Caring for migrant care workers

Taiwan has nearly 1 million people in need of long-term care, yet the proportion of people with severe disabilities receiving long-term care benefits has been declining year by year. The gap is not being filled by the government, but by more than 200,000 live-in migrant care workers who are not covered by the Labor Standards Act (勞動基準法).

Wages are rising in the home countries of most of Taiwan’s care workers, such as Indonesia, the Philippines and Vietnam. Meanwhile, Japan, South Korea and Hong Kong are competing to attract those workers. The question is not whether families can afford carers, but whether any will still be willing to move to Taiwan three years from now.

The Ministry of Labor’s Diversified Companion Care Service Pilot Program is a step in the right direction. Under the program — which was launched last year — nonprofit organizations hire care workers who are covered by the Labor Standards Act. After 90 hours of training, they provide in-home services in shifts of at least two hours, demonstrating that migrant workers do not have to be tied to a single household to work with dignity.

However, with just 13 participating organizations and 41 foreign care workers, the program is nowhere near large enough to meet the demands of even a single district of Taipei.

There are three keys to solving the problem:

First, care services should be a part of long-term care benefits. Under the diversified companion-care system, services running at NT$300 to NT$400 per hour are difficult for struggling families to afford.

If the services provided by migrant domestic care workers for people with severe disabilities were incorporated into the long-term care benefits system — with partial subsidies based on the individual’s level of disability and the household’s financial circumstances — that could ease the burden on families, and improve migrant workers’ pay and access to days off.

The long-term care budget for this year has already exceeded NT$100 billion, yet people with severe disabilities have among the lowest takeup rates. Redirecting funding toward those who need it most should be at the heart of long-term care policy.

Second, talent pools and career pathways must be built up. The system treats migrant workers as disposable labor: When their work permits end, one group is replaced by another and the process starts over. Japan, by contrast, allows skilled care workers pathways to extend their work visas and transition to other forms of residency. Taiwan should allow trained foreign care workers who have accumulated experience to move into institutional care, advance to supervisory positions and ultimately qualify for long-term residency.

Third, cultivate differentiated pathways rather than a one-size-fits-all approach.

People with mild or moderate care needs could receive services through institutional staffing agencies, using multiple caregivers working in shifts and flexible hours. For people with severe or profound disabilities, one-on-one care could be retained, but wages should be supported through long-term care benefits, with mandatory respite care shift rotations implemented.

Neither employers nor the government wants to shoulder the additional costs, but the cost of care does not disappear simply because no one is willing to bear it; it is merely shifted onto people with disabilities, the careers of family members and the years of migrant workers’ lives.

Taiwan is using the silence of more than 200,000 foreign care workers to subsidize a society that refuses to confront the true cost of care.

As Long-Term Care 2.0 enters its 10th year, migrant domestic care workers have been waiting outside the system for two decades. The overdue bill for care is one the government must start facing up to.

Huang Jin-shun is a former Presidential Office national policy adviser and an honorary president of the Federation of Taiwan Pharmacists’ Associations.