Taking After Taiwan

by Hillary Lum

As a geriatrician, I am passionate about improving the health and wellbeing of older adults, especially those who are frail and experience difficulties in daily life.

As I strive to build partnerships that help care systems and communities serve vulnerable older adults, I’m motivated by the fact that this is not the way things are meant to be.

“For the LORD your God is God of gods and Lord of lords, the great, the mighty, and the awesome God, who is not partial and takes no bribe. He executes justice for the fatherless and the widow, and loves the sojourner, giving him food and clothing. Love the sojourner, therefore, for you were sojourners in the land of Egypt.” (Deuteronomy 10:17-19 ESV).

I recently traveled to Taiwan with friends to visit other friends. Thus, for 8 days, I was fortunate to have cultural navigators who introduced me to a bit of life in Taiwan. While there, I saw how another culture and society seeks to care for the poor, the widowed, the blind, and the disabled.

As I think about how our country can improve care for our older adults, here are some observations from Taiwan that we can learn from.

In Taipei, Taiwan’s largest city and home to 2.7 million, people eat most meals out because meals are affordable, accessible, efficient, and healthy. Every city block boasted restaurants that served tasty breakfasts and cost $6 US for four people. A lunch of hot pot stews, each with seafood, beef, and fresh veggies, cost $17 US for four people.  

There is no food insecurity; there are no food deserts. A Taiwanese elder can eat lunch for about $1.25 US. In the US, funding for Meals on Wheels faces a funding crisis and there is a waiting list in Denver.

In Taiwan, I saw older adults exercise in city parks. In fact, there is equipment specifically built for older adults alongside playgrounds for children. Many do Tai Chi, which has proven benefits for balance, pain, and fall risk.

Unfortunately, Tai Chi classes in the US are not widely available or covered by US insurances (similar to the lack of coverage for yoga, acupuncture, massage – which also have evidence to support their use).

Taiwan’s public transportation system works. It is affordable, accessible, and efficient. For many of my patients in Colorado, not being able to drive means that food, medical visits, community, and other necessities are incredibly hard, so effective public transportation could be a huge benefit to them.

In Taiwan, I observed that older adults who use wheelchairs or otherwise need assistance can afford paid caregivers. Like many other developed countries, Taiwan has a significant need for a caregiver workforce, and I learned that many caregivers are from Indonesia or the Philippines. They are paid a living wage, and often send money home to support family members. They are documented. They receive the National Health Insurance through their employment.

Because we lack a sustainable and affordable system for caregiving in the US, family members often serve as caregivers. Family caregivers are often unprepared and unsupported, which results in health issues for caregivers due to stress and other significant costs. For Colorado’s 500,000 family caregivers, a typical cost is $7,400 per year.

In the US, there are many challenges for older adults as they progressively lose their independence. The median US income of older persons (age 65+) in 2015 was $31,372 for males and $18,250 for females. When living on a fixed income, being able to afford medications, food, transportation, housing, and caregiver assistance becomes a significant issue. In public health or medical terms, these are some of the “social determinants of health.” For the frail elder, these things are daily struggles that often contribute to worsened physical, emotional, and spiritual health and social isolation.  

Even as a visitor, I can tell that Taiwan’s Health Promotion Administration has actively shaped Taiwan as an age-friendly society. They’ve embraced the eight aspects of “active aging” and “age-friendly cities” as defined by the World Health Organization in 2010: respect and social inclusion; social participation; outdoor spaces and buildings; transportation; housing; communication and information; community support and health services; and civic participation and employment. Denver is part of the WHO Global Network of Age-friendly Cities and Communities.

While no society is perfect, including Taiwan, I appreciated the opportunity to see and experience a culture that has developed systems and services that recognize the needs of the vulnerable, including adults as they age.

I was reminded that the brokenness I feel within the US healthcare system and our communities, which are largely ill-equipped to help older adults age with dignity and respect, isn’t absolute reality.

There is much good work to be done.

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Hillary Lum

Dr. Lum is an Assistant Professor of Medicine in the Division of Geriatric Medicine at University of Colorado Anschutz Medical Campus. She received her medical degree and doctorate in Cellular and Molecular Biology through the Medical Scientist Training Program at University of Wisconsin School of Medicine and Public Health. She did her internship and residency in Internal Medicine at University of Pittsburgh Medical Center, followed by fellowships in Geriatric Medicine and Hospice and Palliative Medicine at the University of Colorado. As a health services researcher, Dr. Lum’s interests are in improving healthcare for older adults with multiple medical conditions through implementation and dissemination of novel programs that support decision-making and goal-concordant care, especially at the end-of-life. Dr. Lum practices clinical geriatrics in ambulatory settings and is the Assistant Medical Director for Hospice Care at the Denver VA Community Living Center.
(From her bio found here.)