Taiwan

Today, Taiwan stands at a demographic turning point for which it is proactively adapting through both policy and social innovations. It became an aged society in 2018 and Taiwan is projected to become a super-aged society within the next decade. Taiwanese society’s ability to adapt to its demographic shift lies in a strong government commitment coupled with extensive grassroots engagement.

Taiwan’s social infrastructure on the community level is one area of strength. Taiwan is also the world’s first society where all its cities are committed to age-friendly initiatives, and it has extended that movement down to the smaller, local community level. In terms of health care, while the universal health system allows for easy access to affordable health care, the system is currently fragmented, and innovative efforts are needed to provide older adults with integrated care. Recognizing that the changing family structure is weakening a traditional source of care for many older adults, the government has stepped up to build a formal long-term care system that is achieving early success.

Thanks to its world-class information and communications technology (ICT) infrastructure, Taiwan is well positioned to harness the power of digital technology to meet the needs of older adults and the government has integrated the development of ICT innovation for aging into its industrial competitiveness strategy. Economic participation of older adults, however, is an area of tremendous untapped potential.

Becoming an aged society this year, Taiwan is projected to be a super-aged society within the next decade, faster than it took Japan to complete the transition. By 2050, close to 35 percent of the population will be age 65 and older, with nearly 20 percent of that group age 80 years and older.

Source: United Nations, Department of Economic and Social Affairs, Population Division

Percentage of Population Age 65 and Over

(Source: United Nations, Department of Economic and Social Affairs, Population Division)

Ecosystem for Policy and Social Innovation

While Taiwan became an aged society just this year, it is setting itself apart with a proactive approach to aging and an openness to policy innovation and experimentation. Local experts cited three key elements that are enabling Taiwan’s policy and social innovation: the unique cultural mix of traditional Chinese values and a historic engagement with the rest of the world; long-standing empowered nongovernmental forces at the grassroots level; and strong cross-sector collaboration. Building on these elements, Taiwanese society is seeking to promote an active, healthy population, through a rigorously evidence-based approach that combines national goal-setting with strong bottom-up engagement.

“The community empowerment movement has helped to establish a solid community base and strengthened their capability to enable strong support for aging in place, including the effort to build age-friendly cities and communities.”

– Hsien-Wen Kuo, Secretary-General of Alliance for Healthy and Age-Friendly Cities

Driving Forces of Innovation and Cross-Sector Collaboration

Community Social Infrastructure

Taiwan’s society fosters opportunities for older adults to age actively in place, built on a traditional focus on filial piety that encourages strong family ties and support. Outside the family, a national network of Community Care Stations provides opportunities for older people to participate in and contribute to society. Collaboration between public and private entities further strengthens the country’s supportive social infrastructure by creating age-friendly cities and local communities. While this places Taiwan at the global forefront of the age-friendly movement, challenges related to physical infrastructure remain.

Living Arrangements of People Age 65 and Older, in Percentage

Today, 97 percent of people age 65 and older live at home and nearly two-thirds of them live with their children or other family members; 39 percent live in a three- or four-generational household.

Source: Ministry of Health and Welfare

Age-Friendly Community Banks in the City of Hsinchu

The Age-Friendly Community Banks initiative, first launched in the city of Hsinchu, presents a successful example built on collaboration among the local government, academia, and business stakeholders.

The initiative was founded and led by the local health authority, which intended to incorporate the protection of older adults from financial fraud into the city’s age-friendly initiative.
The authority partnered with academic experts from National Yang Ming University to develop criteria for age-friendly banks, such as physical infrastructure, service quality, operation and management, and preferential policies.
Representatives from the local banking industry played a crucial role in the process, ranging from initial discussion of the proposal to finalizing certification criteria.
When a bank applies for the certification, a team made up of academic experts, older adult representatives, and local officials pays a field visit and together decides the outcome.

Since the launch, 18 local businesses that provide cash management services have become certified Age-Friendly Community Banks. Typically, a special area is set aside in these businesses for older customers, where they can chat with the staff and socialize with each other. Magnifying glasses, first-aid toolkits, wheelchairs, and barrier-free facilities are also provided. Because of its success, the model has also been replicated in the postal network.

Productive Opportunity

Taiwan is facing a looming labor shortage, as its traditionally defined working-age population (ages 15 to 64) is projected to almost halve by the year 2061. In that context, Taiwan is looking to older adults as one part of the solution, with initial efforts focused on raising retirement and pensionable ages, as well as a new focus on providing greater access to employment assistance for older adults. In tandem with these efforts is continued expansion of the national network of learning centers where older adults can develop marketable skills.

Labor Force Participation Rate, As of 2016

As of 2016, 8.6 percent of people age 65 and older participated in the labor force, up from 7.6 percent in 2006. Less than two-thirds of the OECD average, Taiwan’s LFP is the second-lowest among countries covered in this study, after the Netherlands.

