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Showcase: Developing compassionate communities in Taipei through public private partnership (Oxley/Evans)

Poster Showcase

All authors:

Dr. Chih-Kuang Liu, Superintendent of Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan

Dr. Chin-Yu Ho, Department of family medicine, Taipei City Hospital, Taipei, Taiwan

Dr. Ching-Yao Tsai, Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan

Dr. Lin-Chung Woung, Deputy Superintendent, Taipei City Hospital, Taipei, Taiwan

Dr. Ming-Chen Chen, Geriatrician & Attending Physician, Department of family medicine, Taipei City Hospital, Taipei, Taiwan

Dr. Ming-Chung Ko, Director of Department of Urology, Taipei City Hospital, Taipei, Taiwan

Dr. Pei-Wen Wu, Department of family medicine, Taipei City Hospital, Taipei, Taiwan

Dr. Sheng-Jean Huang, Superintendent, Taipei City Hospital, Taipei, Taiwan

Dr. Sheng-Jean Huang, Superintendent, Taipei City Hospital, Taipei, Taiwan

Dr. Wen-Ruey Yu, Department of family medicine, Taipei City Hospital, Taipei, Taiwan

Mr. Chia-Jen Liu, Superintendent Office, Taipei City Hospital, Taipei, Taiwan

Mr. Shih-Chih Wang, Department of Health and Welfare, University of Taipei, Taipei, Taiwan

Mr. Te-Chun Yeh, Academy of Humanities and Innovation, Taipei City Hospital, Taipei, Taiwan

Mr. Tsun-Cheng Huang, Deputy Superintendent, Taipei City Hospital, Taipei city, Taipei, Taiwan

Mr. Tsun-Cheng Huang, Deputy Superintendent, Taipei City Hospital, Taipei, Taiwan

Mr. Yi-Sung Ho, Chairman of Shennong Temple, Shilin, Taipei, Taiwan

Ms. Chun-Mei Hou, Department of Nursing, Taipei City Hospital, Taipei, Taiwan

Ms. Hsin-Yi Lin, Social worker’s Office, Taipei City Hospital, Taipei, Taiwan

Ms. Ming-Hsuan Hsieh, Department of Planning Administrative Center, Taipei City Hospital, Taipei, Taiwan

Ms. Pei-Jiun Pan, Public Relations Center, Taipei City Hospital, Taipei, Taiwan

Ms. Shih-Ju Wang, Section Chief, Planning Office, Taipei City Hospital, Taipei, Taiwan

Ms. Shu-Wen Wu, Department of Planning Administrative Center, Taipei City Hospital, Taipei, Taiwan

Ms. Tsai-Ping Fu, Department of Planning Administrative Center, Taipei City Hospital, Taipei, Taiwan

Ms. Tzu-Hui Chen, Public Relations Center, Taipei City Hospital, Taipei, Taiwan

Ms. Yi-Chin Lin, Department of Planning Administrative Center, Taipei City Hospital

Ya-Fang Chen, Department of Nursing, Taipei City Hospital, Taipei, Taiwan

a. The Role of a Hospital in the Promotion of Compassionate Community
Background
Hospitals play the roles in community such as medical service provider, providing care to the vulnerable group, integrating community medical resources and health promoter. With the support of the hospital, multiple and creative services could be provided to the community, therefore, the community residents are empowered, people can learn knowledges about health and end-of-life palliative care.
Methods
In 2018, Taipei City Hospital embraced the idea of Professor Allan Kellehear and introduced the concept of palliative care into the community. We promoted Compassionate Community in local communities according to Compassionate Community Charter.
Results
Promoting Compassionate Community with the efforts of our hospital helped construct the core value of holistic care, wisdom of life, humanistic care and social network, therefore enabling the events of home care, seminar about health, Life Issue Café, “Love for Life, Love for the Land Festival”, caring the elderly and congregate meal, advance directive and promoting Good Death.
We investigated 180 of total 1,270 senior residents in Jiujia Village, Shilin, Taipei and 68.9% of them are aware of the promotion of Compassionate Community, besides, the satisfaction of all kinds of events is higher than 90%.
Conclusion
Despite the current trend of interest oriented hospital management, we should have medical institution’s social responsibility, be the companion and carer of community residents, introduce the concept of community palliative care and achieve the goal of aging in place as well as good death.

