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By Gerald Kuo 郭冠廷
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Highways across Taiwan were flooded by cars returning home for the Tomb Sweeping long weekend. Bearing flowers and fruits, people visited the tombs of their forebearers to clean their gravesites and pay their respects.
However, upon opening the door to our family homes, we are confronted with another reality: the ongoing care needs of the older generation. While we visit graves and mourn those who have already passed, we also work tirelessly to look after those who remain.
In management theory, there is a simple formula that states that value is equal to the quality of an outcome divided by its input cost. In other words, overall value only increases when output quality improves without disproportionate cost increases.
Taiwan has over the past few years been continuously increasing its long-term care budget, with the government investing significant resources into addressing the issue of care for its aging population.
This could be understood as part of an input, process and output chain. The nation’s budget, human resources and institutional designs constitute the input. The healthcare system, community centers and long-term care services are the processes. Enabling older people to live with dignity while shielding families from becoming overburdened with caregiving pressures are the intended final outputs.
The system often breaks down for those on the frontline of caring for their older family members.
Although the hospital system’s part might come to an end once older patients are discharged and return home, that is exactly when the real, long-term and meticulous care work done by the family begins.
Unaccounted for by the government’s institutional designs, families are the last pieces of the puzzle, forced to play their part at the end of the line with no salary and no shift relief to speak of.
Policy reports might measure key performance indicators (KPIs) by the number of people served, access points for service, or supply beds, but the reality for families is different. Theirs is one of sleepless nights, dwindling savings and the mounting daily stresses of caring for their loved ones.
Management theory’s “balanced scorecard” tool reminds us that a system’s success or failure is not just based on a single indicator, but on four distinct perspectives: financial, customer, internal process, and learning and growth.
If we apply this framework to the long-term care system, these correspond to government budgets and investment; quality of life for older people and families; healthcare and long-term care systems’ operations; and society’s ability to cope with an aging population respectively.
The issue is that while that system obsesses over the provision and uptake rates of individual services, it fails to account for the long-term burden of care on families.
Tomb Sweeping Day is a time for us to remember and honor our ancestors. However, with a rapidly aging population, the more pressing question is how to take care of those who are still with us.
The quality of our long-term care system is not just measured by KPIs, but also by households which have their lights on deep into the night. If the system only looks at surface-level performance statistics and ignores the enormous hidden cost shouldered by stretched families, it would struggle to find a balance.
We must not leave families to become the care system’s final line of defense.
Gerald Kuo is vice director of the Taiwan Home Health Care Charity Association.
Translated by Gilda Knox Streader
