Migrant Care Workers in Taiwan: Their Role in Long-Term Care and the Challenge of Integration

In many Taiwanese households, long-term care is not delivered by a single formal service. It is assembled around a family, an older or disabled person, and frequently a migrant live-in caregiver whose presence makes it possible for support to continue throughout the day and night. The arrangement can provide continuity and enable people with substantial needs to remain at home, but it also exposes one of the most important structural questions in Taiwan’s care system: how should privately employed migrant care be connected with publicly supported long-term care rather than operating alongside it as a largely separate workforce?

This question has become more significant as Taiwan moves through the first year of Long-Term Care 3.0. The wider Taiwan Ageing, Long-Term Care & Community Support Knowledge Hub examines how demographic change, family caregiving, workforce capacity and community services are reshaping the country’s care model. Migrant caregiving sits at the intersection of all four. It is simultaneously a labour policy issue, a family support arrangement, a major source of hands-on care capacity and a test of whether Taiwan can develop genuinely integrated support around the person.

The challenge is not to decide between migrant care and formal long-term care. Both already contribute substantially to the reality of support. The stronger opportunity is to connect them more effectively: enabling families employing migrant caregivers to use appropriate community and respite services, improving workers’ opportunities for rest and development, strengthening continuity when a caregiver is unavailable, and ensuring that responsibility for complex health and care needs does not fall by default on one worker inside a private home.

Migrant caregiving developed within Taiwan’s family-based care model

Taiwan’s use of migrant live-in caregivers needs to be understood within the country’s broader history of family responsibility for long-term support. Families have traditionally provided a large proportion of care to older and disabled relatives. As households became smaller, women’s employment increased, fertility fell and the population aged, maintaining intensive care entirely through unpaid family labour became increasingly difficult.

Recruitment of migrant workers offered families another way of sustaining care at home. Workers recruited principally from Southeast Asian countries became an increasingly visible part of Taiwan’s care infrastructure, particularly where a person required extensive assistance with daily living, supervision or support across long periods of the day.

This model differs fundamentally from purchasing a sequence of scheduled home-care visits. A live-in caregiver shares the domestic environment of the person receiving support and may become closely involved in everyday routines, mobility, eating, personal care, appointments, companionship and observation of changing needs. For families, that continuity can be extremely valuable. For the worker, however, the boundary between employment, availability and private life can be much harder to maintain.

The employment relationship also sits within a different regulatory framework from much of Taiwan’s institution-based care workforce. Domestic migrant caregivers working in private households are not simply employees of a licensed long-term care provider deployed through the public LTC system. Their employment is governed through Taiwan’s migrant labour arrangements, while the person they support may simultaneously qualify for services under the Long-Term Care Services Act.

That institutional separation helps explain why integration has been difficult. The same person may have a publicly assessed level of long-term care need, a privately employed migrant caregiver, family members coordinating decisions, health professionals treating medical conditions and community services available nearby. Unless those elements connect, continuity can depend heavily on the family’s ability to coordinate them.

The workforce is large, but its role cannot be understood through numbers alone

Migrant caregivers contribute substantial care capacity to Taiwan, but describing them simply as a response to labour shortage understates their significance. They occupy a distinctive position between formal workforce provision and family-organised care. Their work occurs inside homes, often over long periods, and relationships with the people they support can become highly significant.

This creates advantages that scheduled services may find difficult to replicate. A consistent caregiver can become familiar with a person’s routines, communication, food preferences, mobility, behaviour and subtle changes in health. For someone living with dementia, neurological impairment or complex disability, that familiarity can support stability and reduce distress.

Yet continuity created through one individual also creates concentration risk. Illness, leave, resignation, transfer, contract completion or relationship breakdown can remove a very large proportion of the household’s care capacity at once. The issue is therefore closely connected with wider questions of workforce resilience and continuity.

A sustainable system needs to distinguish between continuity and dependency. Continuity means preserving trusted relationships and knowledge of the individual. Dependency means constructing an arrangement in which the person, family and wider service network cannot function safely when one worker is absent.

That distinction has practical consequences. Care plans need to identify which activities depend on the migrant caregiver, which can be supported by family or formal services, what specialist competencies are required, what happens during planned leave and how an unexpected absence will be managed. Similar questions can be explored through the Predictive Workforce Risk Module, used here as a transferable analytical framework rather than a Taiwan-specific regulatory tool. The underlying principle is straightforward: workforce risk should be understood before the loss of capacity becomes a care crisis.

