Easing foreign caregiver application regulations: What comes next?
【The new head of the Council of Labor Affairs Lee Ying-yuan recently announced that regulations covering the importation of domestic helper-type foreign workers will be greatly relaxed and said he plans to adopt a “grant first, check later” policy.
Later on, he denied this principle and adopted the original “check first, import later” principle and subsequently publicly announced several amendments regarding review standards.

How can we understand from these old regulations and new policies the government’s policy direction on foreign workers and the establishment of a domestic care services industry? The organizers of today’s forum, “Taiwan: A Radical Quarterly in Social Studies” and the Alliance for the Amendment of Immigrant/Migrant Rights, have invited scholars and experts to start discussions on the CLA’s new measures and to deconstruct the myth of a clash of interests between “foreign workers versus domestic workers” and “foreign workers versus employers.” They are also asked to explore the significance of care services being thrust into the public eye. The Taiwan News presents here the forum highlights.

引言:勞委會新任主委李應元日前宣佈家庭類外勞引進方式將大幅放寬,擬改採「先給後查」政策,之後又否認了這項原則,採原來的「先審後進」的原則,繼而公布幾項有關審查標準上的修改。從這些舊規定與新政策,我們如何解讀政府在外勞政策以及建立國內照顧服務產業上的政策方向?主辦單位台灣社會研究季刊、移民/住人權修法聯盟特別邀請學者專家,從勞委會的幾項新措施談起,解構「外勞 vs. 本勞」與「外勞 vs. 雇主」的利益衝突之迷思,並探討照顧公共化的意義。本報特別整理其中部分精采內容以饗讀者。

Hsia, Hsiao-chuan, Assistant Professor, Graduate Institute for Social Transformation Studies, Shih Hsin University


Frank T.Y. Wang, Assistant Professor, Institute of Health and Welfare, National Yang-Ming University


Sun Man-wei, Action Alliance for the public provision of early childhood care and education


Tsao Ai-lan, Federation for the Welfare of the Elderly


Hu Yi-ting, Secretary-General, Taipei Association For Mentally Retarded Persons


Hsia Hsiao-chuan: You must all have noticed lately that the Council of Labor Affairs has been making a lot of changes regarding its policy on foreign labor ever since Thai laborers working on the Kaohsiung MRT project protested in August. In particular CLA Chairman Lee Ying-yuan, who took up his post just a short while ago, released a piece of news saying that he wants to liberalize conditions for applying for foreign caregivers. This change triggered some debate among migrant organizations and social welfare groups. Therefore, we have invited to this symposium scholars from the fields of migrant studies and welfare studies as well as representatives from migrant and social welfare organizations to jointly explore this issue.


In public discourse we often hear certain platitudes that stress that “foreign workers create a crowding out effect for domestic workers” or play up “the tense relations between employers and foreign caregivers” and so on. But when it comes to what role the state should play within the care system, namely to provide a comprehensive social welfare and care system, it seems that this question is lightly passed over. Therefore we hope to be able to discuss today more in depth the structural factors behind the conflicts between domestic workers and foreign workers as well as between employers (in particular socially disadvantaged employers) and foreign workers. First we will ask professor Wang to speak.


Frank T.Y. Wang: On October 13, the Liberty Times reported in its front page news “CLA Chairman Lee Ying-yuan…re-examines foreign worker policy…, plans to change policy on the import of domestic helper-type foreign workers into a ‘grant first, check later’ policy, in a bid to give priority consideration to popular needs. This latest measure will be announced and implemented this week at the earliest.” If applicants provide proof through a diagnosis from a medical agency that there is the need for round-the-clock care and nursing, the government will immediately allow them to apply for a domestic helper-type foreign worker. But applicants must first publicize the employment opportunity and provide information on the salary and work content. If no domestic worker is willing to take the job after a private-sector organization or a government agency has acted as broker, the applicant may import a foreign worker, the report said. This report sparked widespread discussion on policy toward foreign caregivers. After consultations among the Ministry of the Interior, the Department of Health, and the CLA, the CLA on October 13 explained its foreign caregiver policy somewhat more clearly at a meeting of the Legislative Yuan’s Sanitation and Environment, as well as Social Welfare Committee. Its key points are as follows:


