The geographical and resource conditions of indigenous areas, along with their caregiving culture, often clash with the government’s dementia care policies that are based on urban models.. The above image shows a mountainous road in the Xinxian Tribe of Wulai (Individual showing in the picture is not related to the text). (Photograph by Jia-Wei CHANG)

Author: Chin-Hsuan HUNG

Photography: Jia-Wei CHANG

Reviewer: Tze-Wu CHANG

Editor: Shih-Yun CHANG

Translator: 十六六 (Shi Liu-Liu)

“Aging in place” has always been a core principle of the Taiwanese government’s long-term care policy. However, in reality, indigenous elders with dementia often struggle to remain in their own communities as they age.

The Reporter visited two Atayal villages under differing circumstances to examine how current dementia care policies conflict with the core “collective-caregiving” culture of these communities, driven by state-led standardized regulations and professional assessments. At the same time, we aim to learn from these villages, recognizing the unique caregiving environments fostered by their close-knit community networks. We therefore ask: What insights might these communities offer [to wider society] in developing “dementia-friendly communities.”[1]

At the end of December 2021, the Hanxi Dementia Care Center in the Hanxi village of Datong Township, Yilan County, shut down after just nine months of operation. The center was run by 38-year-old Yunaw Sili (Han name: Song Sheng-Jun), chairman of the Kangkei Indigenous Sustainable Development Association, and 22-year-old care manager Lapi Hayun (Han name: Luo Yu-Han). They bid farewell to their last dementia patient before closing the Center.

Six or seven years ago, an 85-year-old villager, Ba’ai (pseudonym), began showing signs of dementia. Villagers often saw her wandering around the community. In March 2021, Yunaw accompanied several elders and their families on multiple trips to Luodong, a 30-minute drive down the mountain, for dementia evaluations. Ba’ai was diagnosed with moderate dementia, while two other elders were diagnosed with mild dementia. Together, they became the first group of participants at the Hanxi Dementia Care Center. The care manager Lapi, who grew up in Hanxi Village, incorporated traditional Atayal songs and weaving techniques into cognitive stimulation activities designed to slow the progression of dementia. Although Ba’ai’s hands had grown less nimble, she was still able to complete familiar weaving tasks at a slow and steady pace. Over several months, her condition stabilized significantly.

However, by the end of the year, the Hanxi Dementia Care Center was forced to close down after failing the government’s evaluation.

Ba’ai’s family came to Lapi in tears, asking when the center would reopen, but Lapi had no answer. After the center closed, Ba’ai’s condition rapidly deteriorated; she began experiencing physical decline and incontinence.[2] A month later, like other families in the village who could no longer bear the burden of caregiving, Ba’ai’s family was forced to move her away from the community where she had lived most of her life and into a long-term care facility at the foot of the mountain.

At the facility, Ba’ai shares a room with her relative, Telu (Han name: Li A-You), who is also from Hanxi Village. Eighty-year-old Telu had been living in the facility for three years due to dementia. From time to time, she murmurs in her native language:

“This is the home of the people from the plains, not my home…”

The Pain of Hanxi Tribe: The Final Journey of Dementia Sufferers Ends in a Distant Institution from Home

After Telu’s dementia got worse three years ago, she left the tribe and moved into a long-term care facility at the foot of the mountain, leaving behind photos on the family wall filled with sentimental memories. (Photograph by Jia-Wei CHANG)

Telu was one of the first women who advocated for elderly indigenous people to spend their final years in the tribe.

Located at the foot of Taiping Mountain, Hanxi Tribe is the largest “front mountain”[3] tribe in Datong Township with around a thousand Atayal residents. Long-term care began early in this community. Eighteen years ago in 2007, as the government prepared to launch Long-Term Care Ten-Year Plan 1.0,[4] the Hanxi tribe had already embodied the spirit of reciprocity, positioning itself ahead of the government’s initiative. In 2007, the Kangke Indigenous Sustainable Development Association (hereafter referred to as the Kangke Association) was established with the goal of supporting the local elders. A group of women in their 50s and 60s, known as “home care mothers,” volunteered to clean, visit, and deliver meals to the elders at their homes. Telu, who was a member of the first generation of home care mothers in the association, once said:

“We have no history of sending our elders away!”

