Preparation for Discharge in an Aging Society: Aligning with Long-Term Care 3.0
Update Date：2026/01/05，
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Director Huang Pin-Hsuan, Community Nursing Center
Taiwan officially entered a super-aged society in 2025, with the proportion of elderly people continuing to rise. Chronic diseases and disabilities are increasing, leading to a simultaneous surge in medical and long-term care needs. While Long-Term Care (LTC) 2.0 has established a community-based service network, the rising complexity of elderly care has led to emerging issues such as poor care transitions post-discharge, heavy caregiving burdens on families, and a shortage of caregiving staff.
LTC 2.0 laid the foundation for a long-term care network centered on community and home-based services. However, as care needs continue to increase, both the clinical and community sectors face numerous practical challenges. These include the increasingly diverse patterns of disability and dementia, making care needs more long-term and complex. After discharge, patients often experience delays in receiving long-term care services due to information gaps or late assessments. Furthermore, there is still a need to strengthen caregiving workforce and family support capabilities, and to better integrate medical, long-term care, and social welfare resources.
In response to the growing pressure of elderly care and workforce challenges, the Ministry of Health and Welfare has planned the "Long-Term Care Ten-Year Plan 3.0" to promote "healthy aging, aging in place, and peaceful end-of-life care" as its core vision. This initiative emphasizes extending care from disease treatment to include living functions and social participation. The policy goals include health promotion, strengthening the integration of medical and long-term care, promoting active rehabilitation, supporting family caregivers, introducing smart caregiving technologies, and cultivating professional caregiving staff, all aimed at enhancing institutional capacity and ensuring peaceful end-of-life care. The goal is to enable the elderly to receive safe and dignified care in familiar communities, whether at home or in institutions.
Currently, the LTC 3.0 plan is rolling out in three phases. Starting on September 1, 2025, several restrictions in LTC 2.0 will be adjusted to make services more accessible, including the following four items:
1. Families employing foreign caregivers can use 30% of their care service allocation for community services such as day care and family care.
2. Expanding community transportation services to include transport to day care centers for individuals with physical or mental disabilities, increasing the subsidy per trip from NT$100 to NT$115.
3. Adjusting nutritional care services, changing the previous "4 sessions per set, NT$4,000 subsidy" to "3 sessions per set, NT$4,500 subsidy."
4. Adjusting home respite services to allow elderly individuals to engage in outdoor activities safely, not limited to home settings.
In January 2026, LTC services will be expanded to include individuals with dementia of all ages (currently limited to those over 50), and Post-Acute Care (PAC) services will be added. Additionally, in July 2026, the subsidy for renting smart care assistive devices will be launched, aiming to further integrate medical and long-term care systems and provide more continuous and person-centered care services.
Compared to LTC 2.0, which focused on expanding service capacity and building a service network, LTC 3.0 emphasizes the quality of care and service continuity. LTC 3.0 highlights the importance of starting long-term care assessments and referrals before discharge. During hospitalization, the medical team will assess the patient's functional status and home care needs. Discharge preparation clearly becomes the key to the connection between medical and long-term care. Under LTC 2.0, after the disability assessment, the case manager would refer patients to a long-term care management center, a process that took longer, often leaving patients unable to access long-term care resources until just before discharge.
To address the "care gap" post-discharge, LTC 3.0 plans for case managers to contact the service providers (Unit B) directly, enabling patients to access urgent long-term care services within three days of discharge. After three days, Unit A will fully transition to long-term care services, including home services, home care, assistive devices, and home rehabilitation, ensuring that care is uninterrupted. This approach combines post-acute care with home services, extending the golden period for rehabilitation while strengthening family support and integrating technology, making the care process more efficient and comprehensive.