b. Preventive drug use at the end of life in nursing home in Taiwan

Background
At the end of life, residents in nursing home are significant health consumers. They are at risk of polypharmacy and adverse drug events. Therefore, prescription in hospice care (less than months) should be regularly assessed and inappropriate medications should be withdrawn.
Aims
Our study aimed to examine the preventive drug use in hospice-care patient and usual-care patient at the end of life in nursing home.
Design
We utilized retrospective cohort study. The prescription data of deceased patients in nursing home in Yangming Branch of Taipei City Hospital were extracted from the electronic medical records, 2016-2018. Preventive drugs use in all patients were collected at three time points: 4 weeks before the death, 2 weeks before the death and the date of the death.
Results
In our study, 11 hospice-care and 11 usual-care patients were collected. 22 patients, median age at death 85 years, 68% women. On the day of death, 45.4% had preventive drugs, We found the numbers of preventive drug use in hospice-care are less than those in usual-care patients in each time point. The ratio of patients taking/not taking preventive drugs in palliative care were less than those in usual care in each time point. In addition, we found the three most common categories of preventive drugs in all patients: anti-hypertensive drugs, insulin and oral hypoglycemic and anticoagulants and aspirin.
Conclusion
Preventive drugs are relatively less use in hospice-care than those in usual-care patients at the end of life in nursing home in Taiwan. Improvements in end-of-life care and more appropriate drug use in nursing homes is needed.

c. Promoting the elders’ death literacy with the Life Issue Café in the community
Background
As the promotion of concepts of palliative care, death literacy is gradually known in western countries. Death literacy means the knowledge and ability to gain, to understand and to make use of the information related to end-of-life and palliative care.
Purpose
By 2024, Taiwan will become a super-aged society. Traditionally, Chinese Culture taboos the issue of life and death; only by improving people’s death literacy in communities could the goal of community palliative care and “Good Death” be truly achieved.
Method
The International Compassionate Community in Old Street, Shilin, Taipei has been boldly introducing the Life Issue Café to the community since April 2018, which the student volunteers lead the elderly discussing issues such as “Life and Death” and “End-of-life”. The total time of the event is about 1.5 hours with 3 rounds of 20-minute dialogues. After discussion, the collective intelligence is shown and shared with visualized analysis.
Result
During 2018, 4 Life Issue Café events were held with 60 attendees including table hosts, student volunteers and 27 elder citizens. The result of pre-test and post-test questionnaire for elderly of the attitude toward death is:
1. Do you think it is important to discuss the issue of death with others: 84.2% vs. 90.9%
2. Do you find it difficult to discuss with others: 57.9% vs. 45.5%
3. You can face death bravely: 78.9% vs. 90.9%
Conclusion
The 7 principles of the World’s Café enable us to begin the dialogue about life and death. The World Café is a simple, flexible and effective way to make people have more identity, sense of belonging and sense of participation in their community.

d.

Taipei TianHou Temple is located in Ximending, Wanhua District, Taipei. The Wanhua District is the earliest development township in Taiwan. Ximending is also a downtown in Taipei. The old and new cultures are in harmony and intertwined. In recent years, under the influence of globalization, isolation is a tendency. In the traditional Chinese culture, temples are the center of belief of the people and a place for the community to gather. The temple promotes the "Tianhou Temple compassionate care community” with the concept of "empathy". Temple has the power to gather people, re-energize the trust and subtly enlighten people’s compassion.
Caring of Marginalized people is one of goals of the compassionate care community. In addition to infectious diseases and physical and mental problems, there are many potential social problems. Continued follow-up care and counseling sites have the advantages of accessibility and acceptability, respond immediately to handle these potential social problems. Respect for autonomy, inclusiveness, and medical and social mutual care reflect the four concepts of life and establish a friendly life circle in the TianHou Temple compassionate care community. TianHou Temple was serve as a base, providing basic living services through referrals from community leaders and residents. . Establish a peer-to-peer network through public-private partnerships, and connect local non-profit organizations with powerful locals in the community to work together for take better care of the marginalized people.
It provides the following services through network building and cross-professional and cross-departmental collaboration.
1. Provide emergency supplies: warm supporting events and winter mobile service are providing material services in the cold
2. Medical first aid: marginalized people, who need emergency medical care, can have immediately medical services.
3. Provide volunteer medical consultation for the poor (the homeless or rehabilitated addicts and criminals), such as a free health checkup service yearly.
Government: Social Welfare Division /City Hospitals
Private: Foundation / The Elderly care centers / Association
Local: Community leaders / Friends / Families

e.