Besu Piyas (Han name: Fang Hsi-En), the supervisor of the Kangke Association, explained that in the Atayal language of Hanxi, there is an ancestral saying: “ana musa inu ga, ini z’ngi isu ga Kangke no sure” (No matter where you go, never forget you are from Hanxi). This saying serves as a reminder to the tribe members that human life is deeply connected to the land, and each person is like a branch of a great tree. After growing old and withering, one must eventually return to the soil to continue nourishing the roots of the tribe. However, after Telu developed moderate dementia, she too became one of the elderly sent away to a distant place. For the dementia sufferers of the tribe, adhering to this ancestral teaching in their old age has become increasingly challenging.

Over the years, Yunaw has repeatedly witnessed elders with dementia being forced to leave the tribe, which has weighed heavily on his heart.

Indigenous Communities Entering the Long-Term Care System Yet Gradually Experience Constraints

Yunaw Sili (Chinese name: Song Sheng-Jun), the chairman of the Gangge Indigenous Peoples Sustainable Development Association in Yilan County, returns to the now-closed Hanxi Dementia Care Center. He is from the Atayal tribe in Taoyuan. Since returning to his hometown for service after university, he has been working alongside the Gangge Association to serve the elderly in the local area, developing a deep emotional connection with the people of his tribe. (Photograph by Jia-Wei CHANG)

As Taiwan’s long-term care policies developed, the discussions around the legislation of 2014 Long-Term Care Services Act were in full swing. Meanwhile, the government introduced a blueprint for the “professionalization” of long-term care, introducing regulations on spaces, personnel, and more. However, these measures raised the bar for implementation in indigenous communities. The Kangke Association suddenly found that their original home-based care services might become “illegal” under the new framework.

That same year, the Kangke Association attempted to adapt their services to the government’s planning. They started with community care centers and then progressed to long-term-care alley stations. In 2021, several elders in their station began showing signs of dementia. Among them was Ba’ai who frequently ran out of the station during activities. The alley station, already short-staffed and lacking experience in dementia care, struggled to keep an eye on her. In response to these challenges, Yunaw sent Lapi to take dementia care training and then applied to establish a local dementia care station.

What is the Difference Between an Alley Station and a Dementia Care Station?

Following the rollout of Long-Term Care 2.0 in 2017, the government categorized long-term care facilities into three levels—A, B, and C. The C-level facilities, long-term care alley stations, play a frontline role in the community. They are government-subsidized, with funding for one full-time caregiver and supplemented by locally recruited volunteers. These stations provide services such as communal meals, health promotion, and disability prevention for healthy, frail, mildly disabled, or mildly demented seniors. Typically, each station caters to 10 to 30 people.

In 2018, the government introduced the Dementia Prevention and Care Policy and Action Plan 2.0, which included a new facility category: dementia care stations. While also serving as a frontline community resource, dementia care stations differ from alley stations in their exclusive focus on dementia patients and their caregivers. They aim to assist suspected and mildly demented individuals. Seniors not diagnosed with dementia within six months of entering a dementia care station are transferred back to an alley station. To meet the specific needs of dementia patients, these stations are smaller, with optimal group sizes of 6 to 15 individuals (or 3 to 8 in remote areas). Personnel must meet stricter professional standards, including completing at least 20 hours of dementia care training.

Dementia requires intensive caregiving in terms of time and manpower. But in indigenous areas with limited job opportunities, working-age adults often leave during the day for work, sometimes traveling with crews for several days at a time. With no one to care for elders with dementia, families must rely on local care resources.

Moreover, dementia is a progressive condition that can only be slowed, not reversed. Once seniors enter moderate to advanced stages, their ability to live independently diminishes, and the caregiving burden significantly increases.

Lapi explains that her work at the dementia care station focuses on delaying the onset of dementia among elders while teaching families in the community to care for dementia patients. Her goal is to give families more time to learn caregiving skills before their loved ones reach moderate or advanced stages. “The slower the seniors progress toward severe dementia, more time families will have to adapt,” Lapi says. “When the time comes, families might feel less compelled to send their elders to a care facility.”

The Gap Between Government Plans and the Reality of Tribal Communities

After the establishment of the Hanxi Dementia Center, the team quickly realized a significant gap between the government’s plans and the reality the tribe was facing.

