to straightening up around the house, Wang does it all.

Because the old fellow's mental capacities declined after his stroke and he grew ill-tempered, often flailing his arms and stomping his feet like a child, Wang has to coax him like parents coax their kids to get him to do anything. "I know that he likes to smoke, and so I 'bribe' him with cigarettes," Wang says. "For instance, I say, 'I'll give you a cigarette when we finish shaving.'" Struggling like this for a whole morning is "very tiring," but it's also very fulfilling.

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At 65, Tsou Hsi-yuan counts as elderly himself, but since retiring from the power company, not only has his life not lacked a focal point, it has in fact grown even busier. Every Wednesday afternoon, he regularly goes to visit an old bachelor soldier who is in his seventies. Tsou started by fixing his running toilet, the leaky faucet in his sink, and the sticking drawers in his cabinets, and he has even painted the place for him. Tsou says that you often can't find workmen for hire who do this sort of work, and the old man can't do it himself. "Now everything that needed repairs has been fixed, and every week we just chat about life on the mainland."

On Thursdays he escorts another elderly man, whose spine was injured in an auto accident, to the hospital for physical therapy. "I've accompanied him to these sessions for nearly a year now. Maybe he's not doing enough exercises, but my feeling is that he's not improving," Tsou says sadly.

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On Thursdays Pan Jen-hua gets off from work at 2:30 and hurries to his client's house. When he hears the slurred words of the bedridden old stroke victim, saying that he hasn't had lunch, Pan can't help but feel sad.

"Every Wednesday afternoon, another volunteer and I serve him together," says Pan Jen-hua, who has worked as a volunteer at various organizations for more then ten years. Bone spurs leave him unable to lift heavy loads, and so another volunteer helps Pan lift the old man down the stairs, and then they together push him to a local park or school where he can get some fresh air.

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Liu Hsueh-chin, who sells tickets for the Taiwan Railway Administration, goes to chat with old Mr. Yang two mornings a week. Ever since his wife died last year, the 78-year-old Yang has passed his days alone. Besides straightening up around the house, Liu's main job is just to keep the old man company. "He doesn't lack for clothing or food, and he's still in good health, but he's very lonely, and especially wants to eat his meals in other people's company," Liu says. Whenever it's time for Liu to go, the old man always asks him to stay and eat.

Do you also hope that when you're old, you'll have people to take care of you? Then it can't hurt to follow the example of these volunteers: Whether working or retired, they take at least two hours out of every week to serve the elderly. There's no material reward for this service, just a service card on which hours of service are credited. If the volunteers need service themselves some time in the future, they can then use the card to "make a withdrawal" and get service from someone else.

Money can't buy love

There have always been volunteers, silently making contributions in all quarters of society and getting no reward for them. But certain services society can't simply consign to the "irregular" efforts of these volunteers, like farmers leaving fields unirrigated to depend on the sky for water. This is especially so for the mounting social crisis regarding the problems of the elderly.

Because the birth and death rates have both fallen sharply, the structure of Taiwan's population has aged. Since 1994 the ROC has formally entered the ranks of what the World Health Organization defines as the "elderly nations." The most recently released report estimates that 7.4 percent of Taiwan's population is over 65. According to the estimates of the Executive Yuan's Council for Economic Planning and Development, in another 40 years the ROC's elderly will make up more than 20 percent of its population, meaning that more than one out of every five people will be over 65.

With the elderly population growing, the family losing its duty of caring for its old, and many people no longer expecting to be cared for in old age by their children (as was traditional in Chinese society), how are the elderly to obtain adequate care?

"The wealthy will perhaps be able to pay for needed services, but what are the poor to do?" asks Lin Hui-sheng, director of the Taiwan Provincial Family Planning Research Group. He points out that society should have a system for volunteer work, establishing a channel through which service could be exchanged: an "elderly service bank." Lin says that concept comes from the current system for giving blood: whenever someone with a blood donor card needs blood or has a family member who needs blood, they are given priority. The elderly service bank would treat its creditors with the same preference.

Service traded for service

Lin Hui-sheng points out that this concept has not yet been put into practice by the relevant government agencies, but private groups have tried a model based on the Japanese elderly service bank.

A year ago the Hondao Elderly Fund, which is headquartered in Taichung, began promoting a plan for a "nationwide volunteer network" that isn't far in conception from an elderly service bank. Kuo Tung-yao, who worked for the China Children's Fund for 30 years and has abundant experience in social work administration, says that Hondao hopes to start at the community level. In small towns and rural townships all over the island it will establish volunteer service stations that provide services to "old people living on their own." The hours of service would be noted in detail by the service groups, and the volunteers could then ask for service in return, even by specifying a participating group in a certain place to give service to a particular recipient.

For instance, people who leave their old family home to work in Taipei, Kaohsiung or other major cities could go to an elderly service bank there to volunteer their services, which could be withdrawn in the form of services for their elderly parents living in the countryside. Volunteers in their parents' communities would thus serve as proxies performing their filial duties. It's twisting the Chinese precept of "serving your parents and the parents of others" into "serving your parents through serving others' parents"!