Source: OECD Statistics; International Labor Organization Statistics

Barn Restaurant

Experimental practices are emerging in Taiwan with the focus on creating job opportunities in communities where older adults reside— and adapting to local resources. An early success is the Barn Restaurant project established in 2011 in Sigang, a rural district of Tainan city. The project utilized the venue of an idling barn to operate a restaurant that sells food and handcrafted items made of local materials. Because the rural region produces high-quality sesame oil, the restaurant uses sesame oil in many dishes, including its featured sesame oil chicken. It also markets soaps made of residues from the refinery of sesame oil, as well as leather carvings that are designed and made by people with disabilities, then painted by older adults. Older adults are hired by the restaurant, where they work two or four hours per day in a variety of jobs. Some serve customers, others deliver dining-out orders, wash dishes, or educate patrons on local culture and history. The project creates substantial benefits for older adults by cultivating social awareness of the value older adults bring both to themselves and to the larger community. This model was so successful that it inspired similar practices in other cities.

“The project provides opportunities for older adults to work, socialize, and earn. Particularly when they interact with other older adults, they feel happier and no longer depressed. Although the work is not full time, they can make some pocket money and use it to help their families or buy gifts for their grandchildren and can enjoy a sense of accomplishment.”

– Wen-Chi Chou, Professor of Department of Labor Relations, National Chung Cheng University

Technological Engagement

With world-class ICT infrastructure and manufacturing clusters, Taiwan is well positioned to use technology to improve the lives of its aging population. To tap into the tremendous market of aging-related products and services both domestically and overseas, the government is promoting in its competitiveness strategy the development of ICT-based solutions for aging. However, relatively low penetration of digital technology within the older population represents an obstacle for older adults to enjoy the benefits of technological advances.

Adoption of Digital Technology, by Age Group

According to a 2016 survey, more than 22.4 percent of internet users age 65 and older in Taiwan started using the internet before using computers, higher than any other age groups. The cross-generational gap in mobile device ownership among internet users is much smaller than that of computer ownership.

Source: National Development Council

“Taiwan is at an advantage to introduce its aging-related products into the Chinese world, as it is entering an aged society ahead of [most of] other Chinese societies. And Taiwan is capable of taking this lead, given its robust manufacturing clusters.”

– Keen Chang, Founder and Chairman of L’elan Enterprise

Health and Welfare Innovative Services Promotion Program

The four-year Health and Welfare Innovative Services Promotion Program, launched in 2017, aims to stimulate the incorporation of ICT into services for older adults and expand the focus beyond those who need care to those who are healthy in order to support active, independent aging. To leverage the knowledge and resources of multiple stakeholders, the government brought together research institutions as consultants for selected companies. To qualify for this support, a company must be local and cooperate with NGOs focused on social services. In the first year of the program, six businesses received support. These companies concentrated on online platforms enabling online-to-offline commerce, or one-stop access to diverse information, services, and products. One example is the one-stop platform developed by Chunghwa Senior Care Corporation, a company specializing in home-care businesses. The Chunghwa Senior Care platform enables older adults and their family members to place orders for services ranging from daily life assistance to doctor visit accompaniment, to dementia and hospice care. Another example is I Long-Term Care, a portal that aggregates information and provides consultancy on disease, long-term care skills, public policies, and available resources for older adults and their families.

Health Care and Wellness

Taiwan has seen significant improvement in the health status of older adults over the past two decades thanks to the introduction of a universal health care system and a focused effort by the government to build age-friendly health care institutions. Lack of access to integrated health care, however, remains a significant gap in the system. Nonetheless, the government continues to make strides to improve the health and wellness of older adults, including creating a formal long-term care (LTC) system and focusing on increasing and integrating community-based care services, including dementia care.

Life Expectancy (LE) and Healthy Life Expectancy (HALE), Ages 60 to 64, in Years

Both life expectancy and healthy life expectancy of older adults in Taiwan have significantly improved since 2000, though they are still below the OECD average. As of 2016, an average 60-year-old could expect to live for another 23.5 years, an increase of 2.6 years from the year 2000. Of those additional years, 18.3 could be expected to be healthy, a two-year gain from the 2000 level.

Source: Institute for Health Metrics and Evaluation

Accreditation of Age-Friendly Health Care Institutions

Because of Taiwan’s aging population, the government places great emphasis on providing older adults with easy access to quality care to prevent disease, postpone physical dysfunction, and support aging in place. Key measures include the accreditation of age-friendly health care institutions. The Health Promotion Administration (HPA) introduced its accreditation program in 2011, the first in the world initiated by a national government. Accreditation criteria cover four dimensions of health care: administration policy, communication and service, care procedures, and physical environment.

With the program beginning with hospitals, it was expanded in 2012 to include public health centers (PHCs), clinics, and long-term care institutions. By the end of 2017, 469 institutions were certified, and 90 percent of surveyed older adults reported satisfaction with services provided at these institutions. As the original criteria were developed primarily based on hospital practices, the government continues to optimize and adapt them to different types of institutions. In 2016, it updated criteria to be specialized for PHCs. As of October 2017, 96 centers received their accreditation based on these new standards. The government aims to certify all of Taiwan’s 370 PHCs by the end of 2018. The HPA has also developed new criteria for long-term care institutions, which it began testing in 2017.

“We see accreditation as an important administrative strategy and tool. It enables us to systematically integrate standards into institutions that provide care for older adults.”

– Ying-Wei Wang, Director-General of Health Promotion

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