Grey Crisis: Government and Individuals Must Prepare

Grey Crisis: Government and Individuals Must Prepare
United Daily News editorial (Taipei, Taiwan, Republic of China)
A Translation
February 19, 2014

Summary: "On occasion I venture forth with my staff. At days end I sit behind closed doors. I dare not gaze upon myself in my mirror. I can no longer read books containing fine print." This was Bai Juyi's description of old age. Thirteen hundred years later, elders on Taiwan ought not consider this acceptable.

Full text below:

Within four to five years, Taiwan will become a "grey society." Early retirements in addition to those who are over 65, will account for over one fifth of the population. This means we do not have much time. The average life expectancy has increased. Over the past two decades, many families have experienced tremendous pressure caring for their elders. Baby boomers are now facing old age. Therefore government and society must learn to deal with the problem of aging.

This newspaper's Vision Engineering Department recently published a series of articles on "active aging." They addressed productive aging, care for the elderly, support for the elderly, and end of life care. It depicted what a greying society on Taiwan would look like. It explored what sort of care is required by the elderly. It provided examples of similar experiences from other countries. We hope Taiwan can develop similar elderly care institutions, but with local characteristics.

From a practical perspective, the most pressing issues for Taiwan are support for the elderly and care for the elderly. This is where the concern is the greatest, and the demand is the greatest. But government policies and private industry have failed to meet these needs.

Consider care for the elderly. The public on Taiwan values family. As many as 60 percent of Taiwan's elderly prefer to live with their children. Most people prefer aging in place. Only 20 percent are willing to live in a retirement home. Yet in recent years the government has invested immense resources in institutional care. Support for aging in place within the community or at home remains extremely weak. Substantial changes in policy are necessary to meet the needs of the community. Thankfully, some local governments and non-governmental organizations seem better able to appreciate public needs. The "in place nursing" model is taking root within society. For example, Taichung City has established a "senior citizen academy." New Taipei City has established combined nursery daycare centers that enable the elderly to attend classes along with their grandchildren, and interact with the very young.

Consider support for the elderly. This is where the government has invested the most resources. It has established long-term care services, long-term care insurance planning, and linked it to NHI sick care. The goal is to use one-stop care to ease peoples' concerns. But diseases have different impacts on the elderly, and their ability to  age in place. The government must be more flexibile in how it provides care for the elderly. It must relieve the pressure on people who adopt different means of care. The government must be more imaginative. Long-term care planning is proceeding at a snail's pace. Legislation and enforcement cannot meet the needs of the community.

Institutions and systems must be established. But care for the elderly involves other, more important issues. The public must learn how to care for their elders. The elderly are not necessarily people who must be dependent upon society. A UK "White Paper on Social Policy for Senior Citizens" shows that during all periods of life, "self-reliance, opportunity, and choice" are of primary importance. The US has also proposed "self-reliance, opportunity, and " dignity" as a social norm for the elderly. The human lifespan is akin to the four seasons of the year. Ideally one will be able to preserve one's autonomy and dignity between eldership and the end of life. One should make plans. One should continue learning. One should continue working. If one retires, one should do volunteer work to remain active. This makes one's life more meaningful. It also helps one maintain physical and mental health.

In recent years, many advanced nations have been promoting "age friendly" employment policies. They hope to promote the employment of senior citizens. This makes more effective use of the elderly population's accumulated wisdom. It also reduces the impact of an aging society on the nation's finances. Mainstream society on Taiwan has long lacked this age friendly consciousness. For years its "respect for the elderly" policy has merely kept them at arm's length. The labor market imposes mandatory retirement ages. Health clubs impose age restrictions. Such conduct passes off age discrimination as "compassion."

Consider end of life care. Hospice care is the most significant domestic social trend in recent years. The hospice concept is widely accepted. But resources are inadequate. The government has emphasized hospital hospice care. In fact, end of life care should not be limited to the final farewell. Lifelong health planning for autonomy, for combatting unnecessary medical procedures, and for finding a final resting place for one's remaining years, and for avoiding a "lonely death" may be far more important. End of life care is a long road. The individual and the family must cultivate a more positive view of life. Governments need to invest greater resources to help society complete the rites of life.

"On occasion I venture forth with my staff. At days end I sit behind closed doors. I dare not gaze upon myself in my mirror. I can no longer read books containing fine print." This was Bai Juyi's description of old age. Thirteen hundred years later, elders on Taiwan ought not consider this acceptable.

