Long-Term Retention of Migrant Care Workers: Together Building a Welcoming Society for Sustainable Care and Integrated Diversity with the Garden of Hope Foundation
Press Conference Launch of the Migrant Care Worker and Policy Outlook Forum—Pandemic Responses and the Way Forward
On 16 June, 2011, the International Labor Organization adopted the Domestic Workers Convention (No. 189), which protects the rights and interests of domestic workers worldwide. This year, the GOH-Migrants for Garden of Hope conducted a survey on migrant workers and their mental health. We released the results today on 16 June and invited parliament members Hung Sun-Han (洪申翰) and Lai Hsiang-Ling (賴香伶), both of whom have long stood for migrant worker rights; Jason Hwang (黃光杰), American Institute in Taiwan Political Section Acting Chief; Zhuang Guo-liang, Ministry of Labor Senior Executive Officer; Ms. Marites, National Domestic Workers’ Union Case Specialist; and Doctor Wen-Chuin Hsu, Director of the Dementia Center at Taoyuan Chang-Gung Memorial Hospital, who has worked with the Garden of Hope to train migrant workers in dementia care. The guests together responded to migrant worker issues of dignified work and sustainable long-term care.
On the same day, we also held the Migrant Care Worker and Policy Outlook Forum, inviting domestic and international experts on migrant worker and long-term care issues. The experts discussed policies such as Taiwan’s program for long-term retention of migrant workers and training programs for migrant caregivers. This dialogue between government and civil society strengthened understanding, enabling us to work together to promote the rights of migrant workers and long-term family caregivers.
Press Conference and Forum Livestream
Long-term retention of migrant workers: Together building a society of sustainable care
Since the coronavirus outbreak in early 2020, the number of migrant workers in Taiwan has been in decline due to border controls. According to the Ministry of Labor, there were 719,487 migrant workers in Taiwan at the end of February 2020, falling to 666,371 by the end of April 2022, representing a decrease of 53,116 in just over two years. Over this period, industrial migrant workers fell from 455,934 to 446,485, a decrease of 9,449. The number of institutional care workers in social welfare has remained stable at around 15,000. However, domestic care workers decreased from 246,446 to 203,453 between late February 2020 and late April 2022, a decrease of 42,993.
The pandemic caused many family care workers to leave or change jobs, leading to a sharp drop in numbers. Government, employers, agents, migrant workers, civic groups, and other stakeholders have all evaluated this issue and provided recommendations to help protect the rights of long-term family care workers in Taiwan. The government has developed a program to retain them by awarding the status of ‘mid-level skilled worker’ to social welfare migrant workers with language skills or professional experience. Zhuang Guo-liang, senior executive officer of the Ministry of Labor, says, “in this program, family care workers are the target group for retention. If a family care worker has worked in Taiwan for more than 6 years, earns more than 24,000NTD a month, and meets requirements for language ability and education and training, then they may stay in Taiwan to work in family care by applying through their employer.”
Immigration policy reform should start from the perspective of migrant workers
Member of Parliament Lai Hsiang-Ling points out, “the Ministry of Labor, Ministry of Health and Welfare, and local governments can work together to bring language skills, care resources, and professional skills into the set of criteria for a migrant worker’s eligibility to continue working. We shouldn’t determine policy on standardized data or only consider years worked in Taiwan. Rather, we ought to account for their work environment and the factors that make them willing to stay in Taiwan and continue working. We should take a broader view in our plan to retain migrant workers long-term.”
As employers worldwide compete for labor, what else can Taiwan do besides increase economic incentives such as wages and relaxing required work years? Member of Parliament Hung Sun-Han says, “migrant workers and their employers have had tense relations for a long time. The root cause is policy. To ease tensions, the long-term care system and migrant worker system must be integrated. Only then can we get out of the current quagmire. Our present policy for retaining migrant workers was, from the beginning, based on the views of business owners who needed manpower, not on the rights of migrant workers themselves. Our immigration policy should be more comprehensive, more sound. We can’t leave all problems up to the agent.”
The state must take the lead in realizing substantive reform of labor conditions and safeguards and in helping migrant workers in family care reduce their work hazards and psychological stress. Only by increasing their interest in Taiwan and through sustained long-term investments in the care sector can we create a sustainable care system together with fellow Taiwanese, building a foundation for stable economic development.
Domestic workers even more vulnerable in the COVID-19 pandemic
The US State Department’s 2021 Trafficking in Persons Report includes a special global chapter on the challenges of combating human trafficking in the COVID-19 era. The report points out that domestic workers face particular vulnerabilities. Stay-at-home orders confine these migrant workers to their place of work, leading to a risk of being forced to work on designated rest days. Entering the post-COVID era, we should take the opportunity to reflect on the pressures and vulnerabilities faced by domestic migrant workers, as exposed by the pandemic. Even as the world economy and daily life return to normal, their challenges will remain. Policymakers should think deeper about them.
In 2021, the World Health Organization put forward a fact sheet, Mental Health and Forced Displacement, which points out, “migrants and refugees can be exposed to various stress factors which affect their mental health and well-being before and during their migration journey and during their settlement and integration.”
