Taiwan's long-term care 3.0 pilot "symbiosis house": providing disabled elders with a living option between home and institutions

◎ Chen Xiuan

After Taiwan entered a super-aged society, the long-term care policy reached the next turning point. Minister of Health and Welfare Shi Chongliang recently announced that long-term care 3.0 plans to pilot "symbiotic residences" to allow disabled elderly people who do not know each other and are not related by blood to live together, and then introduce long-term care services into residences. This policy superficially touches on a long-neglected issue in Taiwan’s aging policy: We have always discussed who will take care of the elderly, but less about where they should live. When a person gradually becomes disabled, families are often left with only two options. One is to be cared for at home by family members, foreign caregivers or residential staff, and the other is to live in a residential long-term care institution. But between "home" and "institution", there is actually a large institutional gap.

Minister of Health and Welfare Shi Chongliang recently pointed out that it is expected to launch a trial run of "Symbiotic House" (or Symbiotic House) in 2026. (File photo)

This gap will become more and more obvious as the demographic structure changes. The long-term care system in the past was based on an important premise: the elderly usually have families, and there are people in the families who can assist in taking care of them. However, this premise is rapidly disappearing due to declining birthrates, late marriage, unmarried people, and an increase in the number of people living alone. In the future, many elderly people in their 70s and 80s may have pensions, homes, and some ability to take care of themselves, but they will not have children who can accompany them every day. If you have to leave your familiar life and enter a large institution just because you need assistance with bathing, preparing meals, or taking medication, it may not be the most ideal choice for the person involved. What long-term care really needs to deal with is not just the "level of disability", but also the person's lifestyle and living dignity.

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What is worth looking forward to in "Symbiotic House" is that it attempts to bring care into life, rather than bringing people into a care institution. Several elders live together in a general residential space, each retaining a certain degree of private life, and they can share the living room, dining room and care resources. When necessary, residential services, nursing or other long-term care professionals can provide services. If this model can mature, on the one hand it can reduce the risk of isolation for elderly people living alone, on the other hand it can also allow limited care manpower to serve multiple residents and improve the efficiency of resource use. More importantly, it makes "life after old age" no longer just the two extremes of home and institution, but adds an intermediate option that is closer to daily life.

The ideal "symbiosis house" blueprint is for several elderly people to live together in a general residential space, each maintaining a certain degree of private life, and sharing the living room, dining room and care resources. When necessary, residential service, nursing or other long-term care professionals can provide services. (Drawing by this newspaper)

But the real success or failure of the symbiotic house depends on whether the elders really have the right to choose. Symbiosis is not just accomplished by arranging several strange old people in the same house. Who decided to live together? What should I do if there is a conflict between different living habits? Can I continue to live as my dementia worsens? If one of them requires round-the-clock care, will the lives of other residents be affected? These seemingly trivial matters in life are actually the key to the long-term operation of the system. Therefore, what the government needs to build most during the trial is not beautiful hardware, but occupancy assessment, resident autonomy, exit mechanism and connection with care resources. The reason why symbiotic housing is valuable is that it is still a "home", rather than changing a small institution to a warmer name.

If Long-term Care 3.0 is a step further than in the past, it should gradually support a person to continue living. Aging does not mean that a person suddenly loses all autonomous abilities, nor does disability mean that a person can only be placed somewhere under management. For many seniors, what they really want may be very simple: a room of their own, someone to eat with, and someone to call on when they need help, while still being able to decide when they wake up today, what they eat, and what they watch on TV. These things are difficult to turn into KPIs in system reports, but they are exactly where human dignity lies. The next stage of Taiwan’s long-term care reform should be to increase the number of options for post-retirement life. When a person is old or disabled, he can still choose how he wants to live. This is truly people-centered long-term care.

What many elders really want is to be able to decide by themselves what time to get up today, what to eat, and what to watch on TV; diagram. (File photo)

(The author is a master's degree from National Taiwan University School of Medicine)