Caring of Marginalized people is one of goals of the compassionate care community. In addition to infectious diseases and physical and mental problems, there are many potential social problems. Continued follow-up care and counseling sites have the advantages of accessibility and acceptability, respond immediately to handle these potential social problems. Respect for autonomy, inclusiveness, and medical and social mutual care reflect the four concepts of life and establish a friendly life circle in the TianHou Temple compassionate care community. TianHou Temple was serve as a base, providing basic living services through referrals from community leaders and residents. . Establish a peer-to-peer network through public-private partnerships, and connect local non-profit organizations with powerful locals in the community to work together for take better care of the marginalized people.
It provides the following services through network building and cross-professional and cross-departmental collaboration.
1. Provide emergency supplies: warm supporting events and winter mobile service are providing material services in the cold
2. Medical first aid: marginalized people, who need emergency medical care, can have immediately medical services.
3. Provide volunteer medical consultation for the poor (the homeless or rehabilitated addicts and criminals), such as a free health checkup service yearly.

f. The Reciprocity of Student Participation in Compassionate Community- An Example of University Social Responsibility

Background
As a part of community, university student can play an important role in community living. Universities are expected to engage more in contributing to the betterment of society through the integration of social responsibility into institutional management, teaching, research, services and public activities. Universities are obligated to work together to address the economic, social, cultural and environmental challenges in the their local community and to find solutions.

Method
The Shilin Old Street Compassionate Community collaborates with the universities nearby, and set up courses in community setting. A curriculum was designed to specifically divides students into four groups and assign them with care responsibility of different condition elderlies: healthy, sub-healthy, severely disability, and terminal cancer. During weekly visit, university students walk into the community and successfully link the theory in higher education with practice in community.

Result
Reciprocity can be found in this project, students take part in community care and also learn the experience of community development, reflect the knowledge of life and death, and also improve the inter-generational conversation between elderly and youth. The concept and the delivery of public health palliative care thereby are enhanced, death literacy are promoted, and the culture and respect for life are inherited.

g. A New Role as a Community Manager in the Promotion of Compassionate Community

The promotion of compassionate community can’t be simply relied on the community and needs the intervention of supportive groups such as the authorities, the city council, hospitals, schools and religious organizations. Besides, a mediator is needed to integrate the community and surrounding organizations.
Taipei City Hospital promotes Compassionate Community in Taipei, Taiwan. We founded Compassionate Community Committee and employed a community as well as hired a community manager to be the mediator. The community manager is not only responsible for contacting the community with surrounding organizations, but also assisting in home visit, holding community lectures and events and caring the vulnerable groups.
The community manager could devote to community service, provide people in the community with more support. Therefore, people could give more care to the place they live and be more identified with it; furthermore, they could also be supportive to each other.

h. International Compassionate Community Day of Taipei City

The grand opening ceremony of Compassionate Community in Old Street, Shilin, Taipei City, Taiwan was held on April 6th, 2018. The concept of the ceremony was “Bringing back both Fudeyang Aqueduct and the affections in Shilin Old Street”. In testimony of the authority and NGOs, Taipei City Mayor Dr. Wen-Je Ko signed to support Compassionate Community in Old Street, Shilin, Taipei City, and announced April 6th to be “International Compassionate Community Day of Taipei City”. Now we have 6 Compassionate Community locations, with everyone’s effort, every single event could be gathered to form a universal value of good intention circle in the society, therefore, a community of “mutual trust, social cooperation, delivering medical care to homes and the aged ones are cared till death”. Furthermore, we want to pass our experiences on and introduce the achievement of Taiwan to the world.

