1. Carers and Work-Care Reconciliation International Conference University House, University of Leeds Tuesday 13 th August 2013 Workshop E Carers and Work-Care Reconciliation International Conference University House, University of Leeds Tuesday 13 th 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, Japa n

2. Outlines 1. Social context/social needs in Taiwan & Japan 1. Social context/social needs in Taiwan & Japan II. Care needs of older people in Taiwan & Japan II. Care needs of older people in Taiwan & Japan III. Disabled child & care III. Disabled child & care IV. Women carers in Taiwan & Japan V. State intervention: Taiwan vs Japan VI. Convergence or divergence VI. Convergence or divergence VII. Future 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…) TaiwanJapanFinlandUK Child Birth rate0.89 in 20111.4 in 20111.9 (2010) Older people rate11% in 2011; 20% in 2026; 37% in 2051 23% in 201018% in 201017% 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 ADLoutingwork etc physical activities others 65 ＋ 226.399.498.184.664.327.5 Men209.587.681.864.368.527.2 Women239.5108.7110.9100.460.927.8 (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 Transitio nal category Care level1 Care level2 Care level3 Care level4 Care level5 Total 2003385---8485363733763602,877 2004493---1,0226054084053903,324 2005584---1,1985674664574323,704 2006659---1,2825825014764433,943 2007706---1,3746165315044454,175 2008-519490458687176205264674,251 2009-54160627487686795564794,378 2010-562639-7647877095694944,524 2011-591631-8258166886075384,696 (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)

6. III. Disabled child & care in Taiwan and Japan lifelong care needs and lifelong carers (Chou, Nakano, et al., 2013) Table 8.1People 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 disabilityTaiwanJapan 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 disabilities93% All under age 18 with disabilities*97% (i)94% (ii)98% All with IDs93%77% % using residential services All with disabilities7% All under 18 with disabilities*3% (i)6% (ii) 2% All with IDs7%23% % employing a live-in migrant care worker All with disabilities11%- All under 18 with disabilities1%- All with IDs0.7%- 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 ～ 6465 ～ 6970 ～ 7980 ～ 8990 ＋ (ag ｇ reged) 60 ＋ 65 ＋ 75 ＋ total [100.0][5.1][4.7][25.9][45.4][18.8][97.9][94.8][80.3] 100 402.914.59.72.71.51.82.62.31.4 40 ～ 49 8.34.29.717.36.12.18.38.67.5 50 ～ 59 26.630.24.613.437.42326.326.430.2 60 ～ 69 29.342.157.615.822.753.229.628.626.8 70 ～ 79 20.6317.542.613.113.920.821.519.5 80 ＋ 12.3618.119.35.912.312.614.5 Men30.646.732.933.329.424.630.129.728.9 4017.73.80.70.40.20.80.60.3 40 ～ 49 2.92.51.56.620.52.82.92.4 50 ～ 59 6.912.10.33.79.35.56.56.67.5 60 ～ 69 7.522.310.70.5713.67.56.77.2 70 ～ 79 60.216.414.41.646.16.34 80 ＋ 6.31.90.37.49.10.76.36.57.4 Women69.453.367.166.770.675.469.970.371.1 401.96.86211.71.81.71.1 40 ～ 49 5.41.78.110.74.21.65.55.75.1 50 ～ 59 19.718.24.39.728.117.519.8 22.7 60 ～ 69 21.719.946.915.315.639.622.121.819.6 70 ～ 79 14.52.81.128.211.49.814.715.215.5 80 ＋ 64.10.60.710.25.266.17.1 (National Livelihood Survey, 2012)

10. V. State intervention Taiwan vs Japan (cited from Kröger and Yeandle (Eds.) (2013) (Chapter 2) Legislation and national policy on carers: Taiwan & Japan JAPANTAIWAN 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) (Chapter 2) Legislation and national policy on carers: Taiwan & Japan JAPANTAIWAN 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 respite/carers’ services. 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 services based on SES; thus social equality reduced 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 lowerhigher Childbirth rate lowerhigher 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 weeklyEU: 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. 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