As more Indonesian migrant workers test positive for COVID-19 after arriving in Taiwan, the Ministry of Health and Welfare plans to further restrict or suspend entry of migrant workers from the country — the main provider of Taiwan’s care workers.
The problem is where could Taiwan find replacement workers and how long will the long-term care system survive without them?
There are about 190,000 Indonesian care workers in Taiwan, with more than 10,000 new arrivals every year. As there is little hope that the COVID-19 pandemic would subside in the next year, how will this labor shortage be filled if Indonesian care workers are denied entry?
The ministry suggests that people instead take advantage of the government’s Long-Term Care 2.0 initiative. Unfortunately, a live-in foreign care worker provides 24 hours of care, while the government program only provides an hourly service, which is only available during the day.
Nursing homes are also not the answer, as the government program only pays nursing home fees for up to 21 days, and after that, a family must pay the rest out of pocket.
The pandemic has highlighted the inherent problems in the Long-Term Care 2.0 program, which seems to be doing fine, but it is the foreign care workers — people from Indonesia in particular — who shoulder the bulk of the work and who cannot be replaced by locals.
Neither is this just an issue of salary. Even if Taiwanese are willing to pay NT$60,000 to NT$70,000 per month, it would be difficult to find 190,000 Taiwanese willing to take care of the elderly throughout the day.
From the demand side, paying that amount to employ a local care worker is simply not affordable for most families.
If a family’s application to employ a foreign care worker is unsuccessful, and they cannot afford to hire a local care worker and the Long-Term Care 2.0 program cannot meet their needs, the care work will fall to the family.
Since the beginning of the year, it has been obvious that the burden of care for many families has increased, as has the physical and psychological toll of doing so. Fortunately, the pandemic has been almost perfectly controlled in Taiwan; otherwise the additional strain of pandemic control along with long-term care would have had disastrous consequences.
A BETTER SYSTEM
If the ministry intends to restrict the entry of care workers from Indonesia, it should comprehensively review whether the Long-Term Care 2.0 program can meet the needs of Taiwanese families. If not, then there are a few ways they can improve it.
First, the maximum amount of pay and working hours of home care services per month should be increased.
Second, home care services should be available during the night and on holidays.
In Japan, for example, home service is available 24 hours a day, and it can even be available on call. Whereas in Taiwan, it is difficult even to have home visits for three daily meals.
Third, if the existing financial resources of the long-term care program cannot meet family’s needs, it could be covered by the anti-epidemic fund.
Fourth, after the pandemic is over, the ministry should comprehensively review and update the Long-Term Care 2.0 initiative to include institutional care, so that the system can truly take care of all elderly people with dementia and disabilities.
Shen Cheng-nan is a practitioner of geriatric psychiatry based in Taichung.
Translated by Lin Lee-Kai
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