30-second overview: Taiwan possesses Asia's most complete long-term care system. Long-term Care 2.0 serves 360,000 people with a satisfaction rate of 85%. Yet simultaneously, 214,000 foreign live-in caregivers quietly uphold another, larger care system. This is a story about institutional design, social values, and pragmatic compromise.
In 2017, the Tsai Ing-wen administration launched Long-term Care 2.0, proclaiming the goal of building a "continuous, universal long-term care service system." That same year, the number of foreign live-in caregivers employed in Taiwan first surpassed 200,000.
This is no coincidence — it is the central contradiction of Taiwan's long-term care system: on one side, an official system into which the government pours an annual budget of NT$65 billion; on the other, an invisible system of 214,000 households each employing a foreign live-in caregiver. The former serves 360,000 people, the latter approximately 210,000 — two parallel care worlds that barely interact.
📝 Curator's Note
The most counterintuitive aspect of Taiwan's long-term care policy: we are building a world-class long-term care system while simultaneously cultivating the world's most foreign-caregiver-dependent society.
The System's Birth: Launching Before the Super-Aged Society Arrives
In 1993, Taiwan's population aged 65 and above reached 7%, officially entering an aged society. Yet politicians' response was remarkably slow — not until 2007, 14 years after aging began, did the "Ten-Year Long-Term Care Plan" officially launch.
This belated plan was unpromising from the start. A budget of NT$81.7 billion over ten years looked substantial, but averaged only NT$8 billion per year — less than 2% of the National Health Insurance budget at the time. Worse, it served only about 20,000 people, a coverage rate of merely 1.5%.
In the 2016 presidential election, long-term care became an issue all three candidate tickets dared not avoid. Tsai Ing-wen pledged to upgrade to "Long-term Care 2.0," shifting the budget from annual appropriations to a dedicated tobacco tax fund, raising it in one stroke to over NT$30 billion per year.
⚠️ Contested Viewpoint
Medical community criticism: Japan's long-term care insurance funds half from taxes and half from premiums, yet still faces severe shortfalls; Taiwan relies solely on tax revenue, raising concerns about fiscal sustainability.
| 29,000 people in 2017 | 360,000 people in 2024 |
|---|---|
| First-year service recipients under Long-term Care 2.0 | Current service recipients (12-fold growth) |
But while the numbers look impressive, the reality is grim.
The Great Labor Shortage: 7 Home Care Workers Cobbling Together Care for 1 Person
"Can't find people" is the long-term care system's biggest pain point. Tu Hsin-ning, chairperson of the Taiwan Home Service Strategy Alliance, notes a structural collapse in home care workforce scale: in 2016, Taiwan's 186 home care agencies employed an average of 47.9 home care workers each; by 2024, the number of agencies had grown to 2,235, but the average per agency had fallen to just 24.3.
More agencies, dispersed manpower — the result is an inability to schedule flexibly. Chen Wan-yu, a case manager at Taipei's Junwei Home Care Agency, has encountered the most extreme case: one client requiring 7 home care workers taking turns, sometimes with different workers arriving at different times in a single day — one for bathing, one for walking, one for repositioning.
💡 Did You Know
Night-shift home care is nearly impossible to staff. Even with a government night-shift supplement of NT$385, willing workers remain extremely scarce. Family caregivers who work day jobs return home to find it hard to "catch a breath."
Even more serious is the mass exodus of case managers in the middle of the personnel chain. The Ministry of Health and Welfare caps each case manager at 120 cases, but in practice they often exceed 150. Shih Sheng-mao, a veteran case manager at the Taipei Red Heart Association, says: "A social worker for solitary elders can handle 30–60 cases with depth; 150 cases makes holistic care impossible."
A piece of gallows humor circulates in the long-term care field: "In the future, our long-term care will rely on only two kinds of people — foreigners and robots!"
The Invisible Other Half: 240,000 Foreign Caregivers Propping Up a Parallel World
While Long-term Care 2.0 shone in the media, another, larger care system was quietly expanding.
Taiwan opened the door to foreign live-in caregivers in 1992, with just 306 that year. By 2024, the figure reached 214,514 — 80% from Indonesia, 10.8% from the Philippines, 8.9% from Vietnam. If lined up, they would stretch from Taipei to Kaohsiung.
