Carers and Work-Care Reconciliation
International conference
13th August 2013
Parent-carers in Taiwan and Japan: lifelong
caring responsibilities within a familistic
welfare system
Yueh-Ching Chou* & Toshiko Nakano**
*Professor, Institute of Health & Welfare Policy, National Yang-Ming
University, Taipei, Taiwan; choucyc@ym.edu.tw
**Professor, Faculty of Sociology and Social Work, Meiji Gakuin University,
Tokyo/Yokohama, Japan; nakanoto@soc.meijigakuin.ac.jp
2
• Note:
▫ This article is the chapter 8 of the book
 Teppo Kröger and Sue Yeandle (Eds.) (2013)
Combining paid work and family care: Policies and
experiences in international perspective, Bristol:
Policy Press.
3
Introduction
• Family care, family responsibility in East Asia
▫ caring for children, frail older people and people with disabilities
• Japan and Taiwan currently
▫ extremely low birth rates (Japan, 1.21 vs Taiwan, 0.89, 2011 )
• Long-term care insurance (LTCI) schemes
▫ Japan LTCI scheme in 2000 vs Taiwan proposed in 2016
• lifelong parent-carers of disabled children, particularly mothers
▫ juggling care and work is a novel topic in all East Asian countries
 E.g. Taiwan & Japan
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Family care responsibilities in Taiwan and Japan
• Civil Code in Taiwan & Japan
▫ Taiwan’s Civil Code places responsibility for the care of people with
disabilities (children and adults) on lineal family members: parents, siblings
and children.
▫ Japanese Civil Code states that lineal kin (blood relatives and siblings) have
a duty to support each other, which includes caring for people with
disabilities.
• People with disabilities (as shown in Table 8.1)
▫ Taiwan: 93% of disabled people of all ages lived with their families; 7% used
residential services (7% people with ID); 11% cared by live-in migrant care
workers.
▫ Japan: 93% of disabled people of all ages lived with their families/living in
the community independently; 7% used residential services (23% people
with ID)
Table 8.1
Number, living arrangements and service use of people with disabilities in Taiwan and Japan
Taiwan
Japan
1,080,000 (5%)
7,443,000 (6%)
With ID
96,565 (0.4%)
547,000 (0.4%)
% living with family or living
All disabilities
93%
93%
independently
All disabilities (age <18y)
97%
94% <18y (persons with
N (% out of national population)All disabilities
physical and intellectual
disabilities)
98%<20y (persons with mental
disorder)
% using residential services
With ID
93%
77%
All disabilities
7%
7%
All with disabilities (age <18y) 3%
6% <18 (persons with physical
and intellectual disabilities)
2% <20 (persons with mental
disorder)
With ID
7%
23%
% employing a live-in migrant All disabilities
11%
-
care worker
1%
-
All disabilities (age <18 y)
Note: ID means intellectual disabilities.
With ID
0.7%
Sources: On Taiwan, Chou et al, 2007, 2010; DSMI, 2007, 2011. On Japan: Cabinet Office, 2010; MHLW, 2005, 2006, 2010, 2011; JILPT, 2011.
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• Taiwan & Japan welfare benefits for disabled children
▫ Both are allocated through a process of registration and diagnosis
▫ Taiwan: a single law covers people with physical and mental disabilities
▫ Japan: four different laws govern arrangements for people with physical,
mental, intellectual and developmental disabilities and a comprehensive
support law
• Caring for disabled children is treated as a family responsibility in both
Taiwan and Japan
▫
E.g., Social services available for disabled children–
▫ a selectivist ideology, means-testing based on total family income, all
income of lineal relatives
▫
services and cash benefits based on both the degree of disability and family
income; co-payments when using services
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Social services available for disabled children in Taiwan & Japan
Taiwan
• Local authorities (LAs) provide a monthly family subsidy and a range of social services (e.g., respite care,
day care, day services/vocational/educational services, home care, residential services)
•Claim to have family subsidy or use social services (families who claim this financial support thereby
become ineligible to use social services)
▫
family subsidy--families with a disabled family member who lives at home & low-income
Japan
• 2 welfare benefits for families caring at home for a disabled child (<20) from state via LAs:
▫
Special Child Rearing Allowance-- families caring for disabled children
▫
Welfare Allowance for Children with Severe Disabilities-- if the child needs round-the-clock care
• after school day care -‘life enhancement’ projects from 2012
•Independence Support (nursing care at home, specialist medical care, equipment) for
disabled children who live at home
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Family Care Leaves Schemes
Japan
Paid or Unpaid Parental leave for 1 year
(children<1 year）, parents with labour
insurance .
