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Challenges of Taiwan's Aging Wave: New Solutions for Inpatient Care ‍ In recent years, the challenges of Taiwan's aging society have become more acute, and the demand for healthcare for the elderly has continued to rise.2025 A heartbreaking news story sparked a lot of discussion: a delivery worker had no choice but to leave his father at home to wait for his life to come to an end because he couldn't afford to pay for his father's hospitalized care. This is not an isolated case, and reflects the financial and human pressures that many families face when faced with hospitalized care. However, there is a solution to this dilemma! The Ministry of Health and Welfare has launched the "Health Insurance Residential Integrated Care Service", which not only reduces the burden on family members, but also provides more complete inpatient care for patients, and has become a lifesaver for many families. ‍What is "Health Insurance Residential Integrated Care Service"? ‍Simply put, it's a team approach to care provided by hospitals with professional caregivers and nursing assistants. Unlike traditional one-on-one private care, this service uses a "one-to-many" approach to address the basic needs of hospitalized patients, including: Cleaning and comfort care Excretory care Meal assistance Activity and safety maintenance Even better, this service is far less expensive than private care! While it used to cost at least $2,000 to $4,000 a day to hire a personal caregiver, with this program, the cost is only $0 to $1,050 a day, and even free at some hospitals, which can help families save a great deal of money. Why is this service important to you? ‍‍1. It reduces the burden on family members who don't have to stay with the patient full time, and allows them to balance work and family without the physical and emotional strain of hospital care. ‍2. Enhance the quality of inpatient care Professional team care allows patients to receive more comprehensive medical services and reduces the risk of medical negligence. ‍3. Enhance infection control and safetyHospitals manage caregivers centrally, reducing the need for family members to enter and exit the hospital room frequently and lowering the risk of infection. How do I apply? Check if the hospital is participating in the Pilot Program by using the Nursing Aid Finder to find out if the service is available at your local hospital. Check with the nursing station of the hospital Each hospital has different service scope and fee schedule, so it is recommended to check with the nursing station of the hospital directly for more information. Fill in the Informed Consent Form After the hospital has assessed the suitability of the applicant, the applicant is required to sign a consent form to enjoy the service. Which hospitals provide this service? ‍A number of hospitals across Taiwan have joined the pilot program, including NTU Hospital, East Asia Hospital, and Kaohsiung Chang Gung Hospital, etc. Some hospitals even offer the service free of charge (e.g., NTU Hospital, Hutchinson Cancer Center, etc.). For a detailed list, you can quickly check through the "escort search engine". (Aide Finder: https://iics.familycares.com.tw/) Why is "one-to-many" care more effective? Although the "one-to-many" model is adopted for inpatient integrated care services, the quality of care provided by the professionally trained and hospital-managed ancillary caregivers is no less than that provided by private caregivers, and the risk of medical errors and infections can be effectively minimized. In addition, this model allows for a more rational allocation of healthcare resources, ensuring that every hospitalized patient receives the basic care they need. Making hospitalization less of a burden for families ‍ "Health Insurance Residential Integrated Care Services" is not only the government's response to an aging society, but also a blessing for countless families. If you or your family members are facing the challenge of hospitalization, don't miss this service! Check with your hospital to see if it's available, and let the professional team help you through this difficult time.

