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，繼而公佈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？主辦單位臺灣社會研究季刊、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. 僱主」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

夏曉鵑，世新大學社會發展研究所副教授

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

王增勇，陽明大學衛生福利研究所助理教授

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

孫嫚薇，幼托公共化行動聯盟成員

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

曹愛蘭，中華民國老人福利推動聯盟

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

胡宜庭，臺北市智障者家長協會總幹事

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.

夏曉鵑：最近大家應該有注意到從高雄捷運的泰勞抗議事件，一直到最近勞委會在很多關於外籍勞工政策上的變化，特別是前一陣子新上任的勞委會主委李應元釋出了一個訊息，也就是要開放外籍監護工的申請的條件。這個改變引起了移工團體、社福團體的一些討論。所以這次座談邀請了移工研究的學者、社福研究的學者、以及社福團體跟移工團體的代表共同來探討這個議題。

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.

我們常常在輿論上看到一些說法，例如「本勞跟外勞工作產生排擠作用」，或「僱主跟外籍監護工之間緊張的關係」等等，至於國家在照顧體系中應該扮演的角色，也就是提供的一個完整社會福利體系、照顧體系的問題，似乎就被輕輕地帶過去了。因此今天我們希望能更深刻地討論有關本勞跟外勞的衝突、僱主（特別是弱勢僱主）跟外勞之間的衝突背後的一些結構性的因素是什麼？我們先請王老師。

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:

王增勇：十月三日自由時報頭條新聞報導「勞委會主委李應元…檢討外勞政策…，家庭類外勞引進方式擬改採「先給後查」政策，以人民需求為優先考量，此最新措施最快本週公佈施行。」「李應元表示，申請家庭類外勞者有如製造業中的３Ｋ產業，可說是因應本勞不願從事而覈準，當申請者經醫療單位診斷為需二十四小時照顧護理者，政府即應同意其申請家庭類外勞，但申請者應先公告就業機會，提出薪資待遇與工作內容，經民間團體或政府機構媒合，仍無本勞願意受聘，即可引進外勞。」這項報導讓家庭外籍勞工政策成為各方討論的話題。經過內政部、衛生署與勞委會協商後，勞委會於十月十三日在立法院衛環委員會，比較明確說明瞭其外籍看護工政策，重點有：

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.

一、巴氏量表將不再是衡量聘僱外勞的唯一依據，評估將交給專業的醫療團隊（醫師、護理師與社工師）來進行。

二、只有被醫院認定需要二十四小時照顧且找不到本國看護的病人，才能申請外籍監護工，但會先通報社政公佈尋找本勞。

三、每僱用一名本國看護，政府每月也會僱用獎助金額以每天八小時，一個月補助五千元為標準；此外，也正在研擬若聘請本勞24小時全天候看護將補助一萬元的可能性。

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?

從申請程式來看，原先的「先給後審」原則已被否認，回歸到目前「先審後進」的原則，甚至還增加公佈機會給本勞的程式。審查標準從身體功能的巴氏量表三十分以下（轉為一般語言就是身體失能程度到達臥床程度）改為以服務時數呈現的24小時照顧，（這其中納入了家庭支援與生活品質要求的主觀考量，也就是臥床的失能者，如果家人被認定晚上可以提供照顧，就只需要12小時而非24小時的服務）。從結果來看，其實並不一定是「放寬」申請外籍看護工的門檻。那我們可以如何解讀這件事情所凸顯的議題？

Highlighting the deficiencies of long-term care policy

凸顯長期照顧政策的缺乏

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.

家庭照顧需求涉及長期照顧服務的規劃，這本是內政部與衛生署的相關業務，但是因為長期照顧體系的落後與缺乏規劃，導致家庭外勞成為國內民眾主要解決問題的方式，以致於家庭照顧政策被扭曲成為以勞委會為主導部門。放寬開放申請手續或許是李應元做為家庭照顧者與外勞使用者經驗出發所投射出的「便民」想像，但引爆的卻是各部會間的角力。凸顯勞委會長期承受審查民眾照顧需求的難題，以回歸專業之名，讓問題的始作俑者衛生署與內政部被迫現身。但這唯一以民眾需求為訴求的便民想像在部會協調中消失，凸顯的是臺灣長期照顧政策的缺乏，連帶外勞在長期照顧體系的定位與功能未被看見與討論過。

Citizens』 needs have never become fully visible

人民需求未曾被完整看見

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.