1. The Barthel’s score will no longer be the only basis for measuring the need for hiring a foreign worker, as the evaluation of care needs will be handed to professional medical staff (physicians, registered nurses and social workers)

2. Only patients for whom a physician has certified a need for round-the-clock care and who cannot find a domestic caregiver are entitled to apply for a foreign caregiver. But they must first report to a social affairs agency that they are looking for a domestic worker.

3. For each domestic caregiver hired, the government will pay a monthly employment subsidy of NT$5,000 based on an eight-hour workday. On top of that, the government is currently also studying the possibility of paying a subsidy of NT$10,000, if domestic workers are hired for round-the-clock care.




As far as the application procedure is concerned, the original “grant first, check later” principle has already been rejected so that things will return to the previous “first check, import later” principle, while even another procedure has been added to publicize employment opportunities to domestic workers. The review standards have shifted from physical abilities reflected in a Barthel’s score of less than 30 (in ordinary language this would mean a loss of physical abilities to the degree of being bedridden) to the required hours of service reflected in round-the-clock care (incorporated in this assessment are family support and objective considerations of living quality needs, in other words, if the family of a bedridden disabled person is firmly believed to be able to provide care in the evening, then it will need only 12 hours and not 24 hours of service).If we look at this outcome, it doesn’t necessarily mean that the threshold for applying for foreign caregivers has been “lowered.” So how can we interpret the issues that have been highlighted by this incident?


Highlighting the deficiencies of long-term care policy


Family care needs pertain to the planning of long-term care services, which are essentially services related to the Ministry of the Interior and the Department of Health. But due to the backwardness of our long-term care system and a lack of planning, the recruitment of foreign caregivers has become the foremost problem-solving approach for our citizens, so that family care policy has been distorted into a CLA-managed area. As far as the relaxation of application procedures is concerned, Lee Ying-yuan probably came up with the idea of “giving citizens greater convenience” based on the experiences of family caregivers and users of foreign workers, but what he definitely triggered are struggles among various government departments. By highlighting the problem that the CLA has for a long time been in charge of reviewing citizens’ care needs in a bid to return to professionalism, the original creators of the problem, the Department of Health and the Ministry of the Interior, have been forced to come to the fore. But the idea of “giving citizens greater convenience,” which solely sought to address peoples’ needs, disappeared in the negotiations among the government departments, underlining the deficiencies of Taiwan’s long-term care policy. Even the position and functions of foreign workers in the long-term care system have not become visible and have not been discussed.


Citizens’ needs have never become fully visible


The Barthel’s score is not the focal point. The focal point is that the state wants to use simple and convenient administrative standards to measure the care needs of all families to facilitate categorization and management. The problem with the Barthel’s score is that it only looks at the care recipient’s ability to perform specific activities of daily living (mobility, bladder and bowel control). It was later modified to also look at the ability to perform instrumental activities of daily living (shopping, preparing a meal, using the toilet), but it neglected mental deterioration, so that the loss of mental abilities in patients with dementia, mental disabilities, or autism could not be appropriately reflected. Even if the loss of individual abilities is reflected, care needs cannot be equated with the degree of an individual’s loss of abilities. The environment in which a patient lives (barrier-free environment, assistive aids and devices) also constitutes an important factor in determining his need for care. Moreover family support also forms an important factor in determining care needs. The government often presumes that a disabled person does not need care services as long as there are (female) family members, which means that in the long term the needs of family caregivers are overlooked. Now it is also regarded as a matter of course that there is no need for care services as long as the patient has a foreign caregiver. These presumptions about care reflect precisely the ideology that concealed care needs in the past.