For example, finding a venue was a major challenge since the beginning. Hanxi Village has few legal and large sites for residential and construction purposes. The Hanxi Dementia Center eventually settled in the only available public space—an old checkpoint located a 10-minute drive from the heart of the settlement.

Hanxi Village consists of four tribes, and some of the connecting roads are long and steep slopes. Elders with dementia live across different areas. Every morning, Lapi drove the association’s only van, picking up the elders along the way and bringing them to the center.

The center required an average of at least three attendees per day, but the challenge with transportation made it difficult to meet this threshold. This is because the indigenous region is vast in area and the Atayal people are used to live in dispersed settlements. Some neighboring tribal villages are separated by mountains, making the travel time easily exceed an hour. Despite conducting a “carpet search” across a few nearby villages, only three elders from the same village agreed to attend the center.

Tribal relationships are close, and the neighbors generally know which elders have dementia. The Hanxi Dementia Care Center visits each village to inquire. The image shows Lapi Hayun (Chinese name: Luo Yu-Han) greeting an elder she came across in the Xinguang Tribe. (Photograph by Jia-Wei CHANG)

Moreover, government subsidies were distributed based on attendance numbers.[5] If the three elders took turns traveling to medical appointments instead of going to the center during the day, the attendance would fail the requirement. Over the nine months of operation—amidst the peak of the COVID-19 pandemic—the center received a total subsidy of only 120,000 NTD, which wasn’t even enough to cover the salary of the care manager, Lapi. Her wages ended up being covered by Yunaw who paid over 100,000 NTD from his own pocket.

Given these challenges, the center could not afford to hire another full-time staff. Lapi had to design courses, teach, and transport the elders while also managing the complex administrative procedures. At times, Yunaw had to step in and handle these tasks himself and even seek voluntary help from another tribal member.

In addition to challenges with space, finances, and manpower, indigenous communities face difficulties stemming from government policies that fail to adapt effectively to local contexts.

The Overlooked Collective Culture of Indigenous Groups

Her first class at the dementia care station left Lapi with a strong impression.

“I need to go to my classmate’s place!”

“Where's my friend?”

As soon as the class began, everyone was anxious. The elders with dementia were eager to find their old classmates from the alley station where they had previously attended classes together.

The government, recognizing the specific care needs of dementia patients, mandated that dementia care stations be separate from other long-term care facilities.[6] Lapi, who had interned at a dementia care station in the city, observed that elders there often came from different communities and lacked prior experience living together. In such cases, separating dementia patients helped prevent potential disruptions. However, for closely connected indigenous communities, this separation inevitably fractures the bonds among their elderly residents, tearing apart their communal ties.

“In the tribe, everyone grew up together. Even if we’re not related, we’re elementary school classmates or childhood friends,” Lapi remarked. She observed that many indigenous elders, rather than being irritated by the sudden disruptive behaviors of other dementia patients, often knew how to comfort their old friends better than the caregivers. For example, after the dementia care station closed, Ba’ai briefly returned to the alley station. When she wandered off, other elders would sometimes guide her back and comfort her, saying, “Let’s draw together!”

The Former president of the Gangge Association, Li Shu-Min, is leading a class for elders at the alley station. Currently, the alley station serves nearly 20 members of the community. After the dementia service center was suspended, two elderly individuals with mild dementia returned to the alley station for services. However, the condition of Ba’ai, who has moderate dementia, worsened, and her family had no choice but to send her to a long-term care facility in the plain. (Photo by Jia-Wei CHANG)

At the dementia care station, Lapi designed lessons rooted in the elders’ daily lives. She used tools like bows, bamboo baskets, and other props to teach Atayal weaving songs and dances, explaining, “This is the action of pounding millet... this is the action of weaving cloth... Our Atayal dances are all based on these daily activities!” Hearing this, the elders became animated and fully absorbed in the class. Even Ba’ai, who typically wandered around, remained seated throughout. However, when Lapi shifted to the government-provided lesson plans, which focused on teaching colors and shapes, the elders grew restless once again.

Lapi also often took the elders to the fields behind the station to plant millet and pumpkins. Elders, who had spent their lives farming, enjoyed showing their skills and sometimes even played the role of teachers in these activities.

