Radiation Environment and Medicine 2024 Vol.13, No.2 65–69

ReportLong-Term Care Facilities and Government Preparedness for ComplexDisasters, including Radiation Disasters, in Taiwan
Chie Kushima1*, Yuko Yoshida1, 2, Fu-Chih Lai3, Toshiko Tomisawa1 and Haruka Otsu1
Department of Nursing Sciences, Graduate School of Health Sciences, Hirosaki University,
66-1 Honcho, Hirosaki, Aomori 036-8564, Japan.
2
Department of Nursing, Sapporo University of Health Sciences, 2-1-15, Nakanuma Nishi 4- jo,Higashi, Sapporo, Hokkaido 007-0894, Japan.
3
College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist, Taipei City 110, Taiwan.
1

Received 18 February, 2024; revised 24 April, 2024; accepted 11 June, 2024

Japan has experienced complex disasters in recent years, including radiation disasters, which havemade evacuation of older individuals critical. In October 2023, we visited Taiwan, which has anaging population and disaster risk similar to Japan. This study highlights the disaster preparation
endeavors of long-term care facilities (LTCFs) and the government using examples of daycare
centers for older individuals; firefighting experts conducting mandatory accident and injury
prevention; and evacuation drills in response to fire, earthquakes, and other disasters.
The Ministry of Health and Welfare (MOHW) has centralized the management of medical
information and information on LTCFs; however, this is not centrally integrated. To facilitate
disaster management and evacuation, central integration and management of medical andLTC information is necessary. Reflecting on the aforementioned issues, the integration andmanagement of medical and LTC information at the central and domestic levels and the delayof information needed for disaster management should be considered when considering disaster
preparedness for Japan and Taiwan.
Key words: Disaster preparedness, Long-term care facility, Government, Medical informationsystem, Radiation disaster, Complex disaster1. Introduction
Over the past few decades, Japan has experienced
complex disasters that have required innumerable
disaster preparedness measures. The 2011 Great East
Japan Earthquake and Tsunami not only caused many
casualties but also the Fukushima Daiichi Nuclear Power
Plant accident, which resulted in severe damage from
*Chie Kushima: Department of Nursing Sciences, Graduate School of HealthSciences, Hirosaki University, 66-1 Hon-cho, Hirosaki, Aomori 036-8564, Japan
E-mail: c.kushima@hirosaki-u.ac.jp
https://doi.org/10.51083/radiatenvironmed.13.2_65
Copyright © 2024 by Hirosaki University. All rights reserved.

radiation exposure. In 2021, a torrential rainstorm centeredin the Kyushu region caused 14 deaths in nursing homes
for older individuals1), and responding to flood damage inlong-term care facilities (LTCFs) was considered urgent2).
The number of older adults in need of assistance in theevent of such disasters is increasing every year3), as is thenumber of people certified as requiring nursing care4).
The Ministry of Land, Infrastructure, Transport, andTourism and the Ministry of Health, Labor, and Welfare
have proposed measures to improve the effectiveness ofevacuation at LTCFs5), and support for older individuals
during disasters has become critical.
The accelerated aging rate in Taiwan is expected to66

Chie Kushima et al. / Radiation Environment and Medicine 2024 Vol.13, No.2 65–69
Nuclear Plant 2 (Kuosheng 國聖)Inactive

Nuclear Plant 1(Jinshan金山)
Inactive
TaipeiCity

Nuclear Plant 4 (Longmen 龍門)*Asset maintenance management

4. Eden Social Welfare Foundation
5. Taitung County Chenggong Township
Multiple Care Service Center

Taitung
County100km

1．Papula Pusung Indigenous Cultural
Health Station
2．Taitung City Yi-Ning Indigenous
Cultural Health Station
3．Canaan Senior Living and Caring House

50km

Nuclear Plant 3(Maanshan 馬鞍山)
Active50km

Fig. 1. Location of the nuclear power plants and LTCFs we visited.

