Care changes no cure-all solution

By Wang Pin 王品  / 

Sat, Oct 06, 2012 - Page 8

The Council of Labor Affairs (CLA) is thinking of implementing a new system next year, for a trial period, in which home help services are to be provided and charged on an hourly basis by a combination of immigrant and local care workers.

The media called this a revolutionary change in how foreign domestic care workers are to be employed in Taiwan: from live-in domestic helper to hourly dispatched workers. The idea behind this new system was inspired by the Danish home help system, in which a single care worker is responsible for visiting several senior citizens within the community.

The proposed system is to have a number of advantages over the current system of immigrant domestic helpers.

It can bring about cost savings for those who do not require around-the-clock care — they will not need to pay a 24-hour wage to the worker, nor will they be responsible for employment security fees or health insurance premiums for immigrant workers.

It also simplifies matters for the host family, who will no longer be responsible for the home help’s bed or board, nor will it be accountable should the immigrant worker abscond.

The new system will also be better for immigrant workers’ human rights, as they should no longer need to worry about being ill-treated by exploitative or abusive employers.

Finally, the new system may well see a reduction in the number of immigrant care workers coming to Taiwan.

Is the point here the hourly-charged services or the fact that the work is to be given to an immigrant? In other words, wouldn’t the advantages of the hourly-charged system be just as applicable to a Taiwanese worker?

We have had a system of pay-by-the-hour home visits by Taiwanese care workers for some time, as part of the home help initiative within the Ten Years Long-term Care Program.

This has attracted large numbers of people looking for a career change and single mothers who have decided to try their hand at community care work.

This is precisely what the Council for Economic Planning and Development had in mind when it was organizing care services in 2002.

Over the past few years, vocational colleges have introduced courses on care provision for the elderly, preparing young people to become care workers and supervisors. Meanwhile, the Department of Health has been legislating to set up long-term care insurance, in which home help is one of the major forms of service provision.

Despite all this, there are still too few families using the government’s home help services. Why?

There are four crucial differences between the home help system and the proposed hourly service system for immigrant care workers.

First, the hourly fee for the proposed program will reportedly be close to NT$240 per hour, more expensive than the NT$180 people currently have to pay for local Taiwanese home care help, unless they are eligible for a government subsidy.

Second, the salary for workers under the proposed program will be more stable. At the moment, Taiwanese care workers within the national home help system get paid NT$150 per hour, which translates into anywhere between NT$25,000 and NT$30,000 per month, although this is subject to fluctuations. By contrast, workers under the proposed program will be paid an agreed and stable salary.

Third, service users can expect more diverse services from the proposed program. Under the current home help system, Taiwanese carers are only expected to work weekdays, visiting either daily or several days a week for one or two hours during the daytime. They do not provide care over many hours in one day, in the evening or at night, for the whole day, at weekends, during holidays, at short notice, or several times on any single day. All of these options, however, are possible under the proposed system for immigrant carers.

The fourth difference concerns taxation and supervision. The salary for local care workers is taxed, and they are expected to maintain records and subject themselves to supervision and on-the-job training according to government long-term care supervisory specifications. The question is, will Taiwanese and foreign care workers under the new system have to pay tax and be subject to this tedious bureaucracy?

The success of Denmark’s home help system, and the popularity of the hourly rate model, is such that there has been no need to even consider introducing and relying on foreign workers to do the job. If Taiwan is to improve its home help services, we need to look at the influence of the four variables in the light of Denmark’s experience.

Will local Taiwanese be more willing to do the job if the salaries were stable and sufficiently high?

Would the public be more likely to take advantage of the service if the available options were more flexible?

Would people be willing to accept price increases if they were happy with the quality of the service offered?

Finally, would the simplification of the supervision requirements lead to a reduction in the supervisory bodies’ administration costs?

If it is possible to fine-tune the current system to address these issues, why is there a need to bring immigrant workers into the equation?

As it happens, over the past decade, several civic groups in Taiwan have been experimenting with different forms of the home help model employing local carers, demonstrating that the answers to the above four questions are, indeed, in the affirmative.

Given that this home help system is continuously being improved, why has it taken so long for it to expand? It is because the current system and the immigrant domestic help system are run in parallel, and because the application process for foreign workers is so full of administrative loopholes.

One example would be that applicants for foreign carers are not required to go through a residence evaluation as part of the application process.

Therefore, the demand for long-term care in Taiwan has been virtually satisfied by foreign workers, whether legally or illegally. Year on year, the number of foreign workers employed as domestic help is increasing by 10,000, and now stands at more than 200,000 in Taiwan as a whole.

It is good that the CLA is attempting to improve the human rights situation for foreign workers here in Taiwan, but does this necessarily have to depend upon whether they provide hourly-charged services or 24-hour services as live-in home helpers? Can their human rights be improved by tightening up other areas of the system?

Ironically enough, now that former Council of Labor Affairs Minister Jennifer Wang (王如玄) — who fought so long to prevent differential wages for local Taiwanese and immigrant workers — has resigned, things are not looking good for the human rights of immigrants even in the proposed reform, nor for long-term care in Taiwan.

Wang Pin is an assistant professor in the Department of Social Work at National Taipei University.

Translated by Paul Cooper