Paid or Unpaid family care leave, max. 93
days for each family member (selfemployed not eligible).
Child Care and Family Care Leave
Supplement (through unemployment
insurance, unpaid parental leave;50% of
salary, unpaid Family care leave;40% of
salary)
Paid or unpaid nursing leave for 5 days
per year (10 days per year if more than
one dependant).
Legal right to request flexible working:
employers must offer carers i) shortened
working hours; ii) flexible working time;
iii) limitation of extra working hours, up
to one year per application.
Taiwan
Unpaid parental leave for 2 years
(until child’s 3rd birthday), parents
without labour insurance.
Paid parental leave (60% of salary)
parents (one at a time) with children
aged 6 mths-3 years, parents with
labour insurance.
Paid care leave, 5 days p.a. children
<12 years, civil servants only.
Flexible working or unpaid onehour early leave, employees with
children <3 years, companies with
30+ employees only.
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How do mothers reconcile paid work with caring for a
disabled child? 2 examples from each country, Japan & Taiwan
Mrs Takahashi• She is 48 years old and a care manager working full-time in a community care
centre for older persons. She has worked there for over 15 years, ever since her
husband became ill. Five years ago she decided to improve her career and moved
from a part-time job to full-time employment.
• Mrs Takahashi lives with her son, Ryota, aged 22, who has a mild ID, another
son, her husband and her mother-in-law. Ryota has a full-time job in a small
company where he cleans the offices and sometimes helps with the company’s
events and entertainment activities. He does not use any care services. All his life,
Mrs Takahashi has been Ryota’s primary carer, offering him supportive
surroundings.
• She has established an informal carers’ network for Ryota using voluntary
support in their community to enabled him making friends in the community.
▫ Ryota attended a class for children with additional needs in a mainstream
school. Because he was frequently in poor health, I regularly had to take him
to appointments with doctors. Fortunately, I worked in a job with a flexi-time
system. I was also fortunate to have various supportive social networks,
including my colleagues…Of course, it is probably true that I will never in
my life escape from caring for my son as a parent.
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Mrs Sasaki • A self-employed, freelance editor and writer carrying out contract work for
publishers. Aged 40, she lives with her husband and two sons. Her working
hours depend on the schedules offered by the publishers. Her husband, also
a freelance writer. One of their sons, Taro, aged 8, has severe intellectual
and physical disabilities through cerebral palsy and attends a school for
children with additional needs.
• Taro has various kinds of social support and services in his daily life-afterschool care, respite care and supported transport. Occasionally he is
also hospitalised for short periods. The family also uses private care services
(at ¥800-1000/€7.50-9.50 per hour). This helps Mrs Sasaki to be flexible,
to respond to Taro’s care needs and to reconcile her work and caring roles:
▫ …working is the reason for being who I am to me. Keeping Taro’s daily life safe and
secure is important …. We have supported him towards independent living in the future,
and we have managed all the risks in our lives ourselves….sharing information, keeping
in touch with society, and having standing in the community are the best ways of
developing the supportive network for my son.
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Mrs Lin• She was working as a government official in the income tax bureau
and her husband held a managerial position in a private company.
She was also the chair of a parents’ organisation. Their only
daughter, Jen, has moderate intellectual disabilities (ID). Jen is 23
years old and regularly attends a day care service.
• She displayed a very positive attitude towards her caring work,
referring to herself as ‘a mother who cannot be substituted’. She
mentioned she was ‘lucky’ to have plenty of resources available
through her social networks:
▫ My mother takes a great interest in my daughter and my sister looks after my
daughter a lot. That’s why I can continue my work…Earlier, the principal of the
kindergarten was very kind to us; now the staff at the day care centre are very
helpful, too. If I am unable to fetch my daughter, I just make a phone call and I have
lots of support - lots of people who are able to help me, including my colleagues, my
friends and my sister. My colleague’s brother-in-law is a physician and he also has
become a good friend of my family.
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Mrs Kou• She is 54 year old self-employed hairdresser who works from home. Her husband was
unemployed.
• Their daughter, Yen, is 27 years old and has ‘profound’ ID. Each week, she uses a
respite care service for two hours to care for Yen.
• Mrs Kou works almost every day from morning until late in the evening sometimes,
depending on her customers’ needs, her work continues until 11pm. She is Yen’s
primary carer and Yen usually spends her time in the living room where Mrs Kou
works.
• Combining her work and care in this way means Mrs Kou is constantly busy. She has
some problems with her leg (varicose veins) because she is standing for many hours
each day while she works:
▫
‘Last night I did not go to bed until 3am. Usually I do not sleep well because I have to
get up every two or three hours to check if Yen is OK. I do not have time to rest’.
