In other words, of Taiwan's roughly 1.1 million elderly, at least 80-90,000 can't look after themselves. Statistics show that 84% of these are looked after by family members (usually daughters or daughters-in-law). Handicapped elderly must rely on two or three offspring. In terms of impact, then, perhaps more than 100,000 households feel the "elderly problem" deeply.

With the rapid growth of the elderly population, a declining birth rate, rising willingness of women to work, replacement of the traditional by the nuclear family, and other factors, you can imagine that in less than a decade the problem will become a quandary for every family.

Families ordinarily happily take in the eldarly who can care for themselves, but "a person long ill has no filial sons." Where are those people who must rely on others to turn?

Those with money or health insurance can go for long term hospital care. But is this really favorable? This view poses great difficulty for modern medicine.

Take for example Veterans General Hospital, which treats mostly veterans. "One out of every four patients is elderly," estimates Teng Kuang-jei. Because geriatric illnesses are mostly chronic, long term residence in hospitals of the elderly creates a shortage of hospital beds.

Hong-hsin Lee, director of the Department of Health, Executive Yuan, points out, "Generally speaking, 'hospital' implies emergency treatment, sophisticated examinations, and life saving equipment." Conservatively estimating, the cost per bed in the newly constructed building at Veterans General Hospital is not less than NT$12 million. In terms of cost effectiveness, putting the money in the bank would yield interest of NT$3,000 a day. From this angle, an elderly patient paying one or two thousand a day who doesn't need surgery or high-tech exams is not only a loss for the hospital, but also "a terrible waste of resources," suggests Hong-hsin Lee.

Hospitals want to get rid of their elderly patients, and families are also quickly exhausted. Public rest facilities have a one or two years' waiting list. Private ones, if they aren't too expensive, are of poor quality. No wonder many families don't know what to do.

In the West, only after years of effort has a relatively sound elderly health care system recently taken shape.

"Geriatric health care should have a conception of different stages," proposes Teng Kuang-jei.

First is the "health maintenance stage." Many diseases have no symptoms early on. But once they strike, they are next to impossible to cure completely. Therefore, prevention is more important than treatment. Last year the Administration of Health held activities to measure blood pressure. The activity involved 3.77 million visits. This year the Taipei city Department of Health has set "Draft Points for Elderly Health Care Policy." There should be a checkup once every two years.

"Some elderly think even going for a checkup is too much time or money." Perhaps having this basic welfare could overcome their reluctance and even save many lives.

Second is the "emergency stage." If elderly unhappily fall down, suffer a stroke, or suffer heart disease, they must be sent to the hospital as quickly as possible. At this point, surgery, transfusions, and medicine are the only paths to saving the life.

After the illness is stabilized, then comes the "gradual recuperation stage." Some lucky elderly have no serious worries. When they leave the hospital, those with homes go home; those without go to rest institutions, where they only need boarding and housing and not special care. As for those who are slightly handicapped by their illness, they can still return home to recover. "Home care" and "day hospitals" meet this need.

Health care facilities for the elderly do not end there. In new areas in the West, the needs of the elderly are considered. There are centers for the aged: shopping in the basement, a lounge on the first floor, a medical care and recuperation unit on the second floor, and care and rest facilities on the third floor and above. Naturally, everything from ramped hallways to temperature control is designed to minimize the chances of accident.

"If you only have the commitment, the elderly health care problem isn't hard to solve," notes Hong-hsin Lee.

Teng Kuang-jei points out that overseas large medical institutions are happy to establish home care centers, day hospitals, or long-term illness hospitals next door. Since the cost is low, and the return is not bad, with an existing hospital as the basis, things are quite easy. Secondly, being next to major hospitals, doctors and nurses can come through on rounds, increasing the sense of security of the elderly and their families. The sense of dependency will decrease, and the hospital occupancy problem can be resolved. Especially important is that the elderly who keep in close touch with the institutions can be the subjects of studies.

Looking at the ROC, many hospitals also have satellite care facilities. In the area of Veterans General Hospital there are 40 or 50 such centers. But many of these, if they are not outright illegal, have the image of being just for profit.

"These are called care centers, but often they don't even have qualified nurses. And in practice they give shots, put in tubes, even dispense medication, greatly exceeding the scope of a care center," describes Teng Kuang-jei.

A visit to one makes one even more skeptical. An area of not more than 40 ping is stuffed with at least 20 beds. There isn't a smile to be seen. Three or four nurses aides are responsible for all the feeding, cleaning, and care. They haven't got the energy to walk or talk with their charges. And if they lose their tempers, elderly abuse often results, ranging from verbal ridicule to even blocking their breathing.

And the centers are not cheap. On average they cost NT$20,000 a month. Add in other fees and ordinary households just can't bear the cost.

"This problem must be approached through a health insurance system," argues Hong-hsin Lee. Currently only 270,000 people enjoy social health insurance, less than one quarter of the elderly. What's more, it only pays for hospital care. This is another indirect reason causing seniors to stay in the hospital.

In fact, costs in hospitals for chronic illnesses are much lower than in ordinary hospitals, notes Lee. Illnesses should be divided into urgent and chronic; only treating the urgent and not the chronic does not meet current needs.

Of course, no institution can compare to one's own home and the sincere concern of family. But that the elderly are the respon-sibility of all of society has already become a consensus. Only this way can the tragedies of elderly abuse or family collapse be avoided. Then, after all, the aged will have a place to rest at the end of their life's journey.

Geriatric Health Care System

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[Picture Caption]

To have a partner in growing old is the greatest consolation in life. The photo shows a double room for husband and wife at a rest home in Taipei city.

With a little effort, falling down--the most serious accident for an elderly person--is not difficult to prevent.

A forest of medical products are available to help the elderly live a more comfortable, dignified life. The photo shows tableware suitable for use by victims of stroke.

How to maintain activity and health to the very end is a major challenge for modern medicine.

A young couple with two kids--the model nuclear family. How are the elderly to look after themselves?