Yunaw shared that, just before the dementia care station closed, he and the Taiwan Indigenous Long-Term Care Services Rights Promotion Association had presented their vision for elder care to the Long-Term Care Department. In his view, the elderly at both the alley station and the dementia care station belonged to the same community. He proposed that the two institutions share the same space and caregiving resources. This approach would help the alley station care for elders with [mild] dementia, preventing it from becoming overwhelmed, while also enabling the dementia care station’s care managers to train alley station staff in dementia care techniques. However, the Long-Term Care Department simply reiterated existing policy and suggested that, if the tribe insisted on sharing a space, they could “put up a curtain” to separate the two groups of elders. Yunaw laughed bitterly and remarked, “What’s the point of that?”

Evaluation Results Reveal Value Conflicts

Yunaw (left) and Lapi (right) stand at the door of the defunct Hanxi Dementia Care Center. Last year's thunderstorm burned out the electrical circuits, and only half of the lamps could be turned on. The brand-new lamps that Lapi bought are still in the storage room, but the cost of repairing the electrical circuitry is tens of thousands of dollars, so the center can't raise the money. Instead, they usually open the door and use natural light to lead classes. (Photo: Jiawei CHANG)

In the middle of November 2021, Hanxi Dementia Care Center received a “D” rating in [the government’s] evaluation, resulting in a one-year long suspension.

Li Shih-Hung, the executive director of the Catholic Chinese Sacred Mother Foundation, was one of the evaluators. He mentioned that during the on-site observation, Hanxi Dementia Care Center lacked adequate space, lighting, and accessibility facilities. He emphasized that ensuring the safety of the elderly through proper facilities was a basic requirement.

Li also pointed out that within the long-term care system, dementia care stations are intended for primary prevention and cannot replace professional care. However, during the evaluation process, he noticed that since dementia care stations offer free services, many families unable to afford professional care[7] or elderly day-care center[8] or unfamiliar with the professional care system continued to send elderly dementia patients—even those at and above the moderate stage—to these stations for care. He believed that relying on non-professional care systems for patients in later stages of dementia put them in danger.

The Catholic Sacred Mother Foundation (中華聖母基金會)has been involved in long-term care in Chiayi for over 20 years and has also extended its services to indigenous communities in Alishan. Li acknowledged the challenges of finding suitable spaces in indigenous areas. Building legal facilities required significant time, followed by substantial funding for renovations. In 2022, the foundation planned to establish an elderly day-care in center the Dabong Tribe of Alishan. Securing the venue alone took three years, and renovation costs were exorbitant. For instance, an elevator that costs NT$1 million on flat land would cost NT$5 million in the mountains. Li remarked, “We still have to grit our teeth and get it done.”

Upon seeing the evaluation results, Yunaw could only smile bitterly. The concrete accessible ramp at the entrance of Hanxi Dementia Care Center was built by him and a fellow tribe member. Yunaw purchased cement and salvaged iron railings to complete the project. Meanwhile, the Catholic Sacred Mother Foundation, as a professional organization, spent significant time and money constructing a facility for elders with severe dementia. How much more challenging must it be for the local indigenous people, who have far fewer resources? For the Hanxi Tribe, where even basic services are still lacking, “professional care” under the current system continues to mean sending elderly dementia patients down the mountain to facilities in the plains.

Now, Yunaw often reminisces the time when he and Telu used to provide home care for elders fifteen years ago. After completing their work around 3 pm, the young people would spend the afternoon pulling weeds and chatting with a group of grandmothers by the fields. “It felt like we were doing a better job than we are now with long-term care services.”

The hope that dementia patients can be accompanied by their loved ones and spend their final years on their own land seems like a distant dream.

The Resilience of Elderly Care in Tribes Seen by a Han Medical Worker in the Remote Mountains

In the afternoon at the Xinxian tribe in Wulai, the residents gather at the pavilion in front of the grocery store. Si-Lang, also known as Gu Mai (his Chinese name is Lin Jin-Tu), used to often chat and drink with friends here. During the years when he first developed cognitive impairment, he would often run out in the middle of the night and sit at the pavilion. (Photo by Jia-Wei CHANG)

In fact, the dense social networks within the tribe provide crucial support for dementia patients. The key to dementia care is to allow elders to do as much as they can and engage with the people and things around them, which helps slow the decline of their cognitive functions. In contrast, dramatic changes to their environment and the loss of familiar people and things pose significant challenges for these elders.