Long-Term Care 3.0 is changing the boundary between migrant and formal care

One of the important directions within Taiwan’s recent reforms is a gradual reduction in the separation between households employing migrant caregivers and the publicly supported long-term care network.

Historically, the existence of a live-in migrant caregiver affected the care services a household could use. The policy logic was understandable: public resources needed to take account of care already available within the household. Operationally, however, treating a migrant worker as though their presence resolved the household’s entire long-term care requirement could create unintended consequences.

A live-in caregiver does not replace social participation, rehabilitation, professional assessment, day services, accessible transportation or every form of specialist support. Nor should employment of one worker mean that a person becomes disconnected from community-based care.

Reforms associated with the transition into LTC 3.0 have therefore widened the ability of eligible households employing migrant caregivers to use community-based services, including day care and family care within the applicable benefit arrangements. This is strategically important because it begins to treat migrant care as one component of a wider support package rather than as an alternative system.

For an older person, attending a day service may provide activity, relationships, rehabilitation and participation outside the home. For the migrant caregiver, the same arrangement can create protected time away from direct care. For the family, it reduces reliance on a single person. The value therefore lies not merely in adding another service but in changing the architecture of support.

Scenario: combining live-in care with community participation

Consider an older woman living with moderate dementia and mobility difficulties in a Taiwanese city. Her daughter lives nearby and manages appointments and household finances, while a migrant caregiver provides most daily support. The arrangement has enabled the woman to remain in her own home, but over time her world has narrowed. Most days are spent with the caregiver inside the apartment, and both have become increasingly isolated.

A reassessment identifies that the woman could benefit from structured community activity and that her family is eligible to use appropriate community-based long-term care support alongside the migrant caregiving arrangement. Day care is introduced on selected days, with transportation coordinated where available.

The outcome is not simply several hours of replacement care. The older woman gains social contact, activity and a different environment. Staff at the day service observe her mobility and engagement and can communicate significant changes through the appropriate care network. Her daughter gains greater confidence that support does not depend entirely on one individual. The migrant caregiver receives predictable periods during which she is not responsible for continuous supervision.

Good support planning and review would then examine whether the combined arrangement remains appropriate as dementia progresses rather than assuming either day care or live-in support should remain unchanged indefinitely.

This illustrates a central principle of integration: the migrant caregiver remains important, but no longer has to function as the person’s entire care system.

Rest and respite are care-continuity issues as well as employment issues

The ability of migrant caregivers to take meaningful leave is one of the clearest examples of how worker rights and care-system resilience intersect.

If a household depends almost completely on one live-in caregiver, allowing that worker time away immediately creates another question: who supports the person while the worker is absent? Without substitute capacity, families may resist leave, workers may feel unable to take it, or care may transfer suddenly to relatives who are themselves unprepared or unavailable.

Taiwan has progressively developed respite and short-term substitute arrangements for eligible families employing migrant caregivers. These can include temporary support at home, day services and short stays in appropriate care settings. Such arrangements matter because they recognise that the right to rest cannot be separated operationally from the availability of replacement care.

The strongest model is therefore not one in which respite is treated as an emergency favour. It is one in which planned leave forms part of normal care-continuity arrangements. Where needs are substantial, the household should understand in advance how temporary support can be accessed, what information another caregiver will require, how medication and mobility needs will be communicated, and who should be contacted if the person’s condition changes.

This is particularly important where a migrant caregiver has accumulated extensive tacit knowledge. A replacement worker may know how to perform a care task but not know that the person becomes frightened when approached from one side, prefers medication after a particular routine, communicates discomfort non-verbally or requires a specific sequence during transfers.

Continuity therefore depends on transferring knowledge, not merely filling hours.

Care quality depends on the environment around the worker

Debate about migrant caregiving can become overly focused on whether an individual worker is sufficiently skilled. Competence matters, but quality is shaped by the wider system in which that worker operates.

A migrant caregiver supporting someone with significant disability may encounter falls risk, swallowing difficulties, behavioural changes, pressure-area concerns, medication routines, deteriorating cognition or new symptoms. Some needs can be addressed through ordinary daily support. Others require professional assessment or intervention. The critical question is whether the worker and family know the boundary and can obtain help when that boundary is reached.

A safer care environment therefore depends on several connected conditions:

• clear understanding of the person’s needs, preferences and risks;
• appropriate preparation and practical competence for the support being provided;
• access to professional advice when health or functional needs change;
• communication that accommodates language differences;
• realistic opportunities for rest and time away from caregiving;
• effective escalation when a task exceeds the worker’s role or competence; and
• continuity arrangements when the normal caregiver is unavailable.