Kaili Lee, Director of GOH-Migrants for Garden of Hope, says, “many migrants and refugees are unable to access mental health services, or for various reasons are unable to receive continuous comprehensive care, making it difficult for them to resolve their mental health issues. We should build inclusive and accessible promotional and prevention programs, recognizing that mental health is health. We should ensure prompt diagnosis, treatment, and recovery to meet the mental health needs of migrants and refugees. Migrants and refugees can make a great difference to society, but to do so they need healthy bodies and minds, or they will not be able to reach their full potential.
In recent years, Garden of Hope and migrant worker groups have found that in their experience, migrant care workers, compared to migrants in other occupations, face severe physical and mental pressures including both emotional labor and physical strain in their high work hours. Without active intervention and assistance, these can often lead to more serious issues.
Unreasonable work requirements: The great physical and mental toll on migrant care workers
GOH-Migrants for Garden of Hope conducted a survey to understand the overall state of migrant worker labor conditions and mental health. A total of 531 migrant workers completed the full survey, of which 150 were industrial workers and 381 were social welfare workers (including institutional caregivers and family caregivers/helpers).
According to the survey, 14.3 percent of respondents were in a state of extreme stress, the point on the scale at which professional consultation and assistance is recommended. Only one third of people reported low levels of stress, that is, mentally healthy with no emotional distress. Compared to the average statistics for adults—87 percent mentally healthy with low stress levels—migrant worker mental health needs urgent attention. Notably, in the survey, the stress levels of family care workers were higher than that of migrant workers overall, with 14.7 percent in a state of extreme stress needing professional help. Stress levels of social welfare workers engaged in care work were also higher than that of industrial workers.
Looking into the reasons for this, we found that the stress experienced by social welfare migrant workers is related to the unreasonable labor requirements common in their field. These include prohibitions on mobile phone use during breaks; prohibitions on leaving the house for reasons other than work, representing a lack of physical and virtual social life and personal autonomy; and demands to stay with the care recipient for 24 hours a day. The more unreasonable the work requirements, the greater the psychological stress experienced by social welfare migrant workers.
On job satisfaction, 52 percent of industrial migrant workers are satisfied with their jobs, with as much as 13 percent feeling very satisfied. For social welfare migrant workers, nearly 44 percent find their jobs acceptable, but the proportion of dissatisfied respondents was higher than that of industrial migrant workers. Job satisfaction is closely tied to job stability. If we want social welfare migrant workers to work stably, we need to understand where expectations are not being met to improve job satisfaction.
Ms. Marites, a case specialist for the National Domestic Workers’ Union who has been a care worker in Taiwan for 10 years, says, “the most common problem we all share is not getting enough rest. Due to lack of sleep, we have friends who are sick. As carers, we don’t get time off. We hope our desire for weekly breaks is noticed. This would really ease our caregiving situation.”
In addition, when asked about the benefits of working in Taiwan, less than a quarter (22.6 percent) of migrant workers responded that they were only here to build savings. Over half responded that they could learn Chinese (55.2 percent) and experience living abroad (55.2 percent). This shows that rich experiences of language learning and social life are important considerations for migrant workers.
Garden of Hope calls for facing up to the issue of migrant worker mental health
Garden of Hope believes that, besides economic incentives, migrant care workers’ physical and mental wellness and social life are key factors for retention. Kaili Lee says, “local communities must affirm the social contribution of these migrants. We should welcome migrant workers into our social spaces with open minds and get rid of the stigma of discourse.”
Doctor Wen-Chuin Hsu, Director of the Dementia Center at Taoyuan Chang-Gung Memorial Hospital, shared his experience in assisting migrant workers. He explains, “during the acute stage of dementia, the accompanying role of migrant workers is very important, as well as spreading the care time and work for family members. Dementia care is not easy to begin with and new migrants face additional language barriers. Chang-Gung Memorial Hospital arranges for migrant workers familiar with Chinese and Taiwanese to help new migrant workers consult with families. These consultations involve understanding the new migrant’s difficulties and teaching them to communicate with employers, and aged care skills. This improves the relationship between migrant workers, care recipients, and family members. In addition to education, counseling and support are also very important. Migrant workers will see Taiwan as their second home and will more readily give it their all.”
In this regard, Taiwan should refer to the World Health Organization’s strategy for promoting migrant worker mental health. It includes overcoming obstacles to migrant workers’ access to mental health services, integrating migrant worker mental health into primary healthcare, ensuring continuity of care, and putting greater emphasis on the impact of social determinants. Equal access to employment opportunities and dignified work, vocational training, financial support, social protection services, legal and law enforcement agencies, and mental health care and psychosocial support can promote the social integration of migrants and refugees. Taken together, these actions squarely address the issues of dignified labor and mental health for migrant workers.
Among them, promoting social integration and inclusion is a beneficial preventative measure. Garden of Hope recommends:
- Recognize the contribution of migrant care workers to Taiwanese society. In substantive laws and regulations, enshrine labor protections for dignity and equality, reducing the mental health burden of unreasonable work requirements.
- Both employees and employers should put greater emphasis on caregiver mental health and self-care ability. Enhance primary healthcare units’ multicultural awareness and communication skills. Remove the stigma of psychological distress and mental disorders.
- Put migrant workers at the center, giving them voices as agents and building cross-cultural experience. Let us create a migrant worker-friendly, multicultural society.