Fig. 2. Disaster drills for earthquakes.

exceed 20% by 2025, which is similar to that of Japan,
thus contributing to many LTCFs6). These LTCFs arealso exposed to the risk of complex disasters such as
floods, earthquakes, typhoons, heavy rains, and radiation
disasters caused by nuclear power plants. Taiwan
currently has one nuclear power plant in operation, andthe other two have been decommissioned, as shownin Figure 1. Hospitals respond to radiation disasters
near nuclear power plants with constant training using
simulations and regular exercises and drills7); however, nosuch training program is currently in place for LTCFs.
In October 2023, we visited Taiwan, a country thatshares similarities with Japan with respect to an aging
society and disaster susceptibility. This study reportson the current disaster preparedness in LTCFs that arelocated within a 100-km radius of the active Nuclear Plant
3 (Maanshan 馬鞍山 ) and the efforts of the governmentof domestic Taitung County located in Eastern Taiwan
with great proportion of the indigenous population andthe central government of the Ministry of Health andWelfare (MOHW).
2. Disaster Preparedness in LTCFs
2.1. Papula Pusung (巴布麓 ) Indigenous Cultural HealthStationThis indigenous cultural health station (原住民文化健康站 ) is a daycare center set up for approximately 70
non-disabled indigenous older individuals who live in
the Papula Pusung community. As one of the variousactivities, firefighting experts are invited to conduct
accident and injury prevention and evacuation drills fordisaster preparation for fires, earthquakes, floods, andtyphoons, as shown in Figure 2. In the event of a flood

Chie Kushima et al. / Radiation Environment and Medicine 2024 Vol.13, No.2 65–69

67Fig. 3. Drums for fire warnings.

Fig. 4. Evacuation routes to quickly guide older individuals withdementia.

that might occur in the Amis tribe (阿美族 ), traditional
tribal drumming is used for disaster evacuation warning,as shown in Figure 3. Each drumming pattern indicatesdifferent warnings, and residents have been educatedto distinguish between different disasters and informed
about disaster evacuation actions.

and community care, is a welfare center for older
individuals that forms a continuous network of medical,
institutional, and community care to meet the needs ofthe aging and disabled population. This center acts as abridge between diverse and high-quality care in homeand community care networks, families, and communities.
This facility complies with the Nursing Care Safety
Ordinance and includes thorough fire safety managementand disaster preparedness measures. Furthermore, thisfacility provides special consideration to older residents
with limited motor, sensory, and cognitive functions, andconducts annual fire safety and disaster evacuation drills.

2.2. Taitung City Yi-Ning (伊濘 ) Indigenous Cultural
Health Station
This indigenous cultural health station is a free daycare
center for Yi-Ning community residents with disability
grades of 2 or 3 of 8 who require preliminary care
support. This facility is open from morning to evening
on weekdays, and is staffed by four caregivers andvolunteers. This facility aims to provide care services
that connect to government care resources to meet thehealthcare needs of indigenous older individuals andalleviate the care pressure or burden on their family
caregivers. In addition to onsite care, indigenous culturalcare services include telephonic greetings, follow-ups forolder individuals, caregiver visits, and lifestyle counseling.
These services establish the foundation for sustainingmultidimensional healthcare and cultural care during
disasters.
2.3. Canaan (迦南 ) Senior Living and Caring House
This Taito Christian facility, which focuses on medical

2.4. Eden (伊甸 ) Social Welfare Foundation
This is a comprehensive LTCF that provides day care,in-home services, and meal delivery services for older
individuals in the remote Changbin (長濱 ) township.
Volunteer workers provide meal delivery services andbuild individual relationships with older residents, whichis especially critical for disaster preparedness because of
their remote location and isolation during disasters.
2.5. T aitung Count y Cheng gong (成功 ) T ownshi p
Multiple Care Service Center
This center provides community-integrated service
centers, family care support services, home services,and dementia group homes. To prevent residents with68

