The legislature is currently deliberating on a draft law drawn up by the Cabinet that addresses long-term care. The bill only seeks to regulate what kind of training caregivers, who now number more than 180,000, should receive. However, the scope of the draft is not enough to solve the many problems that have been generated by having two systems — foreign migrant caregivers and long-term care services — operating in parallel. Only by actively integrating overseas migrant home care workers into the long-term care system can the government ensure care quality and safeguard the labor rights of migrant workers.
According to current regulations, people who employ foreign caregivers in their homes are not eligible to use -government--subsidized long-term care services. This has resulted in a twin-track system in which Taiwanese are forced to choose between foreign migrant caregivers and the official long-term care system.
Taiwan started legally admitting foreign migrant workers in 1992. Since then, the shortage of long-term care services has made employing caregivers from overseas a necessary option for many people. Originally seen as “supplementary” help, the number of foreign caregivers has grown from 306 in 1992 to more than 180,000 this year. In contrast, although the government has worked on developing a long-term care system that employs Taiwanese, the number of workers in the official system is only 13 percent of their migrant counterparts.
Most licensed caregivers are paid by the hour and provide home care service only during the day. If they had to provide care outside of normal working hours, the strain might be more than many of them could bear. In contrast, foreign caregivers are expected to be on hand 24 hours a day. From the employer’s point of view, foreign workers undoubtedly have the advantage because of their highly flexible work hours.
Institutional care is generally seen as a last resort in Taiwan because it means that those receiving care are separated from their homes, families and friends, and children who place their elderly parents in institutions are often accused of being unfilial. Employing a migrant caregiver allows families to adhere to the tradition of filial piety by keeping the elderly at home.
It is ironic that existing long-term care policy excludes families who employ foreign caregivers from the official long-term care service system, resulting in these families and their foreign employees bearing the full burden of caring for those who can no longer care for themselves.
Consequently, the conditions under which foreign workers provide care are exploitative and contrary to labor laws and regulations. The great majority of foreign caregivers live in the same room as the people they care for, so it is hard for them to get enough rest. It is also common for migrant caregivers to be asked by their employers to provide tubing care — inserting and removing breathing and feeding tubes, urinary catheters, etc — which they are not legally qualified to do.
Such abuses of migrant caregivers’ services inevitably cause the quality of care to fall. For example, overworked and exhausted caregivers may fail to stop the people they are caring from accidentally falling down and hurting themselves. Depriving foreign migrant workers of their labor rights indirectly undermines the quality of care received by those they are caring for and it also tarnishes the nation’s human rights record.
It is necessary to recognize that foreign caregivers have long been the bulk of the nation’s long-term care personnel. The existing parallel-track long-term care policy has to be changed to include migrant caregivers in overall policy considerations and absorb them into the long-term care system. The draft law for long-term care law currently under discussion should not exclude the employment of foreign caregivers. More than that, the new law should start the process of ending the parallel-track system. We suggest taking the following steps:
First, the management of foreign caregivers’ work, their training and their work conditions should gradually be brought in line with those of Taiwanese home care providers. All caregivers should be given one day off for every six days of work.
Second, the role of labor brokerage companies should be restricted to solely introducing foreign caregivers to prospective employers. Once migrant caregivers have entered the homes in which they are to work, the task of managing and guiding them should be handed over to departments familiar with home care work, so that all Taiwanese who require long-term care can be managed and supported by a single system.
Currently, employers are required to pay an employment stability fee of NT$2,000 a month. Some of these fees could be allocated to pay for monitoring of foreign domestic workers. This would ensure quality service without creating an extra burden for employers. In addition, home care departments could help employers find Taiwanese care providers to fill the gap when their primary caregivers have a day off or return to their native country.
Finally, the model for employing foreign domestic workers should gradually be changed from the current system of individual employment to employment through home care departments. This would completely resolve the problem of not being able to safeguard migrant domestic workers’ labor rights. This would also allow families who employ overseas workers to ask those departments to take responsibility for foreign workers’ education, training and service quality.
Only if foreign caregivers are gradually integrated into the nation’s official long-term care system will it be possible to safeguard their working conditions. Doing so could reshape the relation between employers and foreign caregivers from one that is antagonistic, rife with control and exploitation, into one based on mutual trust and companionship. These steps are necessary to assure that those receiving care are receiving quality service.
Chen Chen-fen is an assistant professor at Chinese Culture University’s department of social welfare. Frank Wang is an associate professor at National Chengchi University’s Graduate Institute of Social Work.
TRANSLATED BY JULIAN CLEGG
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