Lacking administrative systems that come close to the lives of elderly and disabled


A (caregiver application) review method based on the assessment of professional staff ranging from a certificate from one’s personal doctor to a certificate from a physician at a regional hospital and consultation among government departments highlights the following problems: Taiwan currently does not have a set of administrative systems that comes close to the lives of elderly and disabled people in need of care as well as their families so that it would be able to correctly and convincingly assess care needs. In the past, doctors were granted a screening role by the state based on their position in the professional power hierarchy. But when physicians can also be bribed or even collaborate with manpower brokers to “sell” certificates, the fallacy of the tenet that medical professionals can fully understand family care needs is exposed. The government team probably thinks that the current changes will make the review mechanism more reasonable, but there are still unreasonable circumstances: Are doctors, nurses and social workers truly cooperating as equal members of a team that could provide understanding from different angles? How can doctors who have not visited the patient’s home know how many hours of care he needs? Can a team of medical professionals that is not rooted in the community truly understand the care needs that a family states? Helping an old person who lives in a shipping container or an elderly person who lives in an apartment block take a bath are two completely different kinds of care. Quantifying care needs with a score aims to mystify professional authority and to prevent people from understanding. Consequently they are not able to challenge professional decisions. There is no popular involvement, decisions cannot be monitored, and there is no counterforce that could challenge the system. Corruption is bound to occur, only it will occur in different forms.


Why does the state only act as administrator?


The most fundamental problem reflected by this matter is that when families in need of care go out of their way to find substitute services, the state surprisingly responds by emerging in the role of the administrator. Assuming the team of medical professionals is able to appropriately evaluate a family’s care needs, how does the state then respond to the needs of those families who have been assessed as falling short of regulations for the application of foreign workers? Assessing needs amounts to entering another person’s life situation. Does the professional team that carries out the assessment have the responsibility to make sure that the care needs are met? The state has definitely remained silent on these follow-up services.


Improper discourse that stigmatizes foreign workers


Subsidizing domestic workers with NT$10,000 per month will create confrontation between domestic workers and foreign workers over employment opportunities. Being neglected are the following problems: Who has allowed foreign workers to turn into the cheapest substitute for family care? Has the state ever discussed or planned the position of foreign workers within the long-term care system? Is the work that foreign workers have taken over truly work that domestic workers are willing to do? The truth is that domestic workers are not willing to work under the working conditions of at-home (care) services. Domestic workers who are willing to work long hours are hard to find. The reasons why Taiwanese women have entered the care services sector are flexible work hours and low technology. But since the substitutability of such jobs is high, the dropout rate of personnel being trained to provide home care is also high. The majority of domestic workers who are willing to take 24-hour caregiving jobs are women in dire economic straits. The confrontation between domestic workers and foreign workers over employment opportunities results from deficient government policies. If it is not possible to improve the working conditions of foreign workers, employers will tend toward using foreign workers. Then the so-called “foreign workers substituting domestic workers” conflict will erupt. A way to fundamentally solve the problem is simply to improve the working conditions for care-service jobs. A lump-sum subsidy of NT$10,000 will not only fail to encourage Taiwanese employers to hire domestic workers, it also guarantees the opposite of a desirable reallocation policy. It’s the upper class that gains the benefits, while the lower and middle classes who cannot afford domestic workers are left with nothing.


Low-level publicity of long-term care


The heart of the problem is that the state, by making needs invisible and a matter of personal affairs for a long time, has legalized the extremely supplementary and low-level development of long-term care services, shifting the pressure to provide care to individuals, families and the market. The state defines low-income households very strictly, using the broadest definition of family responsibility, automatically presumed income and other methods to exclude people in need of long-term care services. It is estimated that Taiwan should have 2 to 5 percent low-income households, while it has only 0.7 percent. Then again, the state uses an ethic of filial piety to exclude the households of disabled people within a family. The care services system step-by-step releases resources based on a categorization and classification of the recipients (veterans, low-income households, the physically and mentally handicapped, the elderly, single mothers, indigenous people, employers of foreign workers and employers of domestic workers), but only creates comparison and competition among social disadvantaged groups, as well as opposition from the weak against the state. On the grounds that “national resources are limited” current care services even stipulate that services must be mutually exclusive, which makes it impossible for them to serve the needs of care recipients. In a care services system that lacks public involvement and is not widely available, care recipients and their families enter the system begging the state for grace. They are not able to demand the state’s involvement in their “capacity as citizens” and to rationalize the state’s role as an administrator. More so, they get lost in the false superficial confrontation between domestic workers and foreign workers over employment opportunities and the clash of interests between employers and foreign workers.