These are not solely worker responsibilities. Families, employment intermediaries, health professionals, long-term care services and relevant public bodies all influence whether the arrangement functions safely.

This is why quality and governance in services for older people cannot stop at the organisational boundary of a formal provider. Where a significant proportion of care takes place through privately employed migrant labour, system-level quality policy needs some visibility of the conditions surrounding that care without turning the private home into an unnecessarily institutional environment.

Language, training and cultural understanding affect practical safety

Migrant caregivers arrive in Taiwan with different languages, educational backgrounds, care experience and familiarity with Taiwanese households. Some become highly experienced over repeated employment periods. Others may be supporting complex needs for the first time.

Language is especially important because care involves much more than following instructions. Workers need to understand changes in health, appointments, medication information, emergency instructions and the preferences of the person they support. Families need to be able to explain expectations accurately. People receiving care need, as far as possible, to communicate choice, discomfort and consent.

Where communication is weak, risks can remain hidden. A worker may recognise that something has changed but lack the vocabulary to describe it. A family may interpret apparent agreement as understanding. Written information may exist but not be accessible in the worker’s strongest language.

Training also needs to reflect the reality of the work. Generic preparation cannot anticipate every condition encountered in a household. Someone supporting advanced dementia needs different knowledge from someone assisting a person with a spinal injury, and both may require additional guidance as needs evolve.

The implication is a shift from one-off training towards continuing competence. Digital learning can help, particularly where multilingual materials make knowledge easier to access, but technology does not replace observation, coaching and access to professional advice. The wider principle of staff training is therefore highly relevant even where employment arrangements differ from those of formal provider organisations.

Scenario: a change in health exposes an integration gap

A migrant caregiver has supported an older man with limited mobility for two years and knows his routines well. Over several days she notices that he is eating less, appears unusually tired and needs more assistance to stand. Nothing dramatic has happened, and his family initially assumes that he is simply having a few difficult days.

In a fragmented arrangement, the caregiver may continue compensating by providing more physical assistance. The increased workload masks the deterioration until a fall or acute illness results in hospital admission.

An integrated model responds differently. The caregiver has a clear route for reporting a meaningful change to the family and appropriate health or care contact. Information about the change is taken seriously because the caregiver’s longitudinal knowledge of the person is recognised as useful evidence. Assessment then determines whether the issue reflects infection, medication, deconditioning, nutrition, an emerging mobility problem or another cause.

If the person returns home following treatment, the support arrangement is reviewed rather than automatically reverting to its previous form. Rehabilitation, equipment, temporary formal care or changes to daily routines may be required. The migrant caregiver is included in practical instruction because she will be implementing much of the day-to-day support.

The lesson is not that migrant caregivers should become clinicians. It is the opposite: good integration allows them to remain caregivers while ensuring that changes requiring professional attention reach the right part of the system promptly.

Family employment can blur responsibility

Private household employment gives families substantial influence over how migrant caregiving operates. That can enable highly personalised routines, but it also creates governance challenges that differ from those within a formal care organisation.

A provider organisation normally has defined supervision, policies, management escalation and organisational responsibility for worker deployment. Inside a private household, these functions may be informal. The employer may simultaneously be a stressed son or daughter trying to sustain a parent’s care while managing work and their own family.

Expectations can consequently expand gradually. A worker employed to provide personal support may find that domestic work, overnight availability, accompaniment, emotional support and increasingly complex care become intertwined. The physical workplace is also the worker’s living environment, making separation between work and rest particularly difficult.

These conditions require a rights-based approach that recognises both sides of the relationship. Families should not be portrayed simply as exploitative employers: many are responding to genuine care needs within difficult circumstances and may have few realistic alternatives. Equally, family pressure cannot justify arrangements that leave a worker without adequate rest, privacy, dignity or protection.

The policy objective is to reduce the conditions that force the interests of the family and worker into opposition. Accessible respite, clearer support, alternative care capacity and better integration with formal services make it easier to protect both.

The person receiving care must remain at the centre

There is another risk in framing migrant care entirely through labour supply and family burden: the person receiving support can disappear from the analysis.

Living with a caregiver creates an unusually close relationship. The person may value familiarity and companionship, or may experience dependence on someone they did not personally choose. Where communication is difficult or cognitive impairment is present, family members may make most decisions. Good long-term care therefore needs to retain attention to autonomy, preferences, privacy and meaningful participation.

