Carers and Work-Care Reconciliation
International Conference
University House, University of Leeds
Tuesday 13th August 2013
Workshop E, Afternoon session
Convergence or Divergence in Family Care between the East
and the West:
care, work, gender & state
Yueh-Ching Chou. Masaya Shimmei & Toshiko Nakano
1. Institute of Health and Welfare Policy, National Yang-Ming
University, Taipei, Taiwan
2. Human Care Research Team, Tokyo Metropolitan Institute of
Gerontology
3. Faculty of Sociology and Social Work at the Meiji Gakuin University,
Tokyo/Yokohama, Japan
Outlines
1. Social context/social needs in Taiwan
& Japan
 II. Care needs of older people in Taiwan
& Japan
 III. Disabled child & care
 IV. Women carers in Taiwan & Japan
 V. State intervention: Taiwan vs Japan
 VI. Convergence or divergence
 VII. Future

2
1. Social context/social needs in Taiwan and Japan:
ageing society, low birthrate, women involved in labor market,
migrant care worker increased/involved, growth of the
immigrant wife family (source: Kroger & Yeandle eds., ch.1, & etc…)
Child Birth rate
Taiwan
Japan
Finland
UK
0.89 in 2011
1.4 in 2011
1.9 (2010)
1.9 (2010)
18% in 2010
17% in 2010
Older people rate 11% in 2011; 20% in 2026; 23% in 2010
37% in 2051
employment rate
of women (16-64
ys)
Family structure
change
Older people live
w/family
Migrant care
worker
54% in 2010 -full-time)
3.5% part-time ?
60% in 2010 67% in 2010
65% in 2010
34% part-time 16% part-time 39% part-time
70% in 1986; 57% in 2005
(Hsueh, 2008)
Since 1991:
306 in 1991;
197,854 in 2011
(VS. Japan in 2006/2007;
South Korea in 2003)
Immigrant wife
324,932 (18.7% of all
family (becoming families) in 2009—
unpaid family
“new family carers”
carers)
3
II. Care needs of Older people in Taiwan
•4 types LTC service models in Taiwan: family care, institutional care,
cared by migrant care worker, home-based and community care
•Based on the analysis of the data set conducted by 2005 National
Taiwanese Health Interview Survey: n=30,680, 2727 older than 65
and 630 persons of them (23.1%) requiring personal care in daily life
(Chou, Pu & Chu, 2012)
Taiwan
Disabled older people (age;
sex)
Care by family
Mean age=77.7 (SD=7);
female: 59.8% (59% single)
74%
Care by live in migrant care
worker
11.7% (Cost: 500 Euros)
Older people use formal
service—institution
9.8% (Cost: 1200 Euros)
Older people use community
and home-based services
4.3%
4
Care needs of Older people in Japan
・about 20% of the aged population are estimated to have needs
4.62 million alzheimer patients aged over 65
(http://www.mhlw.go.jp/stf/shingi/2r98520000033t43-att/2r98520000033t9m.pdf)
difficulties in
ADL
outing
work etc
daily life
65＋
226.3
99.4
98.1
84.6
Men
209.5
87.6
81.8
64.3
Women
239.5
108.7
110.9
100.4
(National Livelihood Survey, 2010, numbers per 1,000)
physical
activities
64.3
68.5
60.9
others
27.5
27.2
27.8
Transition of the LTCI system admitted applicants who applied to
per
evaluation
1,000
Transitio
Support Support
Care
Care
Care
Care
Care
Support
nal
Total
level1
level2
level1
level2
level3
level4
level5
category
2003
385 848
536
373
376
360
2,877
2004
493 1,022
605
408
405
390
3,324
2005
584 1,198
567
466
457
432
3,704
2006
659 1,282
582
501
476
443
3,943
2007
706 1,374
616
531
504
445
4,175
2008
519
490
45
868
717
620
526
467
4,251
2009
541
606
2
748
768
679
556
479
4,378
2010
562
639 764
787
709
569
494
4,524
2011
591
631 825