Chie Kushima et al. / Radiation Environment and Medicine 2024 Vol.13, No.2 65–69

dementia from wandering outside the facility, the exit
doors have been painted as bookshelves to prevent themfrom recognizing the doors. In addition, the evacuationroutes shown in Figure 4 were posted on the walls of thefacility, allowing older individuals with dementia to beevacuated quickly and smoothly.
3. MOHW Department of Long-Term Care
Although the MOHW centrally manages medical
information in Taiwan7), information on the insuree ofLTCFs is managed locally instead of centrally. This
indicates that older individuals using these facilities
are not identified quickly without the assistance of thelocal government in the event of a disaster, including
a radiation disaster. This issue was evident during theCOVID-19 pandemic and vaccination. We discussed thisissue with an officer of the department, who told us that
she was interested in how information on the Japanese
LTC insuree is managed and utilized in disasters.
4. Discussion
During our visit to Taiwan, we learned about disastercountermeasures and issues throughout Taiwan byinspecting the LTCFs used by indigenous people in
Taitung County and the MOHW. Taitung County is home
to a large number of Amis and other indigenous tribes,
and disaster countermeasures have been implemented
by integrating the indigenous cultural perspectives of theenvironment, humanistic harmony, and sustainability.
However, the Changbin township is a remote andindigenous-based area, which has a greater risk of being
isolated during a disaster.
Taiwan has a comprehensive National Health
Insurance (NHI) system with a 99.9% coverage rate;
however, a Taiwanese LTC insurance system with thesame information infrastructure as the NHI has not been
established. Moreover, the LTC insurance system is not
symmetrically connected to the NHI system, as the LTC
insurers are covered by the NHI as well, which has madedisaster management of dual insurees of LTC and NHI
difficult, as shown during the COVID-19 management
in Taiwan. The MOHW is concerned about this, and tofacilitate rescue operations during disasters, including
radiation disasters, central management of insuree
information of LTCFs is necessary, similar to how theMOHW manages medical information in the NHI. The
central management of insuree information is a significant
issue in Japan as well. At the time of the Fukushima
Daiichi nuclear power plant accident, many LTCFs in theYamagata Prefecture, a neighboring prefecture, accepted
older evacuees from the Fukushima Prefecture; however,they reported cases where they had difficulty providing

subsequent treatment and care owing to a lack ofinformation on the medical history and medication statusof the older evacuees8). The central management and use
of user information of LTC insurance facilities to gather
information during disasters will take a considerable
amount of time.
The LTCFs we visited were approximately 100 km indistance from the currently active nuclear power plant
and were outside the PAZ and UPZ, the emergency zones
indicated by the IAEA9). Therefore, their awareness ofradiation disasters is low, and they do not receive any
special training. At the time of the Fukushima Daiichi
nuclear accident, evacuation orders were issued forspecial nursing homes in the UPZ, and older individuals
in severe need of medical care were evacuated out of
the UPZ in Self-Defense Forces convoys10); therefore,
the LTCFs we visited may have received evacuees. Thissuggests that, while evacuation measures for facilities
within the PAZ and UPZ are essential, LTCFs outsidethese zones also need to be prepared to accept older
individuals from LTCFs within their range. In this way,
we believe that Taiwan can learn from Japanʼs experiencein preparing for disasters that it has not experienced.
Taiwan has adopted the LTC service from Japan, as it
will become a super-aged society after Japan. We intend toobserve Taiwanʼs efforts to utilize the existing centralized
medical information system, while taking advantage of
the Japanese LTC system and continuing reforms tocentralize information on the insurees of care facilities
for older individuals. In the future, we need to learn
from and teach each other about disaster preparedness
from Japanʼs and Taiwanʼs experiences and consider
disaster preparedness with more emphasis towards olderindividuals who may need assistance during a disaster.
Acknowledgments
We thank the LTCFs in Taitung County and the MOHW
Department of Long-Term Care for their cooperation
during the visit.
Conflict of Interest
The authors declare that they have no conflicts ofinterest.
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