i. Discussion on the Compassionate Community by News report
Background
In the spirit of compassion city charter of international concern, through the cooperative medical institutions and community life of the dying policies, life hospice care, concern for community life death issues, combined with Taiwan media reports. Therefore, Taipei City Hospital and the Scholar Shennong Palace, Shihlin District, the old Yukari Yukari join hands in Shihlin District, the old established Taiwan's first international compassionate care for the community and become "an international city and Mercy Care Community" (PHPCI) a is the international organization in Asia and the second partner community, and so Taipei Mayor Ko Wen-je announced April 6 for the "compassionate care Taipei international community day", the international charity caring spirit everywhere in Taipei city charter.
Purpose
In order to promote the policy of " Compassionate Community ", the Taipei City hospital has worked with the temple, school groups, communities and other media to support the community and develop community skills, knowledge and ability to enable more people to face the issues of death, dying and bereavement.
As we enter the aging society, the demand for hospice care and long-term care continues to increase, especially when the professional intervention is insufficient at the end of the disease and during bereavement. Community participation can provide continuous support, thus developing a sustainable community support mode.
Method
In order to promote a caring and caring community, people should have a sense of belonging and a sense of belonging in the cafe, compassionate care hall, life and life story films, and life care education. In addition, the media coverage will inspire more government agencies, hospitals and communities in Taiwan to spread influence and help the weaker generation to enhance the quality of care at the end of life.
Result
Since the mayor of Taipei, Ke Wen-zhe, declared the April 6th "Taipei international community compassion day", the 7 affiliated hospitals of Taipei City Hospital have actively worked with community units. Apart from the compassion and care community of shiilin old street, there has been the establishment of Nei Hu Lake, the merciful care community, Taipei Wenshan guide compassion care community, Taipei Thean Hou Temple compassion care community, Datong Qing'an compassion. Five caring and caring communities, such as Huai community, Taipei City, Zhuang Tsai Fu Court, and compassion care community. The media disclosed the relevant reports of compassion and care for the community. It also attracted the attention of other government agencies, religions, non-governmental organizations and schools, and came to visit the benchmarks and gained recognition and support. In succession, it was planning to set up a caring and caring community with Taipei City hospital.
Conclusion
Through the media coverage, we should enhance the public's attention to the compassionate community. The Taipei City Hospital connects civil organizations such as government agencies, communities, social welfare institutions, businesses, and charitable religious organizations to build community partnerships, promote and build community activities of caring for the city, support each other, care for altruism, and realize the "Taipei" in the mind. The city is transformed into the universal value of the good circulation of society, and the experience is shared and passed on to any corner of Taipei, forming a caring community model from birth to death, and then leaps onto the international stage.

j. Death Literacy for the Elders in the Compassionate Community

Background
Death Literacy is an intelligence of execution, as well as the knowledge and ability of gaining, understanding and utilizing information about end-of-life and palliative care.
Purpose
An investigation was performed with a self-administered structural questionnaire to estimate the knowledge and attitude on end-of-life and dying of people in the community.
Methods
We investigated the residents of the International Compassionate Community in Old Street, Shilin, Taipei with a questionnaire to estimate death literacy of the elders in communities in Taipei.
Results
212 elders in the community were investigated and the results show that educational background is highly correlated with death literacy. Besides, a significant difference was found between sexes in the questions “Do you think it is important to discuss the issue of death with others?” as well as “I know that Compassionate Community is promoted in Jiujia Village”
Conclusion
When facing the challenge of aging society, we should not only put emphasis on long term care after dementia and dysfunction, but also continue promoting death literacy of community residents, medical teams and families; therefore, the purpose of providing holistic care from womb to tomb and constructing a compassionate community could be truly achieved.

k. Construct a sustainable “Youth-Elder Collaboration for a better life” community supporting system: Taking Qing-an Compassionate Community in Datong District for example

