The nation’s aging population and the issue of long-term care are turning into a real source of concern, while a spate of care-related tragedies has meant the government can no longer ignore the urgent situation in the long-term care sector. The policies proffered by the Democratic Progressive Party (DPP) and the Chinese Nationalist Party (KMT) are to be financed by taxpayers and through the National Health Insurance system respectively, and have too many problems among them.
The KMT’s insurance-based 10-year plan is expected to cost NT$110 billion (US$3.34 billion) in the first year it is implemented, but the projected demand for the provision of care services at home and within the community has been incorrectly calculated, as it is based on the current use of the services: The estimates will be overly conservative, not least because the current provision is insufficient, but also because they exclude the use of foreign staff.
The DPP’s plan, the “long-term care services program 2.0,” only requires financing of NT$35 billion, but this calculation also failed to take into account the 220,000 households employing foreign care workers.
The KMT and the DPP have excluded the 220,000 households employing foreign carers in their projections. Over the past five years, the number of foreign carers employed by households in Taiwan has increased rapidly, to the tune of 24,000, an average of close to 5,000 per year.
Excluding these households does so at the expense of the carers, and places the responsibility for these people firmly at the feet of their employers. At present, of the 460,000 disabled people over 65, only 150,000 make use of long-term care services and only 43,000 — less than 10 percent of that figure — take advantage of the state-provided community care or home help services available.
So why don’t they use long-term care services offered by the state? Probably because the services are not available to households employing foreign care workers.
The government classes foreign care workers as supplementary labor, and therefore regards them as taking employment opportunities that would otherwise be available to Taiwanese. That is, denying access to state-provided care services, or at least reducing this access, is a form of penalty. By disregarding these foreign care workers, or even by vilifying them, the two parties are classing those households who employ them as not being in need of help and assuming that the decision to employ foreign workers was their own choice. It is no wonder that even women’s groups [that advocate migrant care workers rights] question whether the KMT’s insurance-based plan is beneficial to members of the public who employ foreign carers.
The fact is that, among disabled people over 65, it is only those classed as seriously disabled — about 20 percent — who require care within an institution, with home help or day-care community services being sufficient for the other 80 percent. When the services provided by the state are inadequate, family members have to take up the shortfall.
Hiring foreign carers is not a decision they have chosen to make, it is a decision forced upon them, as there is no one else able to provide around-the-clock care. Also, since double-salary households are the norm, carers need to be flexible and willing to work long hours, and this is the reason home help for a few hours a day, or community-based daytime care services, which only run until 5pm, are simply not a viable option.
At present there are 220,000 foreign care workers in Taiwan, and they send close to NT$37.4 billion — NT$17,000 multiplied by 220,000 every month — back to their families overseas every year, while the Ministry of Labor receives more than NT$5 billion per year in administration fees — NT$2,000 per month multiplied by 220,000 — from their employers. This is peanuts compared with the amount of money the Ministry of Health and Welfare spends on care services for elderly people.
Japanese Prime Minister Shinzo Abe recently announced a raft of new social welfare measures, and an increase in the number of institutions for the care of elderly people was one of the most important items on the list.
The total expenditure is expected to be as much as ¥3 trillion to ¥3.5 trillion (US$24.6 billion to US$28.7 billion). It is hoped that this would boost the Japanese economy prior to the nation’s legislative elections next summer.
The question is, can the KMT or the DPP come up with an adequate solution for the situation in Taiwan, where domestic demand for foreign caregivers is worth close to NT$40 billion, while there are more reports of tragedies related to the provision of long-term care?
Chen Chen-fen is president of the Taiwan Association of Caregivers.
Translated by Paul Cooper
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