Support Systems for Working Carers in Japan and Taiwan-Controls and Globalisation. Masaya Shimmei, Research Fellow, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan Convergence or Divergence in Family Care between the East and the West: care, work, gender & state Prof Yueh-Ching Chou, Institute of Health and Welfare Policy, National Yang-Ming University, Taiwan Carers and Work-Care Reconciliation International Conference University of Leeds, 13th August 2013

1. 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

2. 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

3. 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

4. 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

5. Care needs of Older people in Japan
difficulties
in daily life
ADL outing work etc
physical
activities
others
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
Support
Support
level1
Support
level2
Transiti
onal
categor
y
Care
level1
Care
level2
Care
level3
Care
level4
Care
level5
Total
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
・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)

6. 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 Taiwan Japan
Number and % of total
population
All with disabilities
1,080,000
5%
7,443,000
6%
All with IDs
96,565
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
services
All 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 worker
All with disabilities 11% -
All under 18 with disabilities 1% -
All with IDs 0.7% -
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’.
6

7. 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

8. 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

9. 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＋
(agｇ
reged)
(agｇ
reged)
(agｇ
reged)
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)

10. V. State intervention
Taiwan vs Japan (cited from Kröger and Yeandle (Eds.) (2013)
Le(Cgihslaaptiotenr a 2n)d 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

11. State intervention:
Taiwan vs Japan (cited from Kröger and Yeandle (Eds.) (2013)
Le(Cgihslaaptiotenr a 2n)d 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

12. 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 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
12

13. 13
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
(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
EU: 15 hours weekly
(e.g. Taiwan)
Both paid work and caregiving
demanded heavier among
carers/women
Less demanded?

14. 14
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 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?

15. 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

16. 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.
16

17. 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.
17