Wang Nai-wei, the chairman of the Kuangtien Group, and Ko Li-yung, the head of the Taichung Municipal Aging Care Hospital, as well as many other businesses and charitable individuals, collected NT$10 million as the initial endowment for the Hondao Fund. Hondao is using the interest on this to cover its operating expenses. Founded a year ago, the fund already has had 180 apply to become volunteers, but only 30-some elderly have applied for help, and so only 60-70 volunteers have been used to make home visits to the elderly.

Getting the word out

Why have so few elderly applied for service? Could it be that there are certain conditions limiting those who can apply? In fact the requirements are very broad: people over the age of 65 living on their own--no matter whether they are weak, lonely, poor or just plain bored--are all qualified. And statistics suggest that the numbers of this kind of elderly are growing rapidly.

According to Chen Chao-nan, a research fellow in economics for the Academia Sinica, the number of old people living on their own in Taiwan has increased dramatically in recent years. Twenty years ago only one out of ten elderly in Taiwan lived on their own; but three years ago already one in three did.

Chen points out that even those who live with their children are often left alone during the day when the younger generation goes off to work. And so the pressing social problem of elderly living on their own must be faced.

Even if there are numerous homes and senior citizen centers that have been set up by government agencies and private organizations which can solve the problems of part of the elderly population, many of these places do not accept people who are indigent, too sick or aged, entirely unable to care for themselves, or who have been abandoned by their families. Most of the elderly at home alone aren't served by the homes and senior citizen centers. The volunteers can coordinate care for them, clean up around the house, keep them company, do their shopping, write letters for them, take them to the doctor, go on walks with them, etc. They can help them do all the things that normally family members help them with.

Kuo Tung-yao points out that elderly are most afraid of being poor, sick and alone. Besides reducing their loneliness, volunteers on home visits can also accompany these elderly on visits to the doctor, provide some basic medical services themselves, or tell them where to apply for assistance. These services can help them a bit with the predicaments of being poor and sick.

Guiding principles

Before the volunteers begin to serve, they must first undergo a short period of basic training. Hondao staff teach volunteers principles about how to deal with the elderly, such as listening is better than talking, compassion is better than pity, the right attitude is better than the right skills, etc.

It's also very important that volunteers prudently draw a line between their work as volunteers and their private lives. Because their charges are old people, Hondao has added some special principles for its volunteers to follow. These include: Never suggest where clients should invest money or how they should divide their estates. Always steer contact through Hongdao, and never give clients your home phone number. Never promote a product. Kuo points out there has to be a clear division between one's private life and one's life as a volunteer. Otherwise, not only will service suffer, but much other trouble can result. For instance, some volunteers have given their home phones to their elderly clients only to have them call at all hours of the day and night whenever they feel bored. It can be a major hassle.

To serve and help the elderly does in fact require that one put in some effort studying first. Because old folk have various kinds of situations and temperaments, there are big differences in what volunteers face.

Some elderly aren't very easy to get along with. When they are in a bad mood, they will refuse volunteers entry. Others fear that the volunteers are undercover agents or have their own hidden agendas. They constantly put up defenses, to the point of even asking the volunteers just to call them on the phone and not actually come to their homes.

But there are other old people who have bad relations with their families or have even been abandoned by them and who treat the volunteers as confidantes. Tsou Hsi-yuan points out that he has been dealing with one of his clients for nearly a year, and they've already become friends who can talk about anything. "Every time I take him to the hospital for physical therapy, he'll talk all about his family and children, stuff both important and trivial," Tsou says. "I try to comfort him. Because I'm not that far from him in age, he'll listen to what I have to say."

Kuo Ching-hui, who has been serving an elderly man for 10 months now, says that his old client eagerly awaits his arrival on the day of a visit. Once he was five minutes late for some reason, and the old client complained until Kuo made it up by leaving five minutes late.

Old folks whose minds are still quite clear are grateful for the services the volunteers provide. Yang Ching-chun, a former teacher at the China Medical College who has a good command of acupuncture and has been in retirement for 20 years, says with both gratitude and shame: "I feel that I've gone a little too far. How do I have the gall to ask someone to come and keep me company?"

Chen Chien-yi, who cannot move his legs, was once a famous figure in the world of entertainment. But after falling seriously ill, he lost both his wealth and his wife. Usually he sits alone watching the television all day long. For his meals, he orders take-out from any place that will deliver. He explains that although the food doesn't taste good, he doesn't have any choice. But on the days of his home visits, the volunteer buys some good food for him. "The volunteer is really a big help. It's just that I can't really get used to the idea of having to inconvenience people this way. . . ."

For those old people who aren't very clear about things or have trouble expressing themselves, they just "silently accept" the enthusiastic sincerity of the volunteers. But there are also exceptions. Kuo Ching-hui points out that every time she gives a back rub to one client with relatively advanced Alzheimer's or helps her go to the bathroom, the client will do her best to say "thank you."