銀髮衝擊：政府和個人都須做好準備
【聯合報╱社論】
2014.02.19 04:23 am

再隔四、五年，台灣即將步入「高齡社會」，六十五歲以上加提早退休的人口，將佔總人口的五分之一以上。這表示我們在時間上已沒有很多餘裕。事實上，隨著國民平均壽命的拉長，許多家庭近一、二十年來已經承受了照護家中長輩的莫大壓力，即連嬰兒潮世代也即將面對自己的老年；因此，如何調整政府及社會因應老年的制度和心態，已刻不容緩。

本報系願景工程近日推出「活躍老化」──老有所為、老有所托、老有所養、老有所終的系列專題，目的即在勾勒台灣熟齡社會的生活樣態，探討民眾對於老年生活照養的各項問題與需求，並提供其他國家的類似經驗，希望台灣能夠發展出具本土特色的老年生活哲學和照護機制。

從現實面觀察，台灣社會目前最迫切的老年議題，主要集中在老者的托養與照護上。在這兩方面，民眾的焦慮最多、需求也最大，但政府政策上和民間產業面似仍遠遠落後社會的需求。

在老有所托的部分，由於台灣社會講究家庭倫理的特質，有高達六成以上的台灣老人喜歡與子女同住，不少人願意在家養老，而願意去住安養機構的僅百分之二。然而，近年政府投入的資源卻大量集中在機構照護，對於支持老人留在社區或家中的服務及支援體系十分薄弱；這樣的差距，恐須在政策上作出大幅調整，才能符合社會的實際需要。值得慶幸的是，一些地方政府或民間團體似乎較能體察民間的需求，不少「在地安養」的模式在社區萌芽：例如台中市設立了「托老學園」，新北市出現了「托幼也托老」的托育中心，讓長者與孫兒一起上學，也調和世代間的情感互動。

在老有所養的部分，是目前政府著力最深的一塊，從長照服務機構的設立、長照保險的規畫，銜接全民健保展開的疾病生活照護，希望一條龍式地掃除人民的後顧之憂。但是，由於老人疾病的多樣化對生活自理能力的影響程度各異，政府如何在照護模式上提供更彈性的設計，以紓解民眾不同的照護壓力，實在需要有更大的想像力。以目前牛步化的長照規畫、立法及執行，恐怕無法滿足社會的需要。

除了機構和制度的建立，老年議題還有更重要的一個面向，那就是人民學習如何處理自己的老去。熟齡人口未必就是社會的依賴人口，英國「高齡社會政策白皮書」即楬櫫，在不同的生命周期，都應確保「自立、機會與選擇」三項基本原則；美國也提出「自立」、「機會」與「尊嚴」三大方向，作為建構中高齡族群的社會準則。人生成長猶如四季的輪替，從熟齡至人生的終點站，如能抱持自主且有尊嚴、有規畫的態度，善用終身學習、延長就業、志工服務等來活躍自己的退休生活，不僅讓生命更有意義，也有助保持身心的健康。

近年，不少先進國家都在提倡「友善年齡」的就業政策，希望促成中高齡公民的就業，除更有效運用中高齡人口的智慧和人力，也減輕高齡社會對國家財政的衝擊。在台灣的主流社會，一向缺乏這種友善的自覺，長年來的各種「敬老」政策都隱含著「敬而遠之」的輕慢；諸如勞動市場設有強制退休年齡，運動俱樂部對一定年齡的老人設限等，都反映了這種假「體恤」為名的年齡歧視。

在老有所終方面，「安寧緩和照顧」是國內近年民間發起的社會運動中，成效極顯著的一項。安寧療護的觀念逐漸深入人心，但它的資源卻永遠不足，而且始終偏重醫院的安寧療護。事實上，「老有所終」並不應只局限於向生命告別的這項最後儀式，如何規畫終身醫療自主計畫、對抗無效醫療的凌遲，為自己找到一個最後的安身終老場所，而不會「孤獨死」等，可能更為重要。善終的過程是一條漫漫長路，除了個人與家族要培養更積極的生命觀，也需要政府投入更多資源，協助社會完成生命的儀式。

「有時扶杖出，盡日閉門居。懶照新磨鏡，休看小字書。」這是白居易描繪的老年生活，一千三百年後的今天，台灣老人們不應再以此為足了吧！