Origami

A fire that broke out at the Le Huo Nursing Center (樂活老人長照) in New Taipei City’s Sindian District (新店) on Tuesday last week killed six people and injured 28. Investigations showed that the nursing home had not installed an automatic sprinkler system and that, when the fire broke out, there were not enough staff on duty.

How did this come to pass?

The Standard for Installation of Fire Safety Equipment Based on Use and Occupancy (各類場所消防安全設備設置標準) was amended in 2011 to stipulate that automatic sprinkler systems must be installed in long-term care institutions with a total floor area of more than 300m2. Could it be that because the center was established in 2011 the regulation did not apply?

The residents of long-term care institutions are mostly elderly people with impaired mobility, so once a fire breaks out, no matter how fast staff act, it can be hard for them to evacuate residents in time. That is why automatic sprinklers must be installed to quickly contain a fire and stop it from spreading.

The fire safety standard needs to be amended again to ensure that all nursing homes, no matter when they were established or their size, install automatic sprinklers.

Le Huo received an “A” rating when it was inspected in April, so why was it understaffed at the time of the fire?

One reason is that elderly people with impaired mental and physical faculties are unlikely to protest, and another is that the department responsible for inspections does not make surprise visits. Of course nursing homes are likely to make savings wherever they can, so why does the government not inspect them more often or even conduct surprise inspections? The reason is that government departments are also understaffed.

The nation’s long-term care system is not only short of nursing staff, it is even short of long-term care supervisors, so of course authorities turn a blind eye while care centers go on muddling through.

To save money, nursing homes mostly employ foreign staff, but foreign nurses generally cannot read Chinese or speak it very well. Consequently, they cannot provide as good quality care and they are not as good at handling emergencies.

Why do nursing homes not employ more Taiwanese nurses? Because there is not enough funding for long-term care. Nursing homes like Le Huo charge about NT$30,000 (US$938) per resident per month. Although that might not sound inexpensive, it should be borne in mind that nursing homes have to provide all food and accommodation for the residents, as well as care.

If such a tragedy can happen at Le Huo, with its “A”-grade assessment, what about other nursing homes?

In her inauguration speech, President Tsai Ing-wen (蔡英文) listed long-term care as one of her main policy objectives. The problem is that because the government’s planned tax-funded long-term care will receive no more than NT$40 billion a year — far less than the NT$110 billion that could be generated from long-term care insurance — it will only be enough for community-based long-term care.

Without sufficient funding, it will not be possible to provide proper institutional long-term care.

If we had long-term care insurance, it would be possible to set up small household-style care centers that would disperse the risk of accidental deaths and injuries in such institutions. It would also make it possible to send more inspectors, more often, to check on staff numbers.Whether these things can be done under a tax-funded long-term care system is something that the government needs to consider carefully.