The Challenges of Easing Foreign Caregiver Application Requirements in Taiwan's Long-term Care System
The proposed amendment to Article 46, which allows elderly individuals over the age of 80 to hire foreign caregivers without undergoing a Barthel Index assessment, is about to pass its third reading in the Legislative Yuan. While this change appears to benefit families seeking caregivers, the unintended consequences could outweigh the advantages.
Currently, it is not employers choosing foreign caregivers, but rather caregivers choosing employers! Before accepting a job, foreign caregivers often assess the household conditions. If the care recipient has behavioral disturbances, such as dementia patients who exhibit aggression or refuse to sleep at night, caregivers frequently decline the job, saying, "Grandpa doesn’t sleep at night; Grandma gets violent—thank you, but no thanks!" This issue has arisen due to the gradual relaxation of the Barthel Index assessment standards, allowing even those with mild care needs to apply for caregivers, leaving families with severe care needs struggling to find assistance.
If the proposed amendment passes, allowing all elderly individuals over 80 to hire foreign caregivers without assessment, families with severe and moderate care needs may find it even harder to secure caregivers. Many caregivers would prefer lighter workloads, opting to care for elderly individuals without dementia or disabilities rather than those who require intensive assistance.
Before implementing this policy change, the government should conduct an economic evaluation of foreign caregiver supply and demand, rather than making a hasty decision based on isolated incidents—such as family members attacking doctors over assessment disputes. If the new policy leads to a surge in applications, or if labor-supplying countries like Indonesia and Vietnam cannot meet the increased demand, the caregiving market will fall into chaos, and families in real need will suffer the most.
It is important to recognize that foreign caregivers are a specialized workforce, similar to medical resources or accessible parking spaces, and must be properly regulated to prevent social issues such as an increase in runaway migrant workers, declining care quality, and reduced access for low-income families. If the government insists on allowing elderly individuals over 80 to hire foreign caregivers without assessment, these workers should be categorized as domestic helpers rather than lumped together with caregivers for dementia and disabled individuals. Separate application, fee, and management regulations should be established.
Additionally, recent media reports of family members assaulting doctors stem from doctors requiring a 3 to 6-month observation period rather than outright refusing to issue Barthel Index assessments. The rationale behind this is that foreign caregivers are intended for long-term care rather than short- or medium-term care. For short-term care needs, families can use the "Long-term Care 2.0" program or the government’s proposed short-term foreign caregiver application system, ensuring a more efficient allocation of human resources.
Moreover, the Barthel Index alone is no longer a sufficient assessment tool. The government should adopt a more comprehensive evaluation system managed by long-term care centers, where professionals determine eligibility to ensure fair resource allocation.
Foreign caregivers have become a crucial part of Taiwan’s long-term care system, but their labor rights remain a contentious issue, making it difficult to fully liberalize the sector. Before introducing new policies, the government should first integrate the existing foreign caregiver workforce with the "Long-term Care 2.0" system to ease their workload and enhance the role of domestic caregivers. Taiwan is approaching a super-aged society, and this legislation will shape the future of its long-term care system. Lawmakers must carefully assess its impact to prevent disruptions in existing caregiving mechanisms.