The Xinxian tribe in Wulai District, New Taipei City, is a “back-mountain” tribe which is even more remote than Hanxi. The nearest dementia care station is located in Zhongzhi Village, a 20-minute drive away, while the closest elderly daycare center and long-term care facilities are a 50-minute drive away in Xindian City. There are only three minibuses connecting the tribe to Wulai Old Street on the daily basis. Elders traveling downhill mostly rely on taxis, which cost at least a thousand NTD per trip. During the day, dementia patients in the tribe without caregivers at home rely entirely on home care[9] or services of foreign caregivers.

Thirteen years ago (2012), Chen Mei-Jhen became the first frontline long-term care assessment and management specialist in Wulai working for the “Long-Term Care 2.0 Pilot Program.” She trained the first batch of home care workers in the tribe, meanwhile visiting Atayal elders at home and conducting community-based dementia research.[10] She noticed that indigenous elders showing signs of dementia “wouldn’t even consider getting a diagnosis,” letting alone accessing services such as dementia care stations or daycare centers. Initially, Mei-Jhen observed that challenges of transportation and financial concerns were the primary reasons behind this choice. However, after three years of fieldwork, she realized the culture was the real cause: The tribe’s understanding of and approach to dementia was completely different from that of the Han Taiwanese.

“People in the tribe told me, ‘(Dementia) isn’t an illness!’”

In fact, there is no such word to describe “dementia” in the Atayal language. Traditional Atayal norms, known as “Gaga,[11]” emphasize living according to the course of nature. Since the progression of dementia cannot be reversed, people have learned to accept it [as part of life].

When Mei-Jhen started to offer care services [in the community], many patients had already exhibited cognitive impairments. Sometimes, elders would mumble about the past, but the younger members would simply laugh it off, calling it “cultural transmission.” Also, the close-knit tribal life means that neighbors were either relatives or friends. They would remind the family when a dementia patient wandered outside and help to bring them back home, following the Gaga tradition of helping each other and respecting the elders. As the result, the local police station had never received reports of missing elders. Additionally, when an elder occasionally took items from a store and forgot to pay, the local shipowners would allow them to purchase on credit.

Ten years later, The Reporter revisited the Xinxian tribe with Chen Mei-Jhen. The changes here were minimal — with more indigenous people becoming home care workers, the term “dementia” had become familiar to the locals. However, the living conditions of dementia patients hadn’t changed much, and the tribe’s inclusive and accepting attitude toward elders remained the same.

Mei-Jhen described it as a caregiving environment that feels like “home.”

Ten years ago, Chen Mei-Jhen (the one in the yellow shirt standing in the center) spent three years in Wulai, serving the elderly and researching the care model of the local Atayal tribe. Si-Lang, also known as Gu Mai (second from the left), was one of the cases she worked with at that time. (Photo by Jia-Wei CHANG)

A Care Culture Like “Home”

On a sunny August afternoon, a vegetable vending truck, playing the “Atayal Joyful Song”, arrived at the pavilion in front of the village grocery store. For the villagers, this was the daily signal to gather and chat with friends.

Ten years ago, 79-year-old Si-Lang Ku-Mai (Chinese name Lin Jin-Tu) started showing symptoms of cognitive impairment. These days, he rarely comes to the pavilion to hang out with old friends.

“Who is this?” “Is she your girlfriend?” “Is she your classmate?” Five or six elders gathered at the pavilion and started teasing him when he showed up. They were aware of his condition and would sometimes do these “mental exercises” with him. After Si-Lang’s memory began to deteriorate, he didn’t remember that the grocery-store owner’s husband had passed away years ago. He kept asking about the husband. The group didn’t correct him but instead said, “Oh! You haven’t come to chat in so long, so of course, you wouldn’t know!”

At the sunset, we followed Si-Lang back to his home. Another elder from the village, Chang Hsiu-Ying, who had moderate dementia, suddenly opened the door and entered without speaking a word. For several minutes she sat quietly before opened the door and walked out.

