Mentally and physically overloaded caregivers

Caregiving could be a mentally and physically demanding work that puts overwhelming stress on those who do the job. News about caregivers who just collapsed is not unusual. According to media statistics , in the 10-year period from 2012 to 2021, there had been near 10 cases where caregivers killed the people whom they cared for. Among the cases, one third of them chose to commit suicide after committing the killing. Such cases show just how stressful it is to be a long-time caregiver. Studies show that, 40% to 50% of caregivers who care for dementia patients may suffer from depression, and 20% to 25% of them suffer from severe depression. In Taiwan, most discussions surround family caregivers, and not caregiving workers. In fact, professional caregivers are equally threatened by the risk of stress and work overload.

Taiwan’s birth rate has been dropping year after year with the nation’s overall birth rate stood at 0.99 percent in 2020. Deaths also overtook births for the first time in 2020, with 173,156 deaths and 165,249 births, meaning Taiwan recorded negative population growth in 2020 for the first time on record. In 2020, citizens 65 years old or over stood around 16.07 percent of total population. By 2025, it is estimated that Taiwan will become a super-aged society, in which one in five citizens will be 65 or over. As Taiwanese society has been aging, there are fast-growing demands on caregiving and long-term care businesses in the country.  Manpower shortage issue in the caregiving industry has become more severe.

Currently the caregivers in Taiwan are loosely divided into two groups: the government certified ones and those do not have government certification.

1.Certified Nursing Assistant

Certified Nursing Assistants (CNA) are those who completed a Ministry of Health and Welfare-approved training program and received certification for that to provide intimate, hands-on healthcare to patients. These healthcare professionals provide direct care to patients in hospitals, nursing homes and home care. Some of their job descriptions include taking care of patients' personal hygiene by assisting with or giving bed baths, baths, or showers; toileting by offering bedpans and walking patients to the toilet; providing backrubs; helping the patients to do required checkups; documenting their weight; taking vital signs and records results; lifting and moving patients, etc.

In 2020, there are a total of 73,700 CNAs in Taiwan, among them 85 percent are females. All CNA are under the protection of the nation’s Labor Standards Act, which stipulates that a maximum 12 working hours per day (regular plus extra hours). That is why most of the CNA are working in two or three shifts. Most of them have fixed shifts, with only 20 percent said they need to rotate their shifts. 

According to a 2018 survey conducted by Institute of Labor, Occupational Safety And Health, Ministry of Labor, records show that a total of 47 percent of CNA said their actual average daily working hour is eight hours, 46.2 percent 9 to 12 hours, another 0.2 percent said they worked over 12 hours a day, with an average of 9.06 hours a day. Meanwhile, the same survey showed about 28.3 percent of CNA worked fewer than 22 days a month, 70.6 percent worked 22 to 25 days, with about 1 percent worked more than 26 days on a monthly basis. Due to the laborious nature of their work, nearly half or 42.9 percent said they wish they could work shorter hours, with 57.1 percent said they have no problem with their existing hours.

In terms of their monthly income, 45 percent of CNA have a monthly income of fewer than US$1,014, 39.9 percent have monthly salary between US$1,014 to US$1,182, 12.1 percent between US$1,183 to US$1,351, with 3.2 percent have a monthly income of US$1,352 to US$1,689. The same survey also showed that 55 percent of these assistants have faced problems while working; on top of the list included the decline in physical conditions (16.9 percent), low pay (11.1 percent), hard to find balance between career and family (8.2 percent), and long working hours (7.2 percent).

Also, these assistants said the top three most physical demanding parts of their job are: lifting patients from and to bed, moving patients from and to wheelchair and helping patients taking a bath, said in the survey. The survey results show that the most laborious parts of their job is about lifting and carrying patients. This is also because a majority of these assistants (65.2 percent of them are older than 45, 31.5 percent older than 55) are relatively old, which is why many of them have work-related musculoskeletal disorders.

2.Unlicensed caregivers 

While Certified Nursing Assistants are those who complete government-approved training program and received certification for that to provide intimate, hands-on healthcare to patients, caregivers are their unlicensed counterparts. They are not required to undergo government-approved training program and are therefore not protected under the Labor Standards Act. They are privately hired and some of them are listed under the manpower agency, but do not have employment relationship, their relations with the manpower agency are more like private contractor with a service platform. Therefore, caregivers normally have longer working hours than their CNA counterparts and with almost no labor protections. They usually work as Hospital caregiver or in-home caregiver. 

Hospital caregivers are caregivers who work within a hospital to provide assistance in the daily needs of hospitalized patients. Some hospitals are working with caregiving agencies with the latter recommending caregivers to work in hospitals. Patients can also hire their own caregivers. They are normally charged in hourly rate or half-day (12 hours), full-day rate (24 hours). The average hourly rate for a caregiver stands around NT$200 to NT$500 (US$6.8 to US$16.9); half-day at NT$1,100 to NT$1,500 (US$37.2 to US$50.7); and full day at NT$2,000 to NT$2,500 (US$67.6 to US$84.5).  

In-home caregiver come to the home to help with the daily living of a person who needs to be taken care of. Those who need short term service can also hire a caregiver based on hourly, half-day or full-day rate. One can also hire in-home caregiver on monthly pay. The average monthly pay for a native caregiver stands around NT$50,000 to NT$60,000 (US$1,689.2 to US$2,027). A majority of mid-income families in Taiwan usually find such pay unaffordable. Therefore, they would choose to hire foreign caregivers that only cost half the price. The average monthly pay for a foreign caregiver stands around NT$25,000 to NT$35,000 (US$844.6 to US$1,182.4). As of 2021, there are 210,208 foreign in-home caregivers in Taiwan.

However, due to the fact that foreign in-home caregivers usually live with the person they take care of, meaning they may be asked to work on their breaks. Also, aside from taking care of a person in need, their employers would normally ask them to do other housekeeping works and even restrict their leaves. Many foreign domestic caregivers are required to work all-year-long with no break. Such practice pushes them into the risk of physically and psychologically work overload. Due to language barrier, it would be difficult for foreign workers to understand Taiwan’s laws and culture. They are therefore more vulnerable to working and legal rights violations. This is an issue that still needs attention from all stakeholders across the board.