Last month, a daughter reached out to our care center in distress. Her mother, who suffers from early dementia and mobility challenges, required immediate assistance. She had already contacted five agencies. Each provided the identical response: “We have caregivers, but they are prohibited from working here.”

Not due to a lack of skills among the workers. Not because the families were problematic. But because recent regulations now confine long-term care workers to a single registered employer, restricting their capacity to assist other households even when they are willing and available.

The daughter posed a question that no system should make a family ask: “What are we supposed to do if the system has workers but prevents them from helping my mom?”

I had no reassuring answer.

A system that safeguards caregivers by constricting them

Taiwan is aging more rapidly than most nations, and caregivers represent the foundation of our long-term care network. Yet a new regulation, aimed at clarifying employer accountability and averting worker overload, now mandates that caregivers register with only one facility. Any extra work, even temporarily, is severely limited.

For many frontline workers, this has resulted in:

– Fewer shifts.
– Lower income.
– Severed ties with long-term clients.
– Heightened stress on the remaining staff.

Even worse, families are now turned away not because the demand for caregiving has diminished, but because the system has confined workers within rigid administrative limits. Protection was the intent. Paralysis has become the reality.

The opposite extreme: when flexibility turns hazardous

While caregivers endure stringent restrictions, another group of frontline workers (food delivery drivers) operates in the complete opposite environment.

They experience ultimate flexibility, yet bear nearly all the risks themselves. Algorithms dictate their assignments, income, and even contract terminations. When incidents occur, many face the repercussions on their own.

In Taiwan, these two groups embody a concerning contradiction: One essential service is overregulated to the point of immobility. Another essential service is underregulated to the extent of danger.

Both extremes harm the individuals they serve.

What these two worlds reveal about our perception of care

At first glance, caregivers in elder care and gig workers delivering meals might seem unrelated. However, viewed collectively, they highlight a deeper issue: We have lost a coherent understanding of how society values care.

Caregivers assist families during life’s most vulnerable moments. Their work necessitates training, trust, emotional labor, and physical stamina. Yet their autonomy is diminishing, and bureaucracy often dictates when and how they may provide assistance.

Delivery workers fulfill modern families’ needs for convenience, flexibility, and efficiency. Their labor is evident on every street corner. Yet their safeguards are minimal, and we accept hazardous working conditions as part of a “flexible” economy.

If one group is overprotected while the other is neglected, it is not because either group warrants such treatment. It is because society has not clearly defined what care entails and whom it should safeguard.

Why this is significant for clinicians and health systems

As someone involved in elder care and health system studies, I am concerned that long-term care is being compressed from both sides:

– Workers who wish to assist are hindered from doing so.
– Workers who require protection are without it.

The outcome is an unstable ecosystem where families cannot reliably access care, and workers cannot dependably secure their livelihoods.

In health care, we discuss burnout, staffing shortages, and system fragmentation. However, long-term care often remains at the fringes of visibility, vital yet structurally overlooked. When regulations inadvertently diminish caregiver availability, the repercussions directly impact patients:

– Lengthier waiting times.
– Increased caregiver turnover.
– Disrupted continuity of care.
– Unsafe home conditions for older adults.

These are not minor administrative concerns. They undermine the foundation of elder care.

The lesson both groups impart

From opposite spectrums of the labor market, both caregivers and gig workers are imparting the same caution: A system that fails to balance protection with autonomy will let down the people who depend on it.

Caregivers require safety, equitable wages, and manageable workloads, yet also the liberty to assist more than one family when they wish. Gig workers need flexibility but also the assurance of basic protections when faced with unavoidable risks.

Both groups remind us that dignity in work is not solely a product of rules or markets. It necessitates thoughtful design and a society prepared to ask: What type of care do we wish to value? What type of workers do we desire to support?

If we neglect this now

One day, many of us (or our parents) will need assistance getting out of bed, bathing safely, or simply having someone close by who cares.

On that day, the question will not concern regulations or platforms. It will be heartbreakingly straightforward: “Is anyone available?”

At present, families are already receiving the response: “There are workers, but they are not permitted to come.”

A sustainable care system cannot afford that silence.

Gerald Kuo, a doctoral candidate in the Graduate Institute of Business Administration at Fu Jen