Diagnosed with vascular dementia six or seven years ago, Chang Hsiu-Ying’s language capacity has been impaired. She loved socializing but struggled to express herself. Now, she often “drops by” friends’ and relatives’ homes like this. Si-Lang’s family had grown used to these unannounced visits, and no one found it strange.

Chen Mei-Jhen commented that Si-Lang’s “deterioration has been really slow,” perhaps because he has remained in a familiar environment all these years. He had showed mild dementia symptoms when Mei-Zhen first started working in the village ten years ago. Now, his condition has only progressed to a moderate level.

As we left Si-Lang’s house, Chen Mei-Jhen posed a sharp question: What is the purpose of diagnosing elders and bringing them to dementia centers? If the goal [of dementia care] is socialization and activities, “Don’t you think that pavilion is already a dementia center?”

Reflecting on Indigenous Dementia Care Policies: What Is “Good Care” That Aligns with the Local Culture?

*Si-Lang, also known as Gu-Mai, dining at home with his family. (Photo by Jia-Wei CHANG)*

The situation in these two villages highlights the gap between the indigenous care culture and the government’s vision.

The reporter interviewed Long-Term Care Division Director Chu Chien-Fang, who defended current policies. She explained that the thresholds set by these policies, including the minimum number of participants required for dementia centers, have already been adjusted for indigenous regions. Specifically, the ideal number of participants for dementia care centers in general areas is 6–15, whereas this has been adjusted to 3–8 for remote areas. The government provides funding for every dementia center, and Zhu argued that funding centers serving only one or two elders would not be feasible.

She suggested that indigenous areas without enough participants for dementia centers could incorporate dementia-delaying courses into Alley Stations to serve elders with mild dementia. For those elders with moderate to advanced dementia, micro day-care centers[12] or small-scale services such as home care could be considered under the Pilot Program for Integrated Long-Term Care Services in Indigenous Areas.

Wang Tsen-Yung, a professor of Graduate Institute of Social Work at National Chengchi University, who has focused on indigenous long-term care for nearly 20 years, lamented:

“Current long-term care policies are another form of cultural colonization and invasion for the villages.”

Wang argued that the rationale behind Taiwan’s long-term care is “a one-size-fits-all paradigm created by the central government,” yet care is deeply tied to culture and cannot be standardized. “Everyone eats, but that doesn’t mean everyone eats the same food. You need to prepare meals that align with local culture for elders to feel truly cared for.”

However, from policies to “pilot programs,” the government has by far encouraged indigenous communities to follow its own long-term-care model. Wang believes the government should instead consider, “What is the indigenous definition of ‘good care’? What is their vision for care?” and then give the groups space to develop services that reflect their cultural characteristics—services not yet seen in the existing long-term care systems.

He pointed out that indigenous groups value “collective care”. However, by ranking different levels of care, categorizing elders (based on their condition), and assigning them to different facilities, the government inadvertently fragments the network of the villagers, undermining their invaluable collective care mechanisms.

Finally, Wang raised another critical concern: The challenge in indigenous areas is the extreme lack of resources for elders with moderate to severe disabilities or dementia. According to the current policies, do we have to wait until all indigenous organizations have enough funding and resources based on the government’s standards before their elders can receive proper care?

Waiting to Return Home

In early September 2022, Lapi took us back to the Hanxi Dementia Care Center. Behind the center, in the fields, she had planted pumpkins, cucumbers, and papayas with three elderly dementia patients in a class a year earlier. To her surprise, the papaya seeds they planted had grown into a tall tree and even borne fruit during the nine months since the center closed. Excitedly, she jumped and shouted, “I must tell the elders! I need to show them this!”

But Ba’ai will not be able see it with her own eyes, since she is now far away in a care facility in Yilan City.

Yunaw was bustling around the village, attempting once again to apply to create a homecare agency, hoping this time it will give the elders a chance to stay in their community.

In the Hanxi village, people are still waiting for their dementia-affected loved ones to return home.

