Search

The proportion of elderly (65 years of age and older) in Taiwan has exceeded 10% since 2008. With more elderly, the number of patients suffering from dementia and disabilities has also been rapidly increasing. Japan also has been facing increasing demand for long-term care due to an aging society. Prior to 2000, social welfare programs in Japan, working to cope with changing needs, typically provided insufficient services, and geriatric patients were hospitalized unnecessarily, wasting medical resources and causing undue patient hardship. In response, Japan launched its long-term care insurance program in April 2000. Under the program, city, town and village-based organizations should take responsibility for providing care to the elderly in their place of residence. The program significantly improved previous financial shortfalls and long-term care supply and demand has been met by existing social welfare organization resources. In Taiwan, the provision of long-term care by county / city authorities has proven inconsistent, with performance deemed poor after its first decade of long-term care operations. Service was found to be affected by differences in available resources and insufficient long-term care administration. The cultures of Taiwan and Japan are similar. The authors visited the Japan Long-Term Care Insurance Institute in August 2009. Main issues involved in the implementation and evolution of the Japan long-term Care Insurance are reported on in this paper. We hope such may be useful information to those working to develop long-term care programs in Taiwan.

The development of professionalism in the health care industry has resulted in the existence of distinct lines of demarcation between disciplines. Duplication or absence of services, or lack of connection between services has made it difficult to respond to the needs of people with chronic conditions. With the rapid growth of the population with such conditions, the concept of integrated care has been proposed in order to increase accessibility, quality of care, cost sustainability and user satisfaction for such patients. The main content of this paper includes a definition of integrated care, the rationale behind it, and a model for it, as well as the advantages and disadvantages associated with it. Four integrated care systems were selected from different countries: Social HMO and PACE from USA, SIPA from Canada, Japan's community support system and Taiwan's long-term care resources management centers. Recommendations are also provided for members of the nursing profession actively participating in integrated care systems.