Sun Man-wei: Recently there was a piece of news related to kindergartens. Due to negligence at a kindergarten in Taichung County a child suffocated on the kindergarten bus. This incident actually not only highlights negligence by the kindergarten teacher or bus driver, it also highlights the entire state’s negligence of its responsibility for early childhood care. The state has handed the responsibility for early childhood care to commercial market players. As a result of the commercialization of early childhood education, we can find a lot of kindergartens with a beautiful outer appearance that even advertise bilingual or all-English language classes. Parents spend NT$30,000-40,000 a month to send their kids to such kindergartens, but will later on discover, nonetheless, that the school has not provided an education with corresponding quality and content.


From the perspective of a kindergarten operator, the highest costs in early childhood education are personnel costs. Therefore if I am a kindergarten operator without a conscience, the first thing I will do is to reduce personnel costs. For instance, if I hire a teacher from China with a degree in early childhood education I will need to pay a salary of just NT$10,000. Moreover, the teacher will live in the kindergarten round-the-clock, won’t be able to come and go freely, but you need to provide free food and accommodation. In comparison, if you hire a (Taiwanese) teacher with a university degree in early childhood education you might have to spend more than NT$20,000 on the salary. Together with payments into the Labor Insurance Fund and the new pension system you will probably have to spend NT$30,000-40,000, which means you can of course save a lot of costs if you hire a Chinese teacher. Aside from providing housework services, foreign caregivers also take care of the kids, which compresses our space for establishing a daycare profession and the public provision of early childhood care.


The establishment of public early childhood education and care should incorporate the voices of three groups of people: Parents, teachers, as well as kindergarten and daycare center operators. Presently all policy comes from the government and scholars, while those who are actually working in the first line do not have a voice. Furthermore we hope that relevant non-profit groups and community organizations can get involved in the field of early childhood care.


Moderator Hsia Hsiao-chuan: We would like to thank kindergarten principal Ms. Sun for presenting her views. Now we would like to ask Ms. Hu Yi-ting, secretary general of the Taipei Association for Mentally Retarded Persons, to talk about the care problems of physically and mentally disabled people.


Hu Yi-ting: Thank you Mr. Moderator. Actually I was quite astonished when the forum organizers invited me to speak, because organizations for the physically or mentally disabled are very seldom invited. The problem of long-term care for the physically and mentally disabled is also rarely noticed.


People with physical or mental handicaps are disabled people. In the government’s eyes, however, they aren’t, because the state is not willing to assume responsibility for genuine care. I remember how a representative from the Council of Labor Affairs, raising his hands, once pleaded with me at a conference: “I beg you, we are only an agency that helps you look for people.” The CLA believes it is an “agency that looks for people,” and the health and social affairs agencies hide behind its back without saying anything. We don’t know where the tomorrow of Taiwan’s long-term care will be.


Left without any other choice, many parents are forced to hire foreign workers. Let’s take elderly care institutions as example, which the government does not subsidize at all. As far as I know, the cheapest elderly care institutions in Taipei City cost at least NT$25,000 a month. If an elderly person also needs to wear diapers and requires special nutrition, namely tube feeding, the family needs to pay extra for these things. If unfortunately this old person needs to live in a nursing home, then sorry, costs will start at NT$40,000. These are only the care costs, which do not yet include other consumables. The cost of care is very high, causing a very big burden for families with a member in need of long-term care.