Background
Traditional temple is not only a dominant cultural feature in Taiwan, but also a spiritual sustenance for many people. Besides, neighborhood and schools are critical in bringing the community together. The cooperation between traditional temple, neighborhood and schools could be a major influence of practicing community medical care and strengthen community care.
Purpose
Combining local forces of temples and communities, we want to develop a sustainable community supporting system in the most amiable and approachable way. Therefore, people could receive appropriate care and support in different stages of life including birth, aging, disease and death.
Methods and Results
Qing-an Compassionate Community in Datong District was initiated by Zhongxing Branch, Taipei City Hospital. We integrated resources from the community such as Qing-an Community Development Association, Datong District as well as Fu-Shou Temple, Chongcing Village, Taipei Municipal ChongQing Junior High School and Taipei Municipal Dalong Elementary School. Besides, traditional Glove Puppetry Startles, Congregate Meal for the elders and school education were combined with home care provided by hospital, home palliative care and health screening to form a sustainable community supporting system.
Conclusion
Primary education and junior high school education helps promote life literacy to child at the early stage and introduce the issue of life and death into daily life. By passing on traditional culture and hospitals providing health screening, interaction between different generations would be promoted and the purpose of “Youth-Elder Collaboration for a better life” could be achieved.

l. The Breakthrough on Introducing the Day-Care Institution Disabled Residents to the Community

Background
The time it takes for the disabled people to be integrated into the community life depends on how much the social support network is covered. The higher the acceptance, the more social support network for the disabled people, therefore, the more encouragement for them to be integrated in community lifestyle.
Methods
The International Compassionate Community in Old Street, Shilin, Taipei has been expressing care for the outcasts since it was created. By integrating traditional culture and community campaigns, we planned to help the disabled ones be integrated into the community, as well as to promote the physical, mental and spiritual health of the disabled ones, by introducing the community to them with traditional cultural activities and art campaigns together with accompanying volunteers.
Results
Since 2018, we planned 10 sessions of “Slow angels flying in the community” and other courses of caring technique for the disabled people, as well as inviting them to community activities.
Conclusion
By attending community activities, the bridge between the disabled and the community was constructed. This could be an encouragement for them to be integrated to community, besides, the acceptance would be higher in the community. Furthermore, with the volunteers accompanying, the disables could gradually open their hearts to people.

m. Promoting Death Literacy with The Festival of Life, Death and Dying

Background
According to the Compassionate Community Charter, there are 13 ways of introducing the concept of palliative care to the society and make changes including anniversary celebrations and campaigns.
Purposes
By holding the campaign, it breaks the taboo of traditional Chinese Culture toward life and death, as well as improves people’s knowledge about palliative care and alter people’s attitude toward life and death.
Methods and Results
The International Compassionate Community in Old Street, Shilin, Taipei is a community with traditional culture. We work with the more than 200-year-old Yu-ying-kung Temple by holding campaigns including traditional festivals, cultural guide tour and outdoor activities in order to promote and broaden policies of palliative care. Besides, we utilize the power of the community to form the circumstance of mutual help and care and make people being more positive toward the end of life. We hope people could gain more social support and better recovery after facing death, dying and bereavement.
Conclusion
The campaign rewrapped the issue of life and death with a series of games and took the chance of traditional festivals to make people think the events in life such as being born, growing old and being happy. This is just the spirit of Compassionate Community which aims to root humanistic care and holistic care into the community, therefore, to look after the physical and mental health of the residents.

n. Shorten the Distance among People- Long Chopsticks Activity

Background
There are 50 elder people participate in the gathering meal of Shilin Old Street Compassionate Community per month. All kinds of activities are arranged before the meal for the elderly to learn some talents and for active ageing.
Purpose
Aside from encouraging the elderly to go out and have some fun to learn all kinds of health-promoting concepts, the elderly could learn to take care of each other, and the interaction among them can also be enhanced. By doing so, the self “value” can be developed so as to obtain the daily needs and spiritual satisfaction.
Methods
When having the gathering meal for the elderly every month in Shilin Old Street Compassionate Community, the 30-cm long chopsticks act as the serving chopsticks for the elderly to get the food for other people when eating.
Results
It is not easy for the elderly to use the long chopsticks to get the food; however, they can get the food for many other people on the same table, which is to improve their interaction and care when eating. The 30-cm long chopsticks have the magic to shorten the distance among people!
Conclusion
Through the promotion of the long chopsticks activity can not only shorten the distance among people, but also share the spirit of empathy. It is hoped that the passion of helping each other among people can be retrieved, and the core value of the compassionate community can be reflected.

o. The Promotion of Health Literacy- When the Chinese Medicine Doctor meets Shennong