• In the past, Yen attended a special school and received special home education
provided by the LA’s education service. The family no longer uses the service as
Mrs Kou became very dissatisfied with her interaction with the service workers:
▫ …The teachers were not friendly, …I have never felt supported by the government…
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Experiences of Taiwanese mothers (Mrs Lin & Mrs Kou):
variations in access to support
• Two Taiwanese mothers illustrate how parent-carers’ social and demographic
circumstances can affect their ability to reconcile work and care satisfactorily.
• These women’s experiences of motherhood and of caring for a disabled child
were similar.
▫ Neither complained that their husbands did not make an equal contribution to the
care-giving and both saw taking care of their disabled child as their own
responsibility because they were the child’s mothers.
• Two stories show informal support is as critical for Taiwanese mother-carers as
formal support.
• The availability and use of formal support depends on the LA where the family
lives and is also affected by the mother’s social status.
• ‘Residual’ welfare systems - where social policy relies on family solidarity as the
main source of care - deepen social inequality, as has been observed elsewhere
(see Knijn and Komter, 2004).
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Experiences of Japanese mothers (Mrs Takahashi & Mrs
Sasaki): flexible working conditions and use of private
services
. The factors seem to be important in understanding how these two
Japanese mothers manage her dual roles of work and care:
(1) the flexible working time system in her occupation;
(2) having a workplace which is near her home;
(3) with positive attitudes towards children with disabilities living in the
community; and
(4) Using public and private services.
• Combining work and care for these two Japanese mothers:
▫ how to maximise the independence of each family member: the father,
the mother, the child with disabilities, the other children.
▫ the family needs knowledge and ability to access appropriate social
services.
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The intertwining of policy, culture and society in Taiwan
and Japan
• Taiwan
▫ Most service users are parent-carers who (see, also, Chou et al, 2008):
(1) have a higher level of education (like Mrs Lin);
(2) live in urban areas; and
(3) are involved in voluntary associations (as Mrs Lin is).
▫
helping mothers of disabled children to participate in the labour force
has not (yet) become an advocacy issue for women’s groups in Taiwan
 no specific welfare or employment policies in place
 parent-carers have both lower rates of employment and a poorer quality of
life than other citizens of working age (Chou et al, 2007, especially for
mothers from low socio-economic backgrounds (Chou et al, 2010).
▫
Since 1992, families with a relative needing regular assistance in daily
life have been eligible to hire a live-in migrant care worker
 Having a live-in migrant care worker to share the work of caring for a
disabled child is possible only for well-off families.
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• Japan
▫ child-rearing arrangements are influenced by societal values;
although new family support measures have been introduced
 parental care is deeply embedded that it is very hard for parents
bringing up a disabled child to feel free of social norms
•
‘work-life balance’ policy initiated in 2009:
 Paid care leave could be a useful option for mothers of disabled children,
combining work and care
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Discussion: Taiwan vs Japan
• Consistent findings from the four mothers’ stories in Taiwan and Japan
▫ Regardless of social status and background and whether or not they are in paid
work, mothers are still almost always the primary carers of the disabled child
▫ Care in these two countries remains a private responsibility and a family
obligation
 Financial support and services have developed, but most parent-carers have to
make co-payments when using disability services
▫ Familial ideas - filial piety, patriarchal authority, strict gender role separation,
female subordination, and a fear of bringing shame on the family - remain strong
values in East Asia, especially in Taiwan, low level social security and social
services provided
• Differences:
▫ Japan: care responsibilities are moving away from the family and shifting
towards the state
▫ Taiwan: informal support is the only crucial strategy for parents and mothers
with care responsibilities; families still cope with having limited formal social
support
Recommendations to policymakers
•
Japan measures:
▫
developing positive attitudes towards parent-carers in the workplace, e.g., flexibility in the
workplace
▫ supporting children’s independent lives in the community, with formal or informal
resources available to them and their families
▫ providing a special subsidy for children with disabilities to assure their financial
security; thus parent-carers can choose a working style which suits their caring
circumstances
•
•
Taiwan measures:
▫
Taiwan’s planned LTCI scheme meets not only the care needs of older and disabled people but also
parent-carers’ right to work, especially the mothers
▫
supporting these families’ economic and care-giving needs
▫
Paid parental care leave should be entitled
Both countries: gender equality needs to be concerned
▫
▫
women’s roles increasingly combine both paid and domestic work in two countries
Japan, although, has moved towards universal breadwinner status in terms of paternal and maternal
labour force participation, little evidence of movement toward universal care-giving.
▫
policies designed

to incentivise men/fathers to share care work to improve gender equality

to make paid work and unpaid care equally valued in the society