Background and Objectives Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced two new payment mechanisms in 2018. This study assesses these mechanisms’ impact on growth in numbers of home care workers and use of home care services in Taiwan. Research Design and Methods Data was collected from the Ministry of Health and Welfare (2014–2019) and the Division of Long-Term Care (2017–2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. Results Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post implementation of the payment mechanisms (p < .05), the number of home care recipients (p < .05) and monthly home care visits (p < .05) also increased. Discussion and Implications The new payment mechanisms improved home care workers’ autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined.
Background Whether long-term care service use decreases older adults’ health care service use and cost has been a strong interest among aging countries, including Taiwan. The current study examined the impact of continuous use of HCBS offered by Taiwan’s LTC plan 2.0 on older adults’ health service utilization and cost overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 151,548 clients who had applied for and were evaluated for LTC services for the first time from 2017 through 2019 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were users’ health service utilization and health care cost 12 months before and after starting to continuously use HCBS. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 107324, 70.8%), professional care services (n = 30466, 20.1%), and community care services (n = 13794, 9.1%) were identified. When compared to care recipients in the community care group, those in the home-based PC group had more emergency room expenditures (1 point/month, p< 0.05) but less hospitalization expenditures (38 points/month, p<0.001), while the professional care group had less emergency room and hospitalization expenditures (3 and 138 points/month, p< 0.001). Conclusion Those receiving professional care and home care services spent less on health care service utilization.
Background Long-Term Care (LTC) in Taiwan has been implemented over the last 15 years, focusing on providing home- and community-based services (HCBS). Previous studies have shown that care recipients’ level of unmet needs is associated with adverse health outcomes. This study aimed to identify HCBS use patterns among LTC care recipients and examine the impact of different patterns of HCBS on unmet needs. Methods Surveys of service users were conducted in eight counties. Latent class analysis was used to identify the underlying subgroups of LTC recipients. Multiple regression analysis was used to assess the impact of HCBS patterns and care recipients’ predisposing, enabling, and need factors on the level of unmet needs. Results A total of 952 participants from northern, middle, and southern Taiwan completed the surveys. Three subgroups based on HCBS use were identified, including home-based personal care (HB-PC), home-based personal care and medical care (HB-PC/MC), and community care (CC). Care recipients in the HB-PC group (β = −1.922, p = 0.028) and the CC group (β = −2.177, p = 0.019) had lower unmet needs than those in the HB-PC/MC group. A lower disability level, living in a highly urbanized city, and lower levels of quality of life were associated with higher unmet needs (p < 0.05). Conclusions Our results demonstrating that care recipients with lower disability levels had higher unmet needs may indicate insufficient funding support from Taiwan’s LTC plans. However, multiple service users had high unmet needs, which warrants further investigation.
For its second decade, Taiwan's National 10‐Year Long‐Term Care Plan launched a policy of reinforcing home‐ and community‐based services (HCBSs) with a focus on reablement. This study aimed to (1) identify the distinct service use patterns of reablement‐embedded HCBS and (2) examine the effects of these service patterns on functional improvements among older care recipients, including among groups with different levels of care needs. We collected 2018 data from the Long‐Term Care Service Management System for care recipients in one county located in central Taiwan (N = 4735). Three recipient groups were assigned based on level of care needs. We included data on use of the following services: reablement, home care, respite care, applications for assistive devices and home environmental modifications, transportation to medical appointments and community‐based services. Outcome variables were measured by change scores between successive assessments of activities of daily living (ADL) and instrumental activities of daily living (IADL). Latent class analysis and multivariate linear regression analyses were used to analyse relationships between use patterns, participant subgroups and outcomes. Four subgroups of HCBS use patterns were found. Care recipients with low care needs had greater potential to improve their physical function in ADL through reablement‐embedded HCBS. Care recipients in the groups with low and high care needs showed overall benefits in functional improvements in ADL and IADL from personal care–based HCBS. Care recipients in the community‐based and multiple services–based use pattern subgroups showed the least improvement in physical function. Our study indicates that the effects of reablement‐embedded HCBS use strategies may vary among older adults with different levels of care needs. We recommend further research to examine how to design HCBS with a reablement focus to better fit the needs of those with moderate and high levels of care needs.
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