Background
There are 7000 people in the Old Jiali Village of Taipei City. The population of the people over 65 years old is around 1368 in the village; 56 of the people over 90 years old; 6 centenarians. In the village, the Emperor Shennong is worshipped in the Shennong Temple, who is respected as the founder of the Chinese Medicine. With the historical and cultural fusion, Taipei City Hospital (TCH) held the health lecture “When the Chinese Medicine Meets Shennong” to provide the residents with correct concept of Chinese Medicine and improve their health literacy.
Purpose
Since the high percentage of the elderly, they tend to misuse the Chinese medicine. Through the health lecture “When the Chinese Medicine meets Shennong”, the one blending with the community traditional religious culture, the correct concept of the Chinese medicine can be provided, improve the residents health literacy, and enhance the community care service.
Method
Every third week of the odd months, the Chinese medicine doctors and dieticians show the attendees how to make the medicinal diet and know more about the Chinese herbal medicine. The correct concept of the Chinese medicine is also provided. Therefore, the people could not only come to worship Shennong, but also correct the incorrect concept of the Chinese medicine, improving health literacy.
Result
From the previous lectures of “When the Chinese Medicine Doctor meets Shennong”, the number of the attendees of the community has been increasing, which means the fusion of history, religion and culture. Through the model of “When the Chinese Medicine Doctor meets Shennong”, meeting the community traditional culture, people could understand the needs and attitude of how to use the Chinese medicine, and obtain correct health literacy. This is to avoid the incorrect concept and usage to cause any harm to their health.
Conclusion
Taipei City Hospital, Old Jiali of Shilin District and Shennong Temple created Old Jiali as the “Shilin Old Street Compassionate Community” collaboratively. With the combination of the community traditional humanities and care, the activity promotion of the holistic care was provided, and the exchange of the cross-generation life wisdom was proceeded. Apart from brining the medical service and health literacy into the community, caring for the elderly in the village, it becomes a community health model with the combination of the important temple in the Taipei city, the community, and the professional medical service.

p. Wearable ECG Recorder Helps Improve Community Health and Welfare

Background
Atrial fibrillation is the most common cardiac arrhythmia in Taiwan. Cardiac arrhythmia is a risk factor of stroke, and the risk of stroke in patients with cardiac arrhythmia is 5 times as it is in ordinary people. In Taiwan, it is estimated to be 230,000 people with cardiac arrhythmia, account for 1-2% of the total population.
Purpose
The incidence of cardiac arrhythmia increases with age. Early intervention helps delay dysfunction and improve the quality of life during the final stage of life.
Methods
The International Compassionate Community in Old Street, Shilin, Taipei held a public health education and promotion campaign with a cardiac arrhythmia screening as well as an attitude toward life and death questionnaire for the elders conducted by the community volunteers and health professionals.
Results
Two sessions of the campaign were held in 2018 and 310 elders were involved. The results of cardiac arrhythmia screening showed the detection rates were 1.89% and 2.04%, respectively. As more elders were screened, the detection rate will show a stable interval. It is worth it to mention that the screening rate of arrhythmia including AF were 17.5% and 23.47%, respectively, which may help an early referral to the hospital for further follow up.
Conclusion
The promotion of compassionate community includes not only a life intervention for residents, but also a protection of life. The importance of prevention was long emphasized by the medical community. We expect the public health education and promotion campaign of “Cardiac Arrhythmia Screening Prevents Stroke” helps screening arrhythmia including AF. As cardiac arrhythmia is found early with an early intervention, stroke could be prevented. Thus, we may help the cardiac arrhythmia patients and their families say good-bye to stroke.

q. The Operation of Compassionate Community in Shilin Old Street

The Compassionate Community in Old Street, Shilin, Taipei works in the spirit of International Compassionate City Charter, operates in accordance with the culture in Taipei in order to achieve the goal of providing care physically, mentally and spiritually as well as to enhance the value of Compassionate Community in Old Street, Shilin, Taipei. We continue promoting end-of-life policies, end-of-life care, cooperation between NGOs and communities, caring about end-of-life issues, holding festivals and presenting awards. Also, we introduced aesthetics of living to attract the community putting more emphasis on the issue of end of life. These events help explain the diversified actions and development about end-of-life issues, they also help improve end-of-life care for social outcasts, therefore, the influence could be outreached and the underprivileged next generation.