The papaya planted by the elders with dementia in the fields behind the Hanxi Dementia Care Center have now grown into tall trees. (Photo by Jia-Wei CHANG)

[1] https://dementiafriendly.hpa.gov.tw/resources?rid=20

[2] The progression of dementia is divided into mild cognitive impairment, mild, moderate, and severe stages: 1. Cognitive impairment and mild stage: Possible symptoms include forgetfulness, personality changes, difficulty with language expression, wandering and restlessness, difficulty managing complex daily tasks, etc. 2. Moderate stage: Partial disability begins. The elderly may experience occasional incontinence, inability to perform household chores, and loss of logical language. 3. Severe stage: The elderly experience severe disability, possibly losing mobility, unable to communicate with others, incontinence, bedridden, fully dependent on others, and unable to live independently. More info: http://www.tada2002.org.tw/About/IsntDementia

[3] Indigenous people traditionally divide their land into the "front mountain" and "back mountain" areas. Taking Datong Township as an example, with Taiping Mountain as the boundary, the front mountain refers to the villages closer to the plains, such as Lunpi Village, Yingzhi Village, Taiping Village, Leshui Village, Fuxing Village, and Hanxi Village; while the back mountain refers to Maoan Village, Siji Village, and Nanshan Village.

[4] This refers to the "Ten-Year Long-Term Care Plan" implemented by the government from 2007 to 2016, which provides care services for four groups of elderly individuals: elderly people aged 65 and above, indigenous people aged 55–64, individuals with physical and mental disabilities aged 50–64, and elderly individuals with impaired Instrumental Activities of Daily Living (IADLs) who live alone. The plan includes eight major services: care services, transportation, elderly nutrition meals, provision of assistive devices and accessibility facility repairs, home care, community and home rehabilitation, long-term care institution services, and respite services for family members.

[5] According to the application guidelines for the 2022 Dementia Care Services Plan by the Ministry of Health and Welfare, dementia service centers are subsidized for “activity costs” and “capacity-building costs.” For dementia service centers in remote areas with fewer than 5 people, the activity cost is reduced by 10% for each person below 5, and centers with fewer than 2 people are not eligible for subsidies.

[6] The Ministry of Health and Welfare's 2022 Dementia Care Services Plan application guidelines state: “To ensure the accessibility of services for the public and avoid the duplication of resources, the dementia care center locations should not share the same address as other government long-term care subsidized programs. However, this rule is not applicable if the service operates at the same address but at different times or if there is a clear spatial separation within the same address. Additionally, the same subsidy or service item from different subsidy programs cannot be claimed more than once.” The Reporter also interviewed the Long-Term Care Department, where Director Zhu Jian-Fang explained that the initial planning of dementia care centers aimed to provide services more focused on the special needs of individuals with dementia, as opposed to the general long-term care alley stations. Therefore, more subsidies were provided to the dementia care center. In the past, there were incidents where multiple care services were registered under the same address, leading to subsidy abuse. As a result, the guidelines have been amended in recent years, and now the space must be independent according to the new provisions.

[7] This refers to the “out-of-pocket expenses” for using Level B long-term care services. According to the "Regulations on Applications and Payments for Long-Term Care Services," low-income households are fully exempt from out-of-pocket expenses, middle- to low-income households receive reductions, and regular households are required to cover the costs themselves.

[8] The day-care center serves individuals with mild to moderate or more severe dementia and disabilities. Cases must be assessed by the Long-Term Care Center and must meet the criteria of being dementia patients aged 50 or older or individuals with disabilities aged 65 or older.

[9] Home care services are a type of Level B long-term care service provided by the government. Depending on the dementia patient’s level of disability, home care workers visit their residence to provide a few hours of assistance with daily chores, feeding, bathing and hair washing, accompanying them to medical appointments, and other similar services.

[10] Chen Mei-Jhen (2015). Preliminary Exploration of the Life Experiences and Friendly Communities for Atayal Elders with Cognitive Impairment: Taking Wulai District, New Taipei City as An Example

[11] https://tcmb.culture.tw/zh-tw/detail?id=247358&indexCode=Culture_Invisible

[12] The Day Care Center is a daytime respite service for individuals with dementia or disabilities. Family members drop off their elderly relatives at the center during the day and pick them up in the evening. According to the "Standards for the Establishment of Long-term Care Service Institutions," current day care centers are required to adopt a "unit care model," where each unit must accommodate 10–15 individuals, and each day care center can accommodate up to 120 people. Micro day care centers are currently being piloted in indigenous areas, with a lower threshold for accepting cases. These centers can be established with only 5 individuals with dementia or disabilities.