816
688
607
538
4,696
5
(Report of the Long-term Care Insurance Administration, 2012)
III. Disabled child & care in Taiwan and Japan
lifelong care needs and lifelong carers (Chou, Nakano, et al., 2013)
Table 8.1 People with disabilities: number, living arrangements and use of services in Taiwan
and Japan (Cited from ch. 8, Kroger & Yeandle ed., 2013)
Age / type of disability
Number and % of total
population
Taiwan
Japan
1,080,000
5%
96,565
0.4%
7,443,000
6%
547,000
0.4%
All with disabilities
93%
93%
All under age 18 with disabilities*
97%
(i) 94%
(ii) 98%
All with IDs
93%
77%
All with disabilities
7%
7%
All under 18 with disabilities*
3%
(i) 6%
(ii) 2%
All with IDs
7%
23%
All with disabilities
11%
-
All under 18 with disabilities
1%
-
All with IDs
0.7%
-
All with disabilities
All with IDs
% living either with
family or independently
% using residential
services
% employing a live-in
migrant care worker
Notes: IDs – intellectual disabilities
*For Japan, first figure is for persons under 18 with physical and intellectual disabilities; second figure is for persons under 20
6
with ‘mental disorder’.
Japan vs Taiwan: caring for a disabled child
1.
a family responsibility;
2.
mothers are the primary carers;
3.
formal support based on selective and means -tested ideology
1.
according to both the individual person’s level of disability and
level of whole family income
Coping strategies:
Japan: use private services to cope
Taiwan: hire migrant care worker (for persons from not low family SES
background, they can afford) or family care (develop own
strategies as described previous)
1. Japan formal support: moving away from the family and shifting
towards the state
1.
flexible work; part-time work;
2.
employers involved in support;
3.
parental care leave for disabled child since 2009;
7
IV. Women carers in Taiwan (Chou, Kröger, Chiao, & Pu,
2012)
Based on the data set from the 2006 National
Taiwanese Women Survey (at age 16–64, n=6,017)
The participants characteristic data:
1. 53% employed, 50% of them work for 8-10 hours
2. 85% of them having a child younger than 12
3. Caregiving hours weekly, Taiwan vs EU: 40 vs 15 hours
1. when compared with non-carers, women carers:
1. family carers did many more hours of housework,
2. poorer,
3. more isolated in terms of leisure activities,
4. lacked emotional support,
5. had a lower level of health and a lower level of family life
satisfaction.
2. Most disadvantaged group: non-employed women carers of
disabled adults-- Lifelong family carer severely impact the wellbeing
3. work seems to be good for the well-being of these carers in Taiwan
8
Women carers in Japan
Age of the Cared
Age/Sex of Carers living
with the cared
total
40
40 ～ 49
50 ～ 59
60 ～ 69
70 ～ 79
80＋
Men
40
40 ～ 49
50 ～ 59
60 ～ 69
70 ～ 79
80＋
Women
40
40 ～ 49
50 ～ 59
60 ～ 69
70 ～ 79
80＋
total
40～64
65～69
70～79
80～89
90＋
[100.0]
[5.1]
[4.7]
[25.9]
[45.4]
[18.8]
100
2.9
8.3
26.6
29.3
20.6
12.3
30.6
1
2.9
6.9
7.5
6
6.3
69.4
1.9
5.4
19.7
21.7
14.5
6
100
14.5
4.2
30.2
42.1
3
6
46.7
7.7
2.5
12.1
22.3
0.2
1.9
53.3
6.8
1.7
18.2
19.9
2.8
4.1
100
9.7
9.7
4.6
57.6
17.5
1
32.9
3.8
1.5
0.3
10.7
16.4
0.3
67.1
6
8.1
4.3
46.9
1.1
0.6
100
2.7
17.3
13.4
15.8
42.6
8.1
33.3
0.7
6.6
3.7
0.5
14.4
7.4
66.7
2
10.7
9.7
15.3
28.2
0.7
100
1.5
6.1
37.4
22.7
13.1
19.3
29.4
0.4
2
9.3
7
1.6
9.1
70.6
1
4.2
28.1
15.6
11.4
10.2
(agｇ
reged)
60＋
[97.9]
100
1.8
2.1
