The social structure in Taiwan has changed dramatically in the last twenty years. An increasing population of people aged over 65, a decreasing birth rate and rising numbers of women entering the workforce have led to the need for more aged care services. Research has demonstrated that nursing home placement of older adults in need of advanced care is the most cost effective option for family caregivers. However, filial piety, which entails looking after older parents at home, is one of the core tenets of Chinese society. Placing older parents into nursing homes can lead to conflicts that are detrimental to adult children psychologically. Moreover, the burden of caregiving does not necessarily end for the family once they have placed their parent(s) into nursing homes. It can continue to evoke deep emotional responses in some former family caregivers. This chapter draws on findings from two case studies to illustrate the dilemmas facing Taiwanese families who must cope with changing social conditions and customary filial expectations. The use of assistive technologies as solutions to these dilemmas is outlined. These technologies are argued to be a cost effective way to assist adult caregivers, their charges, and staff in nursing homes. Their use may apply to other Asian countries with similar cultural beliefs and values.
TopDemographic Changes
The island of Taiwan is located in the northwest Pacific Ocean. Like other developed countries, Taiwan has become an ageing society, as illustrated by the following statistics. Since 1990, Taiwan’s total population has increased by 9.1%, and by 2000 it had reached more than 22 million people. The percentage of people over the age of 65 increased from 6.4% in 1991 (Directorate-General of Budget Accounting & Statistics (DGBAS) Executive Yuan, 2002) to 9.9% in 2006 (Department-of-Social-Affairs, 2007). Birth rates decreased from 2.6% in 1976 to 1.4% in 2000. The death rate per 1000 decreased from 11.6% in 1971 to 5.6% in 2000 (Department of Health, 2004). Furthermore, the size of the Taiwanese household decreased from 5.7 people per household in 1956 to 3.9 people per household in 2000 (Directorate-General of Budget Accounting & Statistics (DGBAS) Executive Yuan, 2002), highlighting a significant shift in the family structure from large families to small families.
The number of senior people in Taiwan who live with their children has declined in line with the changing social structure and lower fertility rates (Directorate-General of Budget Accounting & Statistics (DGBAS) Executive Yuan, 2002). In 1990, 62.3% of senior people in Taiwan lived with their children; however, by 2000 this had decreased to 57.3%. In 1990, senior people who lived with their spouse accounted for only 17.3% of the total older population. In 2000, this had increased to 20%. The population of people who are 65 years or over and who lived alone increased from 15.9% (168,000 people) in 1990 to 18.3% (298,000 people) in 2000. These statistics demonstrate that there may be a greater need to increase welfare and provide care and assistance for older citizens. Furthermore, in order to provide better care for older people and to maintain the traditional social structure in Taiwan, the government has created a policy to encourage younger generations to live with their parents. In order to protect older people, the policy clearly states that any family members “dumping” their parents will be fined between NTD$30,000 to NTD$150,000 (approximately US$900-US$4500) and have their name published publicly (Department of Social Affairs, 2003). (Dumping refers to the failure of adult children to care for their parents, both financially and physically.)