Person-centred planning provides a useful lens. Support should not be organised solely around what is convenient for the household or what the worker can provide. It should ask what matters to the person, which activities they want to retain, what relationships are important, how much assistance they actually require and where additional support could increase independence rather than deepen dependence.

This can involve relatively small choices: when to get up, what to eat, whether to attend a community activity, how assistance is provided or which family members are involved. It can also involve major decisions about living arrangements, health treatment and whether remaining at home continues to reflect the person’s preferences and needs.

Where decision-making ability is affected, safeguards and appropriate involvement become more important, not less. Neither a migrant caregiver nor a family member should automatically become the sole interpreter of what the person wants.

Migrant care should complement family support, not conceal its pressures

Employing a live-in caregiver can significantly reduce direct physical caregiving by relatives, but it does not remove the family from the care system. Families often remain responsible for employment, finances, medical decisions, coordination, emotional support and contingency planning.

Some households may therefore appear stable while carrying substantial hidden pressure. A daughter who no longer provides daily personal care may still manage every appointment, translate between professionals and the migrant worker, organise supplies and respond whenever an unexpected problem occurs.

Conversely, a highly capable migrant caregiver may absorb tasks so effectively that relatives become less aware of changing needs. This can make the arrangement vulnerable if the worker leaves.

Strong family partnership and caregiver support should therefore consider the whole caring network rather than classifying households simply as having or not having a caregiver.

This is particularly relevant under LTC 3.0. If formal community services, respite and professional support can be combined more flexibly with migrant caregiving, assessment can increasingly focus on the actual support ecology around the person: what each participant contributes, where the pressure points are and what would happen if one part of the arrangement disappeared.

Scenario: planned leave becomes a resilience test

A migrant caregiver supporting a person with severe physical disability plans several weeks of leave. She normally assists with transfers, personal care, meals and daily routines and accompanies the person outside the home. The family supports decision-making and appointments but cannot safely undertake all physical care.

If planning begins only when the worker departs, the household faces an immediate capacity problem. Instead, the leave is treated as a foreseeable continuity event. The family explores available short-term and respite support, and the person’s routines, equipment, communication preferences and transfer requirements are reviewed before temporary care begins.

The exercise reveals that some essential knowledge has never been formally recorded because the usual caregiver simply knows it. That information is captured with the person’s involvement, while temporary staff receive the practical information required to support them safely.

When the migrant caregiver returns, the household retains a better contingency plan than it had before. The benefit therefore extends beyond the leave period. A single point of dependency has been made visible and partly mitigated.

Organisations examining comparable care-continuity risks can use the Governance Maturity Assessment to structure questions about responsibility, escalation and assurance. It is not a Taiwanese compliance framework, but the governance principle transfers: a resilient care arrangement makes critical dependencies visible before disruption occurs.

Integration requires better information without creating excessive surveillance

Connecting migrant caregiving with formal long-term care inevitably raises questions about information. Care managers and formal services need enough information to understand needs, coordinate support and recognise significant changes. Families need clarity about appointments and services. Migrant caregivers may need accessible instructions and a reliable way to communicate observations.

Digital systems could make parts of this easier. Shared care information, translation tools, scheduling, telehealth, remote professional advice and appropriate assistive technology can reduce coordination burden. Taiwan’s wider development of smart care under LTC 3.0 increases the relevance of these possibilities.

But the private home is not merely a care site. It is also the living space of the care recipient, family and often the migrant worker. Technologies such as cameras, location tracking and sensors therefore create legitimate questions about privacy, consent and workplace surveillance.

The objective should be proportionate person-centred technology: using digital tools where they improve independence, safety or coordination while being clear about who can see information, what is being monitored and why.

The Digital Transformation Readiness Assessment offers a transferable way for organisations examining similar issues to test whether governance, workforce capability and information controls are developing alongside technology rather than following after deployment.

Local implementation determines whether integration is experienced in practice

Taiwan’s national policy can widen access to services, but the practical experience of a household depends on what exists locally. Long-term care management centres, community integrated service networks, home-care organisations, day services, respite capacity, transportation and health services all influence whether a theoretically available package can actually be assembled.

This creates an important geographic dimension. A family in a densely served urban area may be able to combine migrant caregiving with day care and short-term formal support relatively easily. A household in a rural, mountainous or otherwise less well-served area may face longer journeys, fewer providers and less substitute capacity.