巴氏量表不是重點，重點是國家想以一套簡易又方便的行政標準來衡量所有家庭的照顧需求以方便將人民分類與管理。巴氏量表的問題在於它只看受照顧者本身的日常生活功能（移動、大小便控制），後來修正改看工具性日常生活功能（購物、煮飯、上廁所），但是它忽略心智方面的失能，例如失智癥、精神障礙、自閉癥患者的心智失能無法被適當地呈現。就算個人失能被呈現，照顧需求不等於個人的失能程度，所處環境（無障礙環境、輔具）也是形成需要照顧的重要因素。再者家庭支援也是構成照顧需求的要素，政府經常預設只要有家（女）人的失能者就不需要照顧服務，長期造成家庭照顧者需求被忽略。現在，只要有外勞看護，也都被理所當然地認為不需要服務。這些被預設的照顧正是過去照顧需求被隱形化的意識型態。

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

臺灣目前沒有任何一套行政制度是貼近需要照顧的老人與障礙者及其家庭的生活

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.

審查方式從醫師證明到區域醫院醫師證明，再到部會協調後的專業團隊評估，凸顯的問題是：臺灣目前沒有任何一套行政制度是貼近需要照顧的老人與障礙者及其家庭的生活，可以做出正確與說服人的需求評估。過去，醫師以其專業權力結構金字塔的地位被國家賦予把關的角色，當醫師也可以被賄賂、甚至與仲介業者勾結「販賣」證明書時，醫療專業可以充分瞭解家庭照顧需求的謬誤才被戳破。或許，執政團隊會認為目前的改變是讓審查制度更合理，但不合理的情況仍存在：醫師、護士與社工真的是平等合作的夥伴團隊，可以提供不同視角的瞭解？沒去過案主家裡的醫院團隊，怎麼知道照顧所需的時間？未曾紮根於社區的醫院專業團隊，他們真有能力理解家庭所陳述的照顧需求？幫一個住在貨櫃屋的老人洗澡與在公寓大廈的老人洗澡是完全不一樣的照顧。把照顧需求用量表來加以量化是為了讓人看不懂而神秘化專家權力，因而無法挑戰專業的決定，沒有人民參與、無法被監督、沒有反制力量挑戰的制度，註定會發生弊端，只是以不同形式發生而已。

Why does the state only act as administrator?

為何國家的角色只是管理者？

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.

這件事反映出的根本問題在於需要被照顧的家庭在想盡辦法尋找替代服務時，國家回應的姿態居然是以管理者的角色出現。就算醫院專業團隊可以適切的評估出來家庭的照顧需求，那被評定不符合申請外勞的家庭，他們的需要國家如何回應？評估需求代表著進入另一個人的生命情境，評估的專業團隊是否有責任確定照顧需求被滿足？國家對於這些後續的服務卻是一片沈默。

Improper discourse that stigmatizes foreign workers

將外勞污名化的不當論述

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.

補助本勞一萬是形塑本勞與外勞工作機會競爭的對立，被忽略的問題：是誰讓外勞成為臺灣家庭照顧最廉價的替代品？外勞在長期照顧體系的定位，國家曾經討論與規劃過嗎？外勞取代的工作真的是本勞願意從事的工作嗎？真實情況是，居家服務的勞動條件連本勞都不願意作，願意從事長時數服務的本勞不易找。國內婦女投入居家服務的原因是，工時彈性、低技術，但是替代性高，所以接受照顧服務訓練的服務員流失率高。願意從事24小時照顧的本勞多為有迫切經濟需要的婦女。本勞與外勞就業機會的對立是政府缺乏政策所造成的。如果外勞的工作條件無法改善，僱主就會傾向使用外勞，所謂的外勞取代本勞的衝突就會發生。根本解決問題的方法在於，改善正是照顧服務工作的勞動條件。齊頭式補助一萬元不僅無法使本國僱主願意僱用本勞，更是錦上添花的逆分配政策，受惠的反而是上層階層，付不起的中下階層還是什麼都沒有。

Low-level publicity of long-term care

長期照顧低度公共化

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.

