President Tsai Ing-wen (蔡英文) had high hopes of pushing forward the Long-term Care Services Program 2.0, but several family tragedies since its implementation have triggered alarms.
Back in Nov. 24, 2017, then-premier William Lai (賴清德) said that “if a salary of NT$30,000 is not enough for caregivers, they should treat their jobs as doing a good deed.”
The remark sparked heated debate. Lai later said that he was talking about a person’s professional identity — that, aside from earning a salary, being a caregiver is about performing virtuous acts. Lai apparently forgot, in addition to the low salaries, that there is an insufficient number of caregivers in the nation.
Instead of dealing with the shortage, Lai gave a pep talk and asked caregivers not to care too much about earning so little, but to regard their jobs as a sacred calling. At the time, the Tsai administration clearly did not have a comprehensive plan for the program.
Recent family tragedies have highlighted the program’s shortcomings.
On Aug. 26, an elderly man in Taoyuan killed his wife and then committed suicide. This tragedy could have been prevented. The man, 77, had been looking after his 76-year-old wife, who suffered from dementia. Police suspect that because the man had been taking care of his disabled wife for so long and was then diagnosed with cancer, he pushed his wife and her wheelchair into an irrigation canal and jumped in after her.
A few days ago, a 74-year-old retired pharmacist in Taichung allegedly killed his bedridden wife with a knife and locked himself in a second-floor bathroom so that he could slit his own throat.
Both cases involved an elderly person taking care of another elderly person. Both were likely eligible for the long-term care program, yet neither of them sought assistance.
When the caregiver and the one being cared for are old, tragedies like these can happen if the caregiver begins to experience physical or mental problems.
These families needed long-term care services, but they likely did not want outside help or did not want to get others in trouble, because another family member was living with them or they had already hired a foreign caregiver. This might explain why they did not apply for the program, despite being eligible.
The government spends more than NT$20 billion (US$640 million) a year on the long-term care program, but it still failed to prevent these tragedies.
Last year, 20 tragedies related to giving long-term care were reported by the media, compared with 11 reported in 2017, according to the Taiwan Association of Family Caregivers.
That numerous cases likely go unreported is even more worrying.
The initial version of the program, from 2007 to 2016, charged per hour, while version 2.0 charges per service used, meaning that people pay for meals delivered, medication administered, walks taken, baths given and so on.
Only low-income households enjoy these services completely free of charge, while lower and middle-income households pay 5 to 10 percent of the cost and higher-income households 16 to 30 percent.
Many families with elderly people needing long-term care at home are not familiar with what the program offers or how to apply for the services. Many people taking care of family members with dementia, disabilities or mental challenges in the home are not aware of respite care provided through the program, which would allow the caregiver to take a breather or adjust the pace of providing care to their loved one.
The failure to disseminate this information among families in need is a major obstacle for the program.
Elderly people are caring for other elderly people and an increasing number of middle-aged adults are quitting their jobs to return home to care for elderly parents. While the ailing family members are clearly the ones in need of long-term care services, the caregivers — whether a husband, wife, parent, child, sibling or foreign worker — experience physical and mental exhaustion that can accumulate to an overwhelming degree over time.
The caregiving often restricts the life, space and freedoms of the caregiver, but the program’s respite care services do not sufficiently address this. The government and the general public must be more aware of what caregivers at home undergo and target their needs.
Kung Ling-shin is chairman of the Chinese Society for Life and Death Studies.
Translated by Chang Ho-ming
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