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. Future2

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…)

Taiwan Japan Finland UK

Child Birth rate 0.89 in 2011 1.4 in 2011 1.9 (2010) 1.9 (2010)

Older people rate 11% in 2011; 20% in 2026;

37% in 2051

23% in 2010 18% in 2010 17% in 2010

employment rate

of women (16-64

ys)

54% in 2010 -full-time)

3.5% part-time ?

60% in 2010

34% part-time

67% in 2010

16% part-time

65% in 2010

39% part-time

Family structure

change

Older people live

w/family

70% in 1986; 57% in 2005

(Hsueh, 2008)

Migrant care

worker

Since 1991:

306 in 1991;

197,854 in 2011

(VS. Japan in 2006/2007;

South Korea in 2003)

Immigrant wife

family (becoming

unpaid family

carers)

324,932 (18.7% of all

families) in 2009—

“new family 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) Mean age=77.7 (SD=7);

female: 59.8% (59% single)

Care by family 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

difficulties

in daily lifeADL outing work etc

physical

activitiesothers

65＋ 226.3 99.4 98.1 84.6 64.3 27.5

Men 209.5 87.6 81.8 64.3 68.5 27.2

Women 239.5 108.7 110.9 100.4 60.9 27.8

(National Livelihood Survey, 2010, numbers per 1,000)

5

Transition of the LTCI system admitted applicants who applied

to evaluation

per

1,000

SupportSupport

level1

Support

level2

Transiti

onal

categor

y

Care

level1

Care

level2

Care

level3

Care

level4

Care

level5Total

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

(Report of the Long-term Care Insurance Administration, 2012)

・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)

III. Disabled child & care in Taiwan and Japanlifelong 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)

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 with ‘mental disorder’.

Age / type of disability Taiwan Japan

Number and % of total

populationAll with disabilities

1,080,000

5%

7,443,000

6%

All with IDs96,565

0.4%

547,000

0.4%

% living either with

family or

independently

All with disabilities 93% 93%

All under age 18 with

disabilities* 97%

(i) 94%

(ii) 98%

All with IDs 93% 77%

% using residential

servicesAll with disabilities 7% 7%

All under 18 with disabilities* 3%(i) 6%

(ii) 2%

All with IDs 7% 23%

% employing a live-in

migrant care workerAll with disabilities 11% -

All under 18 with disabilities 1% -

All with IDs 0.7% -

6

Japan vs Taiwan: caring for a disabled

child1. 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 well-

being

3. work seems to be good for the well-being of these carers in Taiwan

8

Women carers in Japan

9

Age/Sex of Carers

living with the cared

Age of the Cared

total 40～64 65～69 70～79 80～89 90＋

(agｇreged)

(agｇreged)

(agｇreged)

60＋ 65＋ 75＋

total[100.0] [5.1] [4.7] [25.9] [45.4] [18.8] [97.9] [94.8] [80.3]

100 100 100 100 100 100 100 100 100

40 2.9 14.5 9.7 2.7 1.5 1.8 2.6 2.3 1.4

40 ～ 49 8.3 4.2 9.7 17.3 6.1 2.1 8.3 8.6 7.5

50 ～ 59 26.6 30.2 4.6 13.4 37.4 23 26.3 26.4 30.2

60 ～ 69 29.3 42.1 57.6 15.8 22.7 53.2 29.6 28.6 26.8

70 ～ 79 20.6 3 17.5 42.6 13.1 13.9 20.8 21.5 19.5

80＋ 12.3 6 1 8.1 19.3 5.9 12.3 12.6 14.5

Men 30.6 46.7 32.9 33.3 29.4 24.6 30.1 29.7 28.9

40 1 7.7 3.8 0.7 0.4 0.2 0.8 0.6 0.3

40 ～ 49 2.9 2.5 1.5 6.6 2 0.5 2.8 2.9 2.4

50 ～ 59 6.9 12.1 0.3 3.7 9.3 5.5 6.5 6.6 7.5

60 ～ 69 7.5 22.3 10.7 0.5 7 13.6 7.5 6.7 7.2

70 ～ 79 6 0.2 16.4 14.4 1.6 4 6.1 6.3 4

80＋ 6.3 1.9 0.3 7.4 9.1 0.7 6.3 6.5 7.4

Women 69.4 53.3 67.1 66.7 70.6 75.4 69.9 70.3 71.1

40 1.9 6.8 6 2 1 1.7 1.8 1.7 1.1

40 ～ 49 5.4 1.7 8.1 10.7 4.2 1.6 5.5 5.7 5.1

50 ～ 59 19.7 18.2 4.3 9.7 28.1 17.5 19.8 19.8 22.7

60 ～ 69 21.7 19.9 46.9 15.3 15.6 39.6 22.1 21.8 19.6

70 ～ 79 14.5 2.8 1.1 28.2 11.4 9.8 14.7 15.2 15.5

80＋ 6 4.1 0.6 0.7 10.2 5.2 6 6.1 7.1

(National Livelihood Survey, 2012)

V. State interventionTaiwan 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

that lineal kin (blood relatives

and siblings) have a duty to

support each other, and this

includes caring for people with

disabilities.

Taiwan’s Civil Code places

responsibility for the care of

people with disabilities – both

children and adults – on lineal

family members: 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 TAIWAN

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.

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 mid- or 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 11

VI. Convergence in the East and West -I based on 4 concepts: care, work, gender & statewho are carers?

Family care=woman care, mother care, daughter care, female

spouse care?

Women are primary family carers regardless being employed

or non-employed?

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

13

Divergence in the East and West-IIEast (e.g. East Asia) West (e.g. Northern or Western

Europe)

Women employment rate lower higher

Childbirth rate lower higher

Population ageing process quicker

(e.g. Taiwan); ageing society

indeed--Japan

Slower (e.g. France)

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

new issue?

Care and work reconciliation is an old

issue? Conflict of lifelong care and

work neglected?

Full-time work: 40 hours weekly EU: less than 40 hours?

Caregiving hours weekly: 40 hours

(e.g. Taiwan)

EU: 15 hours weekly

Both paid work and caregiving

demanded heavier among

carers/women

Less demanded?

14

Divergence in the East and West-IIEast (e.g. East Asia) West (e.g. Northern or Western

Europe)

Needs of women carers: Emotional

> instrumental support?

Instrumental > emotional support?

Taiwan State: Selective, means-

tested—

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

liberalism (Ochiai, 2009)

Nordic: move to liberalism?

Family wage model move to

‘universal breadwinner’ model? (e.g.,

Japan) (Fraser, 2000)

Family care=strong woman

care=weak public care?

‘universal breadwinner’ model move to

‘universal caregiver’ model? (e.g. Sweden)

Family care = weak woman

care=strong public care?

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. Chou, Yueh-Ching, Toshiko Nakano, Heng-Hao Chang and

Li-Fang 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.

2. Teppo Kröger and Sue Yeandle (Eds.) (2013) Combining

paid work and family care: Policies and experiences in

international perspective, Bristol: Policy Press.

3. 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.

4. 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.

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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

employed and nonemployed mothers of adults with intellectual

disability. American Journal on Intellectual and Developmental

Disabilities (AJMR/AJIDD), 115(5), 406-420.

8. Kröger, Teppo (2003) Universalism in Social Care for Older

People in Finland: Weak and Still Getting Weaker. Nordisk

Sosialt Arbeid: Tidsskrift for sosialarbeidere i Norden 23 (1), 30-

34.

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