Integration therefore cannot be measured only by national eligibility rules. It needs evidence about utilisation, waiting, unmet demand, service refusals, geographic availability and continuity. If families employing migrant caregivers technically gain access to community services but cannot find an appropriate place locally, the reform has changed entitlement without fully changing experience.

This is where quality data and performance metrics become important. National and local decision-makers need to see whether new flexibilities are being used, where capacity constraints remain and whether access differs significantly between communities.

A practical analytical framework such as the Quality Dashboard Builder can help organisations think beyond activity totals towards a balanced picture of access, continuity, workforce, experience and outcomes. Again, its relevance is methodological rather than regulatory: Taiwan’s own authorities determine the indicators and accountability arrangements appropriate to its system.

Scenario: local data reveals that formal eligibility is not enough

A city government reviews uptake following the expansion of community-service access for households employing migrant caregivers. Overall utilisation has increased, suggesting that the policy is working. District-level analysis, however, reveals substantial variation.

In several neighbourhoods, families are making regular use of day care and respite. Elsewhere, eligible households rarely use either. Further investigation shows different causes: insufficient nearby capacity in one district, transportation difficulties in another, limited family awareness elsewhere and reluctance among some care recipients to enter unfamiliar services.

The appropriate response is therefore not one universal publicity campaign. Capacity is expanded where demand exceeds supply; transportation and service coordination are examined where distance is the barrier; multilingual information is strengthened where families or workers struggle to navigate the system; and gradual introductions are used where unfamiliarity is affecting uptake.

Local feedback from migrant caregivers is valuable because they often see practical obstacles that administrative datasets cannot explain. They may know that a day service timetable conflicts with the person’s treatment schedule, that transportation is unsuitable for a mobility need or that communication difficulties are preventing a family from understanding its options.

The governance lesson is that access should be assessed as a pathway rather than a policy statement. Eligibility opens the door; capacity, information, transport, confidence and coordination determine whether people can walk through it.

The future workforce question is about integration as much as supply

Taiwan’s demographic trajectory means that demand for long-term care will continue to put pressure on the available workforce. Migrant labour will therefore remain an important part of the policy landscape. But increasing the number of workers alone cannot resolve the underlying challenge.

The stronger question is how Taiwan uses the total care workforce. Domestic care workers, migrant caregivers, nurses, therapists, care managers, community staff, family caregivers and other professionals should not be treated as interchangeable labour. They have different roles, employment relationships, competencies and responsibilities.

Workforce strategy should instead consider how those roles complement one another. Migrant caregivers may provide continuity and extensive daily support. Formal home-care staff can contribute structured services. Nurses and rehabilitation professionals bring clinical and specialist expertise. Community programmes can support participation and prevention. Families contribute relationships, advocacy and knowledge of the person.

Effective workforce planning asks how those contributions fit together, where duplication occurs, where gaps remain and which tasks require skills that cannot safely be substituted.

This also creates opportunities for career development. Experienced migrant caregivers can accumulate substantial practical expertise. Taiwan’s wider labour policies have developed routes intended to retain experienced migrant workers in skilled roles where relevant requirements are met. The longer-term potential is to recognise competence more systematically while maintaining clear standards rather than allowing experience to remain largely invisible.

Better integration can improve both productivity and humanity

There is an economic argument for integrating migrant and formal care, but it should not be reduced to extracting more work from a constrained workforce.

Productivity in long-term care can mean preventing duplication, ensuring specialist professionals focus on work requiring their expertise, using technology to reduce avoidable administration and intervening before deterioration creates more intensive needs. It can also mean protecting continuity so that households do not repeatedly enter crisis.

For a migrant caregiver, better integration might mean access to clear professional advice rather than spending hours trying to solve an unfamiliar care problem. For a therapist, it might mean teaching techniques that can be reinforced safely during everyday routines. For a family, it might mean having community services available before exhaustion becomes overwhelming.

The objective is not to make every participant do more. It is to design the system so that each contribution is used appropriately.

This matters because care systems can inadvertently transfer pressure rather than reduce it. Restricting formal services may reduce public expenditure in one part of the system while increasing unpaid family work or migrant-worker workload elsewhere. Technology may save staff time while creating additional monitoring tasks. Hospital discharge may improve flow while shifting complex needs into an inadequately supported household.

Integration makes those transfers more visible.

Worker rights and care quality are interconnected

Taiwan’s migrant caregiving model also raises a broader international question: can a care system deliver consistently person-centred support if the people providing much of that support have insufficient control over their own working lives?