📊 Data Source
According to Ministry of Labor statistics, as of March 2024, Taiwan had 910,000 people aged 80 and above, of whom 41.7% had some degree of disability.
These 214,000 foreign-caregiver households constitute a care world completely parallel to Long-term Care 2.0. Employing one foreign caregiver costs about NT$30,000 per month for 24-hour care; by comparison, Long-term Care 2.0 provides a maximum monthly subsidy of only NT$32,340 for severely disabled persons, with limited service hours.
More critically, the two systems barely intersect. Under current regulations, households employing a foreign caregiver are in principle ineligible for Long-term Care 2.0 services (except for assistive devices and home accessibility modifications). This exclusion clause turns 210,000 households into institutional islands.
⚠️ Contested Viewpoint
Starting in 2026, Long-term Care 3.0 will allow foreign-caregiver households to use community care services, but the Ministry of Health and Welfare worries this could spike migrant worker demand by 160,000, creating supply-demand imbalance.
24 Hours vs. 8 Hours: A Clash of Two Care Philosophies
Why do Taiwanese families choose to spend NT$30,000 on a foreign caregiver rather than use Long-term Care 2.0?
Lian Chin-ying in Hualien cares for her 98-year-old mother with dementia while also looking after her 76-year-old husband. She says: "Long-term care (home care workers) only come for 2 hours a day. I have to rush home during that time to cook for my husband, and be back by 1 p.m. At night, there's basically no one."
This is the fundamental difference between the two systems: Long-term Care 2.0 provides "segmented professional care," while foreign caregivers provide "round-the-clock life companionship." The former meets international professional care standards; the latter meets the actual needs of East Asian families.
📝 Curator's Note
Taiwan's choice of care model is essentially a struggle between two value systems: the Nordic "professionalized, community-based" model versus the East Asian "family-based, holistic" model.
National University of Singapore scholar Lynn Yu Ling Ng, comparing Taiwan and Singapore's care models, found that Taiwan's foreign caregivers function more as "supporters of family caregivers" rather than "replacements for family caregivers." This stems from Taiwan's strict eligibility threshold — a medical assessment is required to hire, forcing Taiwanese employers to learn basic care skills and remain involved in care even after hiring a foreign caregiver.
In contrast, Long-term Care 2.0's professional services are often absent when needed most. Wei Li-hu, one of the few home care workers specializing in night shifts, says: "Most people still don't want night work, even with the NT$385 supplement."
Dignity on the Assembly Line: When Care Becomes Rushed Work
The cost of labor shortage is not just scheduling difficulty — it is compromised care quality.
Zhang Kai-jie (pseudonym), a social worker at a residential facility, observes that even basic services like bathing have become assembly-line operations. "Bathing at 8 a.m., winter temperatures in the teens (Celsius), residents dragged from warm blankets. Residents lined up outside the bathroom door, three care workers dividing labor: one undresses, one supports the body, one rinses."
Assistant Professor Li Shao-fen of the Yang Ming Chiao Tung University Institute of Health and Welfare calls this phenomenon "care rush work" — care workers forced to numb their senses day after day, just trying to complete labor tasks; care agency is constrained, and risk is borne by residents.
💡 Did You Know
Most residential facility residents bathe only twice a week in winter, because insufficient staff cannot provide the service at appropriate times.
Xiao Shi (pseudonym), a former care worker at a residential facility, says: "During bathing shifts we wash 10-plus beds a day, one round every two or three hours, nonstop cleaning, feeding, bathing — very assembly-line, very rushed. By the time I finish, I'm drenched in sweat."
This "efficiency-first" care model is precisely one reason Taiwanese families choose foreign caregivers: at home, at least basic dignity can be preserved.
International Perspective: The Uniqueness of the Taiwan Model
Taiwan's dual-track care system is unique internationally.
Germany established long-term care insurance in 1994, adopting a "cash or services" model — choose cash to arrange your own care, or accept professional services. Japan's Kaigo insurance centers on community integrated service hubs, emphasizing integration of medical, care, and housing. The Netherlands established long-term care insurance in 1968 and now provides standardized services through a "care package" system.
But no country runs two systems of comparable scale that are mutually incompatible quite like Taiwan.
📝 Curator's Note
The contradiction in Taiwan's long-term care system reflects the struggle of East Asian societies in modernization: do we want the professional Nordic model, or the humane family model? The answer is we want both, but we do neither well.