The government dumps the entire care burden on the family, because it only needs to pull out the so-called “mutual obligation to maintain one another” of Article 1114 of the Civil Code, to put all members of the family under a spell. Even brothers and sisters and family members living in the same household are usually listed as having a “joint obligation to maintain one another.” When you need to submit an application to the government for care services, the whole family is probed. We once came across the case of a woman who had turned 60, her husband was deceased, and her son was a drug addict who had been in and out of prison countless times. Her only daughter was retarded, but the women still could not get an allowance under the low-income household rule, because the government found out that her 80-year-old father-in-law in Taichung owns property. This means that her father-in-law had to assume responsibility for her under the so-called “mutual obligation to maintain each other.”


The government is also not willing to sincerely face the problem of lacking fiscal resources for the establishment of a care system. Why isn’t there a single government official courageous enough to loudly say that we need to raise taxes? Our tax rate is very low in the first place. If you only pay NT$10 in taxes per every NT$100 that you make, what are you then expecting to get from the entire public services? Even some people working in social welfare are not honest themselves. I once heard a social worker say “I knew early on that I wouldn’t participate in the national health insurance scheme, because I never get ill.” In such attitudes we can see the selfishness of mankind. Without sufficient fiscal resources, many mechanisms of the care system are difficult to establish.


Moderator: We would like to ask Professor Tseng Ai-lan to discuss long-term care from the perspective of the problems of a long-term care system for the elderly.


Tseng Ai-lan: I will first cite the example of Taipei County. Taipei County’s Department of Social Affairs trained more than 2,600 local people in care services between 2003 and 2005. Up to today just 300 of those who have completed their training as care services personnel are actually doing home-care services. And among these 300 home caregivers, only 78 are working fulltime. However in Taipei County alone a total of more than 20,000 disabled persons need someone to take care of their daily living needs. I beg to ask what are these elderly people supposed to do? They virtually have only three options. The first option is like (Hu) Yi-ting just said, to pay more than NT$20,000 a month and go to an elderly care center. The quality of these elderly care centers leaves much to be desired. Once one of my students told me after visiting several elderly care centers: “Teacher, I don’t want to live beyond age 50.” Because the average elderly care center has seven to eight beds per room. These elderly people have only their beds as living space, they live very miserable lives virtually devoid of dignity. The second option is that a family member quits work to stay at home and take up family care work that is most likely unpaid, round-the-clock, and without any vacation. These are the options that we currently have. If I ask the CLA to act as broker, ask it to help me find a person who is willing to do 24-hour home care, the success rate is virtually nil, even if I am ready to pay NT$60,000 a month, because the pressure from such work is too high. As a result, we have just a single option left: We have no other choice but hire a foreign worker.


The biggest structural problem at the back of this policy is that the state has not established diverse service types in the communities that would allow all kinds of families with disabled persons of different needs to obtain services. Consequently, it can’t help but allow most families to hire foreign workers. The government should design various different types of care services work for domestic workers. Japan, for example, does not use foreign workers to care for its elderly. They have a lot of daycare centers in their communities where disabled elderly people can be sent during the day. At such centers the elderly have a lot of company and can participate in some really good activities. There are also family daycare centers for the elderly, where the caregiver functions as a daycare mother. If I care for an elderly person of my own family and at the same time care for several other elderly persons, I can fulfill my care responsibility and also earn a salary. For the elderly this means that they don’t need to face day in and out a foreign worker with whom they cannot communicate, they have their own elderly companions and can do some light handiwork or sing songs, which enriches their lives mentally. In Japan, there is also have a lot of care housing, not like in Taiwan where many elderly people end up confined to their apartments in five-story apartment blocks without a elevators, never getting out of the house because they can’t walk anymore. The Ministry of the Interior and the Department of Health should work together to create many different types of services for people with different degrees of disability. The state should intervene to regulate the quality of such services and also monitor and subsidize them so that such services can be universally established in every community. In that event, many families won’t need to depend on foreign workers and disabled persons would also be able live their lives in dignity.