Tales from a Home Care Worker

It is Monday, and the noon hour is approaching as a doctor and nurse from the family medicine division of the Yangming Branch of Taipei City Hospital make their way to an old, no-elevator, third-floor apartment just off Yanping North Road Section 6 to pay a home visit. They find themselves in a tiny 10-square-meter living room strewn with bric-a-brac that leaves no space for walking around.

They are at the home of an octogenarian named Mr. Guo, who is sitting on a plastic stool. A closer look reveals that the stool is nailed at the base to a wooden dolly. Mr. Guo's legs atrophied after he suffered a stroke, and since then he has lost the ability to stand. Instead of walking, he uses his arms to push and pull his way around the apartment.

His married daughter lives a few kilometers away in Dazhi, and only makes it back to see him on weekends. Otherwise, Mr. Guo lives alone and is cared for the rest of the time by a Ms. Chen Yifang, a home care provider from the Chinese Home Education Association (CHEA). The Taipei City Department of Social Affairs contracts out home services to the CHEA and 14 other non-profits, including the Eden Social Welfare Foundation, which employ a total of 400 care providers. All told, these organizations served 3,072 people in 2009.

Regulations require that after a person applies for home care service, long-term care specialists must do a home visit to assess the applicant's needs, and within 14 working days thereafter a long-term care provider will start coming to the home. However, "special" requests are sometimes made. The applicant may require that the provider be physically strong enough for the job, that they be able to speak Minnan, or that they always have lunch ready before noon, for example. One applicant even required that the care provider wash clothes only by hand in order to save water. Where special requests are made, it may take longer to find an appropriate person for the job.

Home care provider Chen Yifang (standing at rear) visits Mr. Guo three days a week to prepare meals and tidy up. Mr. Guo's atrophied legs prevent him from leaving his home, so he is eligible for home visits by a doctor from a program run by the Taipei City Government.

Yifang generally spends two hours every Monday, Wednesday, and Friday morning at Mr. Guo's place, where she tidies up, washes clothes, empties the chamber pot, gives him a sponge bath, clips his nails, does shopping, and prepares simple meals. Mr. Guo is missing quite a few teeth and therefore cannot enunciate very clearly or chew tough foods. In addition to feeding him milk and other liquid foods, Yifang will occasionally make up a cup of watermelon juice or a steamed egg.

A week ago she discovered an extremely itchy patch of irritated red skin on Mr. Guo's chest that was tormenting him, and applied some ointment. Still worried about his condition, she put in an application for a home visit by a doctor from a program run by the Taipei City Government.

In her 40s, Yifang worked at a supermarket until she got injured last year and decided to take a break. She began working in home care in November of last year, and is now handling seven or eight cases. The flexible work schedule is nice, but she sometimes has to endure complaints and even verbal abuse from her moody, functionally impaired charges. The rules of her job absolutely prohibit "talking back" to the old folks in such situations, so the work is often emotionally draining.

"I get to feeling pretty down sometimes. The thing I really hate is when they treat me like a janitor or a servant." Some of her charges have shown a particularly bad attitude. A 55-year-old man who had broken his leg and was in a cast told her to scrub the floor and wash the windows, and "others have pressured me to do various things, such as washing the pet dog, on the grounds that previous care givers had done it." She feels such people are disrespectful, and it bothers her.

Mr. Guo also crossed the line a few times early on. While Yifang took his blood pressure and gave him sponge baths, for example, he would touch her breasts and buttocks, which she couldn't let him get away with. She would immediately reproach him ("I look upon you as a father, you cannot treat me that way") and then leave his small bedroom for the living room to get her emotions under control. She also informed Mr. Guo's daughter of the situation, and asked her to help get the old fellow under control.

But she understands that such misconduct may stem from neglect, and often struggles with herself over how to handle difficult situations like that. In any event, she faithfully performs the services for which she has been hired. Even on Tuesdays and Thursdays, when she isn't scheduled to go see Mr. Guo, she calls him if the weather report looks bad to remind him to be prepared. And the chain-smoking Mr. Guo, who used to do two packs a day, has now cut down to 10 cigarettes a day at the urging of Yifang and his daughter. The doctor from the Yangming Branch hospital has been impressed by Mr. Guo's ability to cope with everyday tasks.

Yifang is well-trained and understands her role quite clearly: "The first priority is to look after their health; cleaning up around the house is secondary." Once, after she gave a massage and hair wash to a person long bedridden and in a vegetative state, the person closed his eyes with a pleased expression. Yifang felt very strongly at that moment that she was doing extremely meaningful work.

Because the work is so physically demanding, Yifang only works an average of 20 to 30 hours per week. The Taipei City Government pays her employer NT$230 per hour for her services, and her employer deducts an administrative overhead of 21-34% before passing along NT$150-180 per hour to Yifang, so she earns roughly NT$15-20,000 per month.

The aim of the government's home care policies, which have been in place for many years now, is to see that functionally impaired persons can maintain a certain quality of life. The work is exhausting and emotionally stressful, but the system could be tweaked to address certain problems, such as the fact that care providers are poorly paid. The government could introduce a licensing system, for example, or adopt tiered service charges. A bigger challenge, however, is the need to change the values of society. Home care providers must be respected, otherwise it will be impossible to attract and keep more people with a genuine commitment to the cause of serving those in need.