Singapore scholar Liang Li-fang notes: "Taiwan's foreign caregivers have never been about replacing the family role, but supplementing the family's care gaps. This aligns with Confucian cultural expectations of family responsibility."
But the price of this model is institutional fragmentation. The 210,000 households employing foreign caregivers cannot access Long-term Care 2.0's community resources, respite services, or assistive device support. They live outside the institutional field of vision, left to fend for themselves.
Three Arrows of Rescue: How the Government Responds to the Great Labor Shortage
Facing the long-term care labor drought, the Ministry of Health and Welfare has launched three policy arrows:
First Arrow: Diverse Companion Care Service Pilot Program
Allows the public to purchase temporary, short-term care services out-of-pocket. Three months after its 2025 launch, 15 counties and cities had cumulatively served 485 person-times, demonstrating genuine demand.
Second Arrow: Industry-Academia International Specialized Program for Recruitment and Retention
Recruits Vietnamese and Indonesian students into two-year long-term care programs, with a three-year service bond upon graduation. The first cohort of 22 was fully pre-booked by industry; the second cohort will expand to 40.
Third Arrow: Opening Mid-Level Foreign Technical Talent Pathway
Foreign caregivers with 6+ years of experience and a monthly salary of NT$29,000 can convert to "mid-level technical personnel," removing work-year limits. As of February 2024, 15,000 had obtained this qualification.
⚠️ Contested Viewpoint
Three arrows look like a lot, but 22 Vietnamese students against hundreds of thousands of labor needs draws criticism as "a drop in the bucket." The real solution may lie in raising the social status and wage levels of care services.
Long-term Care 3.0's Gamble: Integration or Further Fragmentation?
Starting in 2026, Long-term Care 3.0 will roll out in phases, with the biggest change being the inclusion of foreign-caregiver households in community services. Will this policy resolve the dual-track contradiction, or make problems more complex?
Deputy Minister Lu Chien-te says: "Foreign workers are supplementary manpower; they do what local workers won't." But the reality is that 214,000 foreign caregivers are no longer "supplementary" — they are the mainstay of Taiwan's long-term care system.
If Long-term Care 3.0 successfully integrates the two systems, Taiwan may create a world-unique "hybrid care model" — combining professional service quality standards with the human warmth of family care.
If it fails, Taiwan may face more severe institutional fragmentation: wealthy households with foreign caregivers enjoy dual services, while poorer households queue for government resources, with class gaps magnified at the moment of most urgent care need.
📝 Curator's Note
The future of Taiwan's long-term care system is ultimately answering a deeper question: what kind of society do we want to be? An efficiency-first professional society, or a warmth-first humane society?
Postscript: Two Ways of Loving
Eighty-six-year-old Tong Fu-chien of Tainan has kidney disease and dementia. His Indonesian caregiver Astuti purees tofu and noodles for him daily, because "Grandpa can't chew, but likes eating noodles." Astuti says Grandpa is "yi ji bang" (top-notch); Grandpa's son says Astuti is "like another daughter."
On the other side, 69-year-old Lian Chin-ying in Hualien cares for her 98-year-old mother with dementia, using Long-term Care 2.0 home care workers to assist with meal prep, but still sleeps on a floor mat in her mother's room at night. She says: "She's my mother! I can't not care."
These two stories represent Taiwanese society's two understandings of "care": one is professional division of labor, quality-controlled service procurement; the other is whole-person companionship, emotionally symbiotic family extension.
The development of Taiwan's long-term care system is a search for balance between these two ways of loving. We are still learning how to maintain human warmth while ensuring professional quality; how to pursue efficiency without forgetting that the essence of care is human-to-human connection.
This learning process will continue for a long time. But at least, we have already begun.
References
- The Reporter: In the Era of Great Labor Shortage, Who Will Support Long-term Care 3.0?
- Straits Times: Taiwan is hiring more foreigners to care for its elderly
- Love Long-term Care: Mirroring the Long-term Care Systems of Seven Countries Including the Netherlands, Germany, and Austria
- Ministry of Health and Welfare Long-term Care Section
- National Development Council Population Projection Report
- Ministry of Labor Foreign Worker Employment Service Network
- Taiwan News: Taiwan on track to be super-aged society
- Straits Times: Taiwan further eases curbs on foreign caregivers