23
53.2
13.9
5.9
24.6
0.2
0.5
5.5
13.6
4
0.7
75.4
1.7
1.6
17.5
39.6
9.8
5.2
(agｇ
reged)
65＋
[94.8]
100
2.6
8.3
26.3
29.6
20.8
12.3
30.1
0.8
2.8
6.5
7.5
6.1
6.3
69.9
1.8
5.5
19.8
22.1
14.7
6
(agｇ
reged)
75＋
[80.3]
100
2.3
8.6
26.4
28.6
21.5
12.6
29.7
0.6
2.9
6.6
6.7
6.3
6.5
70.3
1.7
5.7
19.8
21.8
15.2
6.1
100
1.4
7.5
30.2
26.8
19.5
14.5
28.9
0.3
2.4
7.5
7.2
4
7.4
71.1
1.1
5.1
22.7
19.6
15.5
7.1
(National Livelihood Survey, 2012)
9
V. State intervention
Taiwan vs Japan (cited from Kröger and Yeandle (Eds.) (2013) (Chapter 2)
Legislation and national policy on carers: Taiwan & Japan
JAPAN
TAIWAN
Japanese Civil Code also states
Taiwan’s Civil Code places
that lineal kin (blood relatives and responsibility for the care of people
siblings) have a duty to support each with disabilities – both children and
other, and this includes caring for
adults – on lineal family members:
people with disabilities.
parents, siblings and children.
1995: Childcare and Family Leave
Act (Revised) extended to care of
‘other family members’ in addition
to childcare, employers
recommended to offer family care
leave.
1999: Childcare and Family Leave
Act (Revised) obliged employers to
offer family care leave.
1993: Respite care initially
introduced (in ).
1997: Disabled Persons (Respite
Care) Act.
10
State intervention:
Taiwan vs Japan (cited from Kröger and Yeandle (Eds.) (2013) (Chapter 2)
Legislation and national policy on carers: Taiwan & Japan
JAPAN
2000: Long Term Care Insurance
Act:
(includes a family carer support
programme.
2001: Family Care Leave extended /
amended.
2002: Family Care Leave extended /
amended.
2004: Family Care Leave extended /
amended.
2005: Family Care Leave extended /
amended.
TAIWAN
2002: Gender Equality in Employment
Act: unpaid leave to care for relatives.
2004: 5 days per year paid care leave
(govt. officials only).
2007: Welfare of Disabled People Act:
included Special Care Allowance to midor low-income senior citizens.
2007: Welfare of People with
Disabilities Act: LAs to co-operate with
NGOs on respite/ carers’ services.
2009: Employment Insurance Act:
unpaid care leave for carers of family
members.
2009: Welfare of Older People Act: LAs
to co-operate with NGOs on
respite/carers’ services.
11
VI. Convergence in the East and West -I
based on 4 concepts: care, work, gender & state
who are carers?
Family care=woman care, mother care, daughter care, female spouse
care?
Women are primary family carers regardless being employed or nonemployed?
Different types of care responsibility:
Carer/parents/mother of young children?
Carer/spouse/children/daughter/daughter-in-law of older people
Carer/parents/mother of disabled children-- lifelong carer
carer of double care responsibilities
Paid work is good for carers?
The most disadvantaged carers: non-employed carers (of disabled
family members) (majority studies focus on employed women and
carers/parents/employed mothers of young children)
Solution: family care, migrant care worker, use of private/for-profit
services based on SES; thus social equality reduced
12
Divergence in the East and West-II
East (e.g. East Asia)
West (e.g. Northern or Western
Europe)
Women employment rate lower
higher
Childbirth rate lower
higher
Population ageing process quicker Slower (e.g. France)
(e.g. Taiwan); ageing society
indeed--Japan
Family care, still a family issue? Childcare is a public issue!!