核心問題在於，國家長期透過隱形化與私化需求，合法化長期照顧服務的極度殘補與低度發展，將照顧壓力交託在個人、家庭與市場身上。國家將低收入戶嚴格界定，以最寬廣的家庭責任、自動預設收入等方式來排除需要的人民，預估應有2-5％的低收入戶，在臺灣只有0.7％。再用孝道倫理排除有家人的失能者家庭。照顧服務體系以不同身份別（榮民、低收入戶、身心障礙者、老人、單親婦女、原住民、僱用外勞與本勞）的階層化方式，逐步釋放資源，但造成弱勢族群之間的比較與競爭，削弱與國家抗爭的社會力量。現有的照顧服務更以「國家資源有限」為名，規定服務之間必須互斥，導致服務無法依照受照顧者的需求為依歸。缺乏公共化與普及化的服務體系，受照顧者與其家庭都是以乞求國家恩典的姿態進入體系，無法以「公民身份」要求國家的介入，合理化國家做為管理者的角色，更迷失在本勞與外勞競爭工作機會、僱主與外勞權益衝突的虛假表面衝突之中。

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.

孫嫚薇：最近有一則與幼稚園比較相關的新聞，臺中縣某一所幼稚園的疏忽，使一位在該幼稚園的小孩在娃娃車裡被活活悶死了。其實這個事件呈顯出來不只是一個幼稚園老師或娃娃車司機的疏忽，也呈顯出整個國家對幼托照顧責任的疏忽。國家把幼拖照顧的責任都交給了市場業者，幼托教育市場化的結果，我們可以看到很多幼稚園的外觀都好漂亮，還標榜雙語或全美語教學，家長花了三、四萬塊送小孩去上這樣的幼稚園，但後來卻發現它並沒有提供相對品質與內涵的教育。

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.

從業者的角度來看，從事幼教最大的成本是人事經費，因此如果我今天是一個沒有良心的業者，第一個要做的就是要緊縮人事成本，譬如引進大陸幼教科系的老師，一個月只需要一萬塊的薪水，還可以24小時住在園所裡，不能自由進出、包吃包住。相較之下，請一個大學幼教老師，可能要花兩萬多，加上勞保和新的退休金製度加起來可能要花三、四萬，請一個大陸的老師當然節省很多成本。外籍監護工除了提供家事服務，還兼帶孩子，這也壓縮了我們建立保母專業與幼托公共化的空間。

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.

幼托公共化的建立應該包括來自三方面的聲音：家長、老師與業者。現在所有的政策都來自於政府與學者，沒有實際上在第一線的工作的人的聲音。另外我們也希望相關的非營利團體或社區組織能夠參與幼托照顧這塊領域。

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.

主持人夏曉鵑：謝謝孫嫚薇園長。接下來我們請臺北市智障者家長協會總幹事胡宜庭小姐來談談身心障礙失能者的照顧問題。

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.

胡宜庭：謝謝主持人，其實主辦單位在邀請我的時候，剛開始我蠻驚訝的，因為身心障礙團體很少被邀請，身心障礙者長期照顧的問題也很少被看見。

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.

身心障礙者是失能者，可是在政府的眼裡卻不是，因為國家不願意去負擔真正的照顧責任。我記得在有一次的會議裡，來自勞委會的代表就曾經兩手一攤跟我說說：「拜託，我只不過是幫你們找人的單位。」勞委會認為自己是「找人的單位」，衛生單位、社政單位也躲在幕後不出來說話，我們不知道臺灣的長期照顧的明天在哪裡？

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.

