On March 31, the Cabinet approved a draft law on long-term care and sent it to the legislature for deliberation. The stated purpose of the bill is to “ensure the quality of service and safeguard the rights of people receiving long-term care,” but can this long-term care law really ensure quality of service?
The first problem with the long-term care bill is that it depends on an appraisal system alone, but appraisals are carried out just once a year. It is very common for care institutions to make themselves look good just for the appraisals and to submit fake accounts. If they have more patients than they are supposed to have, they hide them and their beds away on the day of the inspection.
So who keeps tabs on the quality of care outside that three-hour inspection, on the other 364 days of the year? Long-term care is not like daycare for children, where parents deliver their children to a center and pick them up again each day, and so are able to observe the conditions of the place and get an idea of the caregiver’s attitude.
Not many family members of people in long-term care are able to visit them every day. Who is there to keep an eye on the day-to-day quality of these institutions? Can a law in which the government does not lay out a system of routine oversight and relies solely on once-a-year appraisals, really safeguard the rights of those receiving long-term care?
Can such appraisals really ensure the aspects of service quality that residents of such institutions think are important? There are an impressive--looking 124 items on the list for appraisal — everything from the account books to the floor area. However, how many appraisal points out of 100 are awarded for things like “no abnormal body odor,” “getting out of bed twice a day,” “being turned over and given a backrub twice a day” and “assisted limb movement” (passive exercise]) that really give residents comfort and dignity from minute to minute? The answer is 1.2 points for the first item and 0.8 points each for the other three.
What’s more, government penalties only start to be applied if an institution gets less than 70 points out of 100 in the assessment. Even then, it is just a one-off fine of between NT$60,000 and NT$300,000 and a reassessment six months later. It is by no means easy for a substandard institution to get closed down.
The second thing we need to ask about the proposed long-term care law is, if it fails to protect the rights of frontline care workers, how can it safeguard the quality of service and guarantee the rights of service users?
This question applies above all to foreign migrant caregivers, who make up half of all frontline personnel in long-term care institutions. Although the Labor Standards Act (勞動基準法) does apply to them, long-term care institutions often apply for exemptions under Article 84 (1) of the act, whereby they can legally have their foreign migrant employees work subject to only some of the regulations. Gone are the Labor Standards Act’s rules about how much rest workers should get, ie, that they should normally work no more than 84 hours over two weeks, and about how much overtime pay they should receive.
Instead, workers and employers are supposed to work out these conditions between them. As a result, foreign workers in care institutions work under a two-shift system, with each person working 12 hours a day. When you add on the time required for handing over from one shift to the next, ie, the fact that the person starting work has to arrive early and the person finishing work has to stay on longer, which applies to foreign workers, their workday can be as long as 14 hours, but they only get overtime pay for two hours.
Some employers don’t even pay the overtime rate of 1.33 times the regular hourly rate for those two hours, as stipulated in the Labor Standards Act. What’s more, the work done by migrant workers in care institutions is particularly intense. The number of older people or sick patients each overseas worker in care institutions has to care for is certainly more than the standard set by the government.
The Taiwan International Workers’ Association once handled a case in which a female migrant worker had to look after 30 beds on the nightshift and 18 on the dayshift, and worked 18 hours or more a day without a single day off all year round, but when the dispute went to arbitration, the employer said that her workload was very light and that she slept through the nightshift.
In short, migrant workers in care institutions often have to put up with long work hours and heavy work, and their overtime pay is often pilfered one way or another.
Although city and county labor affairs departments occasionally carry out spot checks, this is the exception rather than the rule. Care institutions know about the routine annual appraisals in advance, so they fix things up to make everything look legal and reasonable, sweeping any irregularities under the carpet. If the people who work in these places aren’t treated well, how can we expect the residents to receive decent treatment?
What safeguards can one hope for from this long-term care law, which in its draft form is lax on quality management and fails to protect labor rights?
Do we really want the public’s insurance contributions to be used to pay for poorly managed institutions? Because that is what is likely to happen if the Cabinet’s long-term care bill is enacted without some major changes.
Susan Chen is director of policy research at the Taiwan International Workers’ Association. Wang Pin is an assistant professor in National Taipei University’s Department of Social Work.
Translated by Julian Clegg
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