Family care for older people and
disabled family members is also a
public issue?
Care and work reconciliation is a Care and work reconciliation is an old
new issue?
issue? Conflict of lifelong care and
work neglected?
Full-time work: 40 hours weekly EU: less than 40 hours?
Caregiving hours weekly: 40 hours EU: 15 hours weekly
(e.g. Taiwan)
Less demanded?
Both paid work and caregiving
demanded heavier among
carers/women
13
Divergence in the East and West-II
East (e.g. East Asia)
West (e.g. Northern or Western
Europe)
Needs of women carers: Emotional Instrumental > emotional support?
> instrumental support?
Taiwan State: Selective, meanstested—
Japan State: universal (e.g., LTCI)
and selective (e.g., mother carers of
disabled children)
(Kroger, 2003):
childcare: strong universalism
eldercare: weak universalism
disabled people care: modified
universalism?
Familistic welfare regime combined Nordic: move to liberalism?
liberalism (Ochiai, 2009)
Family wage model move to
‘universal breadwinner’ model move to
‘universal breadwinner’ model? (e.g., ‘universal caregiver’ model? (e.g. Sweden)
Japan) (Fraser, 2000)
Family care = weak woman
care=strong public care?
Family care=strong woman
care=weak public care?
14
VII. Future: East & West



The East: low childbirth rate, ageing society, women
involved in labour force; keep moving from family care
to market purchasing ?
The West: social investment for social equality and
inclusion between social classes, ethnic groups, men &
women? or privatizing welfare state? increasing the gap
between different classes and ethnic groups?
the East & the West:
◦ Care recipients: quality of care/life, quality of ‘ageing
in place’ improved
◦ Carers/women: well-being promoted
◦ What can we do for the issues: care, work, gender &
state?
15
References:
1.
2.
3.
4.
Chou,Yueh-Ching, Toshiko Nakano, Heng-Hao Chang and LiFang Liang (2013). Parent-carers in Taiwan and Japan: lifelong caring
responsibilities within a familistic welfare system. In T. Kroger & S.
Yeandle (Eds.) Combining paid work and family care: Policies and
experiences in international perspective (chapter 8). Bristol: Policy
Press.
Teppo Kröger and Sue Yeandle (Eds.) (2013) Combining paid work
and family care: Policies and experiences in international
perspective, Bristol: Policy Press.
Chou,Yueh-Ching, Fu, Li-yeh, & Chang, H. H. (2013). Making
work fit care: reconciliation strategies used by working mothers of
adults with intellectual disabilities. Journal of Applied Research
in Intellectual Disability, 26, 133-145.
Chou,Yueh-Ching, Fu, Li-yeh, Pu, Cheng-yun & Chang, H. H.
(2012e). Difficulties of work-care reconciliation: Employed and
non-employed mothers of children with intellectual disabilities.
Journal of Intellectual and Developmental Disability, 37(3), 260-268.
16
5.
Chou,Yueh-Ching, Kröger, Teppo, Chiao, Chi,& Pu, Cheng-yun
(2012f). Well-being among employed and non-employed caregiving
women in Taiwan. International Journal of Social Welfare, 22, 164-174.
6.
Chou,Yueh-Ching, Fu, Li-yeh, Kröger, Teppo & Chiu, R. Y. (2011b). Job
satisfaction and quality of life among home care workers: a comparison
of home care workers who are and who are not informal carers.
International Psychogeriatrics, 11 (23), 814-825.
7.
Chou,Yueh-Ching, Pu, Cheng-yun, Kröger, Teppo & Fu, Li-yeh
(2010b). Caring, employment and quality of life: comparison of
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disability. American Journal on Intellectual and Developmental Disabilities
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8.
Kröger, Teppo (2003) Universalism in Social Care for Older People in
Finland: Weak and Still Getting Weaker. Nordisk Sosialt Arbeid:
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