More than enough volunteers to go around

Established for a year, the Hondao Foundation is based in Taichung, where it has served 37 elderly with more than 600 home visits. It has also set up service centers in Tachia, Puli and Yuanlin. Apart from Taichung, the service centers all have more volunteers than people who need their services.

A big problem is figuring out how to inform needy elderly about these services. Those old folk now applying for help all learned about the organization through newspapers or broadcast media, which suggests that many old people on their own who are closed off from outlets of information still don't know that such services are available.

Even if they are in the know, many elderly aren't willing to accept such services, and many members of their families aren't willing to give their problems to outsiders to handle. "Everyone has the wrong idea, thinking that if a volunteer comes to their home it is something inglorious." Kuo Tung-yao points out that traditional Chinese conceptions hold that caring for old folk is the duty of their children, and the elderly are reluctant to let volunteers who aren't their relatives or friends come to their home to lend a hand. He offers the example of his own 93-year-old mother: "During the day, she is very lonely at home all by herself, and very much wants neighbors to come by and chat. I wanted to invite a volunteer to come over and keep her company, but she wouldn't hear of it." Kuo can't help but sigh: "It's harder to find clients than it is to find corporate donors!"

Nevertheless, he understands that this way of thinking can not be changed overnight. Ideals can't be put into practice all at once; every process must be done one step at a time. This year Hondao plans to open five new volunteer stations, and is actively cooperating with other organizations, exchanging information.

A risk that can be borne

Recently there have many well publicized incidents of banks getting into trouble by making bad loans. "Could elderly service banks have a problem with people making a run on deposits, and face the threat of going under?" skeptics might ask. "Who can guarantee that service deposited today can really later be withdrawn in kind?"

Because the process of "first saving and then withdrawing" is quite drawn out, Lin Hui-sheng believes that the "bank" must have public credibility, and so elderly service banks should be operated by organizations that have been endorsed by the government. He points to the local bureaus of health found all over the province as the best possible intermediaries for coordinating this supply and demand. These units already carry out general health planning, have medical personnel and close relations with their communities. The elderly service bank that has been operating in Japan for several years makes use of the local health bureaus there.

Lin Wan-yi, a professor of sociology at National Taiwan University, has reservations about the service bank concept that go beyond worries that it might face a run on deposits. He points out that this is a system that "extends through generations," but each generation has unique characteristics. And because the quality and quantity of service is hard to calculate, those who deposit services won't be able to count on getting something equal in return.

As regards these doubts, Lin Hui-sheng believes that since volunteers can come from all age groups and social levels, with proper publicity and promotion, there's no need to fear that demand for volunteers will eventually exceed supply. Kuo Tung-yao agrees that people needn't get all worked up about the relative size of generations, noting that Hondao volunteers range in age from their twenties to their sixties. Twelve volunteers are even over 65 and thus count as elderly themselves.

Unexpected benefits

As for whether they will be able to "withdraw" the service they are now "saving," the Hondao volunteers surprisingly don't seem to care. "No volunteers have come to ask questions about how much service time they've accumulated," says Li Jen-shun, who is on the staff of the foundation. Nobody seems too concerned about how much they've "saved." Many of them weren't even very clear about the "national service network plan" when they first volunteered. In that case, why are they willing to do for elderly strangers in need what their own children won't?

Tsou Hsi-yuan, who already has more than 200 service hours credited to his account, says that he is "taking advantage of still being in good health himself to serve others." His own mother is 93 and very healthy. Grateful for this, he happily helps others.

After having a major operation, Kuo Ching-hui, another volunteer, resolved that he would do something meaningful with the remaining years of his life, and so he joined the ranks of Hondao volunteers not knowing that there was a system for accumulating service credits. "Neither of my parents are still living, and when my father passed away I wasn't even at his side," Kuo says, choking on his words. "When I'm serving old people, I feel as if I am serving my own parents."

It would seem then that currently the "nationwide service network plan" isn't motivating many people to volunteer their services. Many of these people volunteer for other organizations anyway, and acquiring service credits at Hondao is at most just an added incentive for them.

Although volunteers don't seem to care much whether the service bank plan succeeds and aren't worried about having their efforts rewarded in kind, some volunteers have already enjoyed the benefits of this system.

Kuo Ching-hui, who began volunteering in June of last year, had a foot injury in December that made it difficult for her to get around on her own. Her husband works and her daughter is in school, so during the week there was no one who could take her to the hospital. She asked Hondao for assistance and they immediately sent a volunteer to accompany her to the hospital. "It truly was an unexpected benefit" says Kuo, laughing.

His wife has left this world, and his children have moved away. To reminisce, Yang Ching-chun just opens his photo albums.

Volunteers have their hours of service credited to their accounts, which they can withdraw from when in need. The service records work just like a bank book for a savings account.

The Hondao Fund's executive director with his wife and mother. There's no way to replace the close feelings between family members, and most old folk still want to have contacts with their children.