In addition to the home care provided by nurses and social workers, Tzu Chi Hospital has started new nursing services: adult daycare and home nursing. Although these services are not restricted to the elderly, the hospital has provided a good example of diverse care for senior citizens living in eastern Taiwan, where the population of seniors is very high.

Department of Social Work
Routine Home Care

"Mr. Chao! Mr. Hu! We are here to see you!"

It was a quiet afternoon. The sun was shining idly on a house located on Meilun Mountain in Hualien.

Sister Ming-yueh of the Tzu Chi Hospital Department of Social Work shouted from outside the house, "I've brought some young friends to see you." Six members of the Tzu Chi Collegiate Youth Association were waiting outside, craning their necks and peering inside the room.

After a long while, seventy-year-old Chao came out slowly. When he saw Ming-yueh and the youngsters behind her, he greeted them with a smile. Another old man, Hu, over eighty years old and hard of hearing, was still asleep inside, unaware of what was going on outside.

A high percentage of home care cases handled by the Department of Social Work involves seniors. By 1993, Taiwan had already become a society of senior citizens. In Hualien, many young people have left to work elsewhere, so nine to ten percent of the local population is above sixty-five years of age. The social structure has shifted from large extended families to small nuclear families or families in which both parents are working. Older people either live by themselves or they stay in an empty house all day long, waiting for their children to come back from work and their grandchildren to come back from school. In traditional Chinese society, the elderly were taken care of by their children. Now, however, they must look after each other or else they may even be taken care of by small children (such as their grandchildren).

Chao and Hu provide one example of old people looking after each other. When Chao's wife was still alive, she was paralyzed by a stroke. Chao had to change her diapers, clear her breathing passages, and frequently change her position in bed, all by himself. He himself had high blood pressure and constantly felt fatigued. One day, he ground some sleeping pills into powder to share with his wife so that they could die together. She refused to take them and he gave up that idea.

The nurse who visited them periodically learned of this incident and notified social workers to assist them. Now that Mrs. Chao is gone, Chao and Hu, who was Chao's former subordinate in the military, have to rely on each other.

Department of Public Health
Periodic Home Nursing

In order to provide better service for patients with chronic diseases, Tzu Chi Hospital established the Department of Public Health in 1989. It provides home nursing for patients with chronic diseases and keeps track of their conditions.

Chuang Chih-hua, head nurse of the Department of Public Health, said that most home-care patients were elderly and many had had strokes. "Home nursing is very convenient for older patients, so they look forward to our visits. The most important benefits are convenience and safety. They only have to pay NT$100 [about US$3] or so for our transportation, whereas they can save their own transportation fee and the trouble of coming to the hospital themselves. Family members don't have to accompany the patients to the hospital and the patients still receive good care at home." During a home nursing visit, the public health nurses teach the patients' families simple nursing skills, such as replacing NG tubes and catheters, rehabilitation and sanitation. Because they trust and rely on the nurses, family members pour out to the nurses their anxieties about their family situation. The nurses always smile warmly and listen to the complaints patiently. If families are in need of any help, the nurses request that social workers provide home care.

When an elderly person's family is unable to provide home care and intends to send him or her to a nursing home, the public health nurses provide necessary information about which homes are reliable and which are not, in order to avoid further problems.

However, there are also difficulties in home nursing care. For instance, some elderly persons do not get along with their families at home and are almost deserted by them, or their children may be unwilling to pay the transportation costs for the nurses.

Another difficulty is that the discontinuity of home nursing care may affect its quality. The purpose of home nursing care is to train the patient's family members to do the follow-up jobs. However, it often happens that an old patient with several children may stay in one child's home one day and move to another child's home the next. Taking turns in caring for the parents means there is no one who can provide continuous, effective care for the patient. Some families are reluctant to learn the nursing skills and just want the nurses to shoulder the job. Therefore, the nurses are always worrying about whether these families are capable of handling an emergency.

A woman over sixty years old was paralyzed from a stroke. At first she was taken care of by her youngest daughter. But her daughter became busy with her job, so now her daughter-in-law has to shoulder the responsibility. "Maybe the old woman's daughter-in-law is not as good as her daughter," said Chuang Chih-hua, "but as long as the daughter-in-law is willing to do the job, we still believe it will go well."

The Comfort Home
Adult Day-care and Nursing Home

Extended services provided by Tzu Chi Hospital include home nursing by public health nurses, follow-up care after patients leave the hospital, continuing training for nurses and establishment of patient support groups. In view of the necessity and importance of long-term nursing for senior citizens, the national Department of Health prepared a Senior Citizens' Long-Term Nursing Plan effective July 1, 1998. In coordination with this plan, Tzu Chi Hospital set up an adult day-care and nursing home to complete its multifaceted nursing system and fill the gap between patients' hospitalization and return home.

Located on the third floor of Tzu Chi Hospital, the Comfort Home has fifteen beds for day care and twenty beds for nursing care. The room is well lit and thoughtfully arranged. Nurses can see every patient from any angle. The interior design gives a bright, warm, relaxing feeling, as if it were a vacation resort.

The Comfort Home focuses on patients with chronic diseases (excluding infectious diseases, psychiatric diseases and senility) with services in nursing, rehabilitation and daily care. To reduce the burden on small families, the daytime nursing program also provides wheelchair-accessible transportation.

The difference between the Comfort Home and an ordinary ward is that the former does not provide any medical treatment; it is primarily oriented towards nursing care. Furthermore, it has a rehabilitation room and a physical therapy room with physical therapists from Tzu Chi Hospital providing periodic instruction to patients. In case patients in the Comfort Home need to see a doctor, the nurses will register them, help them to the outpatient department, and get medicine for them. Doctors from the family medicine department make periodic assessments of the patients' conditions.

Head nurse Chiu Shu-ling said, "We concentrate on training patients to deal with daily activities and on providing psychological care. In other words, we want to help them arrange their lives."

To give old patients a relaxed, peaceful place to live, the Comfort Home emphasizes comfort in its furnishings. In addition, there are activities such as movies, calligraphy, painting, tea making, chess, physical exercises and spiritual care.