The answer requires nuance. Many migrant caregivers develop strong relationships with families and care recipients, earn income that supports households in their countries of origin and choose to remain in Taiwan for extended periods. Their contribution should not be described solely through vulnerability.

At the same time, live-in domestic employment creates structural power imbalances. Dependence on an employer for work and accommodation, language barriers, recruitment arrangements and the difficulty of defining working time within a household can increase vulnerability.

Protecting workers therefore supports care quality as well as labour rights. Adequate rest affects attention and judgement. Training affects safety. Respect affects retention. Clear routes for raising concerns reduce the risk that problems remain hidden.

Where there are concerns about abuse, neglect or unsafe care, the interests of the care recipient and the worker should not be framed as competing safeguarding agendas. Both may be vulnerable within the same poorly functioning arrangement. A culture of prevention and early intervention seeks to identify strain before it escalates into harm.

What Taiwan’s experience offers internationally

Many ageing societies face a version of Taiwan’s dilemma. Demand for support is increasing faster than traditional workforce models can easily expand, family caregiving remains substantial, and migrant labour has become important in filling care gaps.

Taiwan’s institutional arrangements cannot simply be transplanted elsewhere. Migration rules, welfare systems, labour law, family structures and long-term care financing differ substantially between countries. The transferable lesson lies instead in recognising the danger of constructing parallel care systems.

When migrant caregivers operate almost entirely outside formal long-term care, several risks arise. Professional expertise may not reach the household when needed. Workers can become isolated. Families carry excessive coordination responsibility. Community participation may decline. Public systems may underestimate the intensity of care being delivered privately.

Conversely, simply absorbing migrant caregivers into highly institutionalised service structures would not necessarily preserve the flexibility and continuity that families value.

The more useful principle is connected plurality: different forms of care can coexist, but the interfaces between them need to work. Assessment should recognise the whole care arrangement. Formal services should complement rather than automatically withdraw because a migrant caregiver is present. Leave should trigger planned continuity rather than crisis. Workers should have routes to knowledge and support. Information should follow the person appropriately without producing unnecessary surveillance.

That principle is relevant well beyond Taiwan.

The next phase is to make migrant care part of system design

LTC 3.0 gives Taiwan an opportunity to move from accommodating migrant caregiving towards designing around the reality that it is already a major component of long-term support.

This does not require turning privately employed caregivers into public employees or erasing the distinction between family-arranged and formally provided care. It does require policy to recognise the interactions between them.

Future development could increasingly focus on whether families employing migrant caregivers can navigate community support easily, whether substitute care is sufficiently available to make leave practical, whether workers can access relevant multilingual training and advice, and whether transitions between hospital, rehabilitation and home include the person who will provide much of the daily support.

Technology can contribute through translation, accessible learning, remote professional input and better coordination, but it should support relationships rather than become a mechanism for constant monitoring. Workforce policy can create stronger progression and retention routes, but competence and worker protection must develop together.

Most importantly, policy should assess outcomes at household level. The meaningful question is not simply whether a migrant caregiver is employed. It is whether the overall arrangement enables the person receiving care to live safely, retain meaningful choice, participate beyond the home where possible and receive appropriate specialist support, while the family and caregiver remain able to sustain their respective roles.

Conclusion

Migrant care workers are not a peripheral feature of Taiwan’s long-term care landscape. They have become deeply embedded in the way many households respond to disability, frailty and intensive support needs, providing continuity that has enabled large numbers of people to remain at home. Their contribution nevertheless developed through an employment structure that has often sat alongside, rather than fully within, Taiwan’s formal long-term care architecture.

The transition to Long-Term Care 3.0 creates an important opportunity to narrow that divide. Wider access to community services for households employing migrant caregivers, stronger respite and substitute-care arrangements, improved health and care coordination and greater attention to workforce rights can create a more resilient model. The objective should not be to replace migrant care with formal services, nor to use migrant labour as a substitute for developing the wider care system. It is to connect the different sources of support around the person.

Taiwan’s central challenge is therefore one of integration. A sustainable model needs to protect the continuity families value while reducing dependence on a single worker; recognise practical caregiving expertise while maintaining appropriate professional boundaries; and protect worker rights while ensuring that people with long-term care needs remain at the centre of decisions.

As Taiwan’s population continues to age, the strength of its system will increasingly depend not only on how many caregivers it can recruit, but on how intelligently migrant workers, families, community services, health professionals and public long-term care infrastructure are enabled to work together.