Political platforms presented in the presidential election campaign must be forward-looking, solve problems and be practical.
New Taipei City Mayor Hou You-yi (侯友宜), the Chinese Nationalist Party’s (KMT) presidential candidate, recently put forward four major proposals for long-term care: scrapping the requirement of a Barthel Index certificate when applying to employ a foreign home caregiver for people aged 80 or older, integrating the migrant caregiver and long-term care systems, improving the skills and quality of migrant caregivers, and improving the quality of care for the elderly.
Moreover, he proposed that the Barthel Index certificate no longer be required for applying to employ foreign caregivers for people aged 70 to 79 who have stage 2 cancer or above.
Hou’s office was complacent when making age the threshold for a Barthel Index exemption when employing foreign caregivers, and mocked Premier Chen Chien-jen (陳建仁), who later announced a similar policy, as being a copycat.
The truth is that Chen does not agree that age should the only condition for a Barthel Index exemption.
As of the end of last year, there were 886,619 people aged 80 or older in Taiwan. If all of them — whether they had a disability or dementia, or not — applied to employ a foreign caregiver, it could increase the number of foreign caregivers by more than 880,000.
As of the end of June, Taiwan had 28,467 foreign caregivers. Would Taiwanese be okay with more than quadrupling that number at once? Who would bear the social costs of this?
Also, allowing families who do not need long-term care to hire foreign caregivers would inevitably lead to caregivers choosing their employers and opting for “easier” jobs, making it difficult for people with a severe disability or dementia to find a caregiver.
About 30 percent of people aged 80 or older have dementia or a disability, and they are entitled to the home care and day care provided by the Long-term Care Plan 2.0. Some of them have been admitted to long-term residential institutions.
If the care is insufficient, it might be that they did not apply for a long-term care needs assessment, they were not eligible for the long-term care service, or they want to shift from the Long-term Care Plan 2.0 services to hiring a foreign caregiver.
If there is no need for long-term care, why hire a foreign caregiver? If you are eligible for long-term care services, but would prefer to hire a foreign caregiver instead, most cases can be processed using the Barthel Index assessment.
To solve the problem, what Taiwan needs is not a one-size-fits-all 80-year-old threshold, which runs contrary to the basic logic that those who need long-term care should receive long-term care services.
Rather, Taiwan should consider how to increase awareness among those in need in the long-term care service program, and further consider the issue of elderly people who do not need one-on-one long-term care, but need companionship because they are lonely, or those who have already received long-term care services and still have unmet needs for diversified care. The inconvenience of traveling to apply for a Barthel Index certificate is also worth thinking about.
This is exactly what Chen meant when he said these problems need to be solved by streamlining administration, facilitating people and assessing cases based on their specific contexts, and considering whether to relax the conditions or methods for hiring migrant workers.
As for exempting the 70 to 79 year olds with stage 2 cancer or above from the Barthel Index assessment, it is unrealistic. The ability of cancer patients to care for themselves varies greatly among individuals, and using age as an indicator would only confuse the issue.
Moreover, the chances of cancer being curable are increasing. If a person is discharged from hospital and needs care after returning home, the prolonged process of hiring a foreign caregiver would take too long.
The Long-term Care Plan 2.0’s discharge preparation strategy has shortened the waiting period for long-term care after being discharged from hospital to a minimum, and the government has already been integrating the migrant workers and long-term care systems.
Families who employ foreign caregivers can take advantage of the Long-term Care Plan 2.0’s respite care service. More than 66,440 families in Taiwan have used the Long-term Care Plan 2.0 service. Integrating foreign caregivers into the plan would not be easy.
Foreign caregivers must be paid as soon as they enter Taiwan, so their training must be conducted abroad. It would be difficult for Taiwan to conduct training abroad. The problem is very complex and must be dealt with pragmatically.
It would be good if all presidential candidates were to address the issue of long-term care, but they must come up with policies that solve problems instead of creating more.
Lin Wan-i is convener of the Executive Yuan’s Long-term Care Promotion Group.
Translated by Lin Lee-kai
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