釵h家長在不得已的狀況之下，必須請外勞。以老人安養機構為例，政府是完全不補助的。然而就我的理解，臺北市的老人安養機構最便宜起價是兩萬五千塊，如果這個老人要包尿布、要吃特別營養的食品——就是灌食，家屬還要自己另外出錢；如果不幸地這個老人家必須去住護理之家，不好意思，四萬塊起跳，這是照顧費，同樣不包含其他耗材。照顧的成本非常高，對家裡有一個必須長期照顧的家人造成很大的負擔。

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.」

政府把所有的照顧責任全部推給家庭，因為它只要搬出民法1114條所謂的「互相扶養義務」搬出來，全家人都被放上緊箍咒，連兄弟姊妹、共同居住之家人，通通都被列為有「共同扶養義務」，當你需要向政府申請照顧服務時，這些人都會找出來。我們曾經碰到的一個例子，有位老阿嬤本身已經六十歲了，先生過世，兒子是一個進出監獄無數次毒蟲，唯一的孫女還有發展遲緩的問題，可是她依然申請不到低收入戶補助，因為政府查到她住在臺中八十歲的公公名下有財產，意思是要她的公公負起所謂「互相扶養義務人」的責任。

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.

政府也不願意誠實面對建立照顧體系財源短缺的問題，為什麼沒有一個政府官員敢勇敢的出來喊加稅？我們的稅率本來就很低，如果你賺錢一百塊，你只拿出十塊錢繳稅，你期待整個公共服務給你什麼？甚至一些從事社會福利工作的人員自己也不誠實，我就曾經聽過一為社會工作者說：「早知道我就不要參加健保，因為我都不生病。」從這裡可以看到人性的自私。如果缺乏財源，很多照顧體系的制度是難以建立的。

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.

主持人：接下來請曹愛蘭老師談談老人長期照顧體系的問題角度來談長期照顧的問題。

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.

曹愛蘭：我先以臺北縣做例子，臺北縣社會局從民國92年到94年一共訓練了兩千六百多位本國照顧服務員，到目前為止，這些受完訓練的照顧服務員有去從事居家服務工作的有三百多位，而這三百多位當中將居家照顧工作當作全職工作的只有78位。然而臺北縣一共有兩萬多位失能者需要有人照顧他們的生活起居，請問這些老人要怎麼辦？他們幾乎只有三個選擇，第一個選擇就是像剛才怡婷講的，繳兩萬多塊以上的費用送到老人安養中心。這些安養中心的品質堪虞。曾經我的一個學生去看過一些安養中心之後回來告訴我：「老師，我不要活過五十歲。」因為一般的安養中心裡，一個房間可能就放了七、八張床，這些老人的生活空間就是那一張床，他們過的是非常悲慘、毫無尊嚴的生活。第二種選擇就是家人辭掉工作，回家去負擔一個可能是無酬、二十四小時、沒有任何假期家庭照顧工作。這是我們目前的選擇。如果我請勞委會幫忙媒合，請它幫忙找一個願意做二十四小時居家照顧工作的人－－即使我願意出一個月六萬塊－－成左瑣鰷v也幾乎是零，因為居家照顧工作的壓力太大，所以剩下唯一的選擇：只有請外勞。

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.

整個政策背後最大的一個結構性問題是，國家並沒有在社區裡面建立多元的服務型態，讓各種家裡有不同需求的失能者家庭得到服務，所以它只好讓大部分的家庭去請外勞。政府應該要設計各種不一樣型態的照顧服務工作給本國的勞工，我舉個例子，譬如日本就不用外勞來照顧他們的老人，他們社區裡有非常多的日間托老中心，白天把失能老人送到中心，讓他們有很多同伴，可以從事一些很好的活動；他們也有家庭托老中心，照顧工作者就像保母一樣，我照顧我自己的老人，也同時照顧其他幾位老人，既可以盡到照顧責任，又可以賺到一些薪水。對老人家來說，也不需要每天面對一個彼此語言不通的外勞，他們有其他老人做伴，也可以做一點小手工或唱唱歌，在精神生活上比較更豐富一些；他們有很多的照顧住宅，不像臺灣很多老人只要不能走路了，就得被關在五樓的樓梯公寓裡，永遠也下不來。內政部跟衛生署應該要整合起來，針對失能的不同程度，去創造很多不同型態的服務，國家應該要介入規範這些服務的服務品質，並且進行監督與補助，讓這樣的服務在每一個社區裡頭普遍設立，這樣的話，很多家庭就不需要依賴外勞，也能讓失能者生活得有尊嚴。