經過前三篇的探討，我們深刻認識到台灣面臨的低生育率危機，不僅根源於複雜的經濟社會壓力，更因近期托育安全事件蒙上了信任破產的陰影；而其對未來的衝擊，更是涵蓋經濟、社會到國安的全面挑戰。面對這道迫在眉睫的人口懸崖，悲觀無濟於事，怨懟也無法改變未來。現在，我們必須務實地問：生機何在？如何才能為台灣的下一代，乃至我們自身的永續未來，尋找到一條可行的出路？答案絕非單一特效藥，而是一場需要政府、社會、企業乃至個人共同參與，且以重建信任為核心的系統性工程。 一、政策領航：打造安心生養的堅實後盾 政府的政策引導，是扭轉局勢、重建信心的關鍵。但政策必須精準、有力，且真正回應人民的需求與恐懼。 1. 重建信任的基石——強化兒童安全網 (回應信任危機)： 制度性改革刻不容緩： 針對「剴剴案」等事件暴露的漏洞，必須進行徹底改革。包括：大幅增加社工人力與資源，改善勞動條件，落實專業督導與培訓，建立更有效的風險評估與訪視機制。 嚴格機構監督與課責： 對於如兒福聯盟等承接政府委託服務的兒少福利機構，建立強制性的、由外部專家參與的獨立稽核與評鑑制度，確保其內部管理、人員訓練、危機處理流程符合最高標準，並對失職者追究責任。資訊必須公開透明，接受公眾監督。 暢通跨體系通報與合作： 打破社政、警政、衛政、教育體系間的壁壘，建立具強制力且即時有效的資訊共享與個案研討平台，確保高風險個案能被及早發現、及時介入。這是重建「體系能保護我」信心的基礎。 2. 可負擔、優質且「安心」的托育體系： 擴增公共化托育資源： 持續、大量地增設公共托嬰中心、非營利幼兒園、準公共托育服務，降低家長負擔。但擴增的同時，必須將「安全」與「品質」置於絕對優先，建立完善的師資培訓、評鑑、不適任人員淘汰機制，並加強無預警的稽查。 提升托育人員專業與待遇： 唯有提供合理的薪資待遇、完善的職涯發展與專業支持，才能留住並吸引優秀人才投入托育工作，從根本上提升照護品質。 發展多元互補模式： 鼓勵社區、部落、企業發展符合在地需求的托育模式（如社區保姆、職場托兒所），並納入有效管理與輔導。 3. 經濟支持與友善職場的雙引擎： 整合性經濟支持： 檢討現行碎片化的津貼補助，研擬更系統性的支持，例如：與家庭收入連動的育兒稅務優惠、針對育兒家庭的住房（購房、租屋）特殊支持方案、減免多孩家庭的教育費用等。 強制落實友善職場： 光有法律保障不夠，必須強化勞動檢查與罰則，確保產假、陪產檢假、育嬰留職停薪（男女共享、提高給付替代率）看得到也吃得到。大力推動彈性工時、在家工作模式，讓工作與家庭照顧不再是零和遊戲。政府可考慮提供企業稅務減免或補助，鼓勵其推動家庭友善措施。 二、社會齊力：塑造擁抱下一代的文化土壤 政策之外，社會文化與價值觀的潛移默化，更是營造友善育兒環境的長遠之計。 深化性別平等實踐： 從家庭教育、學校教育到大眾傳媒，持續破除「男主外、女主內」的刻板印象，倡導家務與育兒是所有家庭成員的共同責任。鼓勵並支持男性更積極地參與育兒。 營造「兒童友善」氛圍： 在公共空間設置更多親子友善設施，推動社區鄰里間的育兒支持網絡（如臨托交換、家長喘息服務、經驗分享團體），減少對育兒家庭的歧視與不友善眼光。 企業的社會責任升級： 企業應將「員工家庭福祉」視為永續經營（ESG）的重要指標，而非僅是成本或額外福利。主動創造支持性的工作環境，這不僅有利於留才，也是對社會未來的投資。 三、開放的選項與永續的未來 理性探討移民政策： 在確保社會融合與文化調適的前提下，適度、有規劃地引進外來移民，或許是緩解部分勞動力短缺、優化人口結構的選項之一，值得社會公開、理性地討論其利弊得失。 滾動修正與長期投入： 人口問題的改善絕非一蹴可幾，需要跨黨派、跨世代的長期承諾與投入，並根據社會變遷與政策效果，持續檢討、修正策略。 結語：共築未來——從我到我們的集體行動 台灣的生機，繫於我們是否能正視危機、彌補裂痕、重建信任。這需要政府拿出破釜沉舟的改革決心，落實能讓人民安心的兒童保護與托育政策；需要企業跳脫短視近利，承擔起支持員工家庭的社會責任；需要社會放下冷漠與偏見，共同營造一個溫暖、包容、支持育兒的友善環境；也需要我們每一個人，從觀念到行動上做出改變。 這不僅是為了挽救生育率，更是為了投資一個更公平、更有韌性、更有活力的台灣未來。這條路或許漫長，但唯有從「我」的關心，擴展到「我們」的集體行動，才能真正承接起未來的重量，讓希望的種子在這片土地上重新發芽、茁壯。

In the previous two articles, we explored Taiwan's worrying ultra-low fertility rate, the economic pressures behind it, the social shackles, and the crisis of trust exacerbated by the childcare safety incident. However, this is not just an issue that affects individual or family choices. The decades-long trend of low fertility is pushing Taiwan toward a steep "demographic cliff," and the impact will be comprehensive and structural, profoundly affecting the future of every person in the land. Without facing these costs head-on, we cannot truly understand the urgency of taking action.

上一篇，我們勾勒出2025年台灣生育率的冰點數據，以及那層因托育安全事件而生的陰影。數字的背後，是無數年輕世代在生育十字路口前的猶豫、掙扎，甚至最終轉身離去。他們為何「不敢生」？這並非單一原因所致，而是由沉重的經濟負擔、僵化的社會結構與職場環境，以及一道新近被殘酷撕裂的信任防線，共同交織而成。 一、壓垮駱駝的經濟重擔：房貸與教育投資的雙重焦慮 談及生育的經濟壓力，許多人的直觀印象或許是初期的奶粉、尿布與托育費用。然而，在現行托育補助下，0-2歲階段送托的月付額雖仍是負擔，但對許多家庭而言，真正讓他們在生育決策前再三猶豫、甚至卻步的，是更為龐大且長期的財務承諾——沉重的房貸壓力，以及對下一代教育投資的深層焦慮。  「有房才有家」的壓力與房貸重擔： 華人社會普遍認為「有土斯有財」，擁有自己的房子常被視為成家立業的基礎。生育計畫的啟動，往往伴隨著購買更大、更穩定住所的需求。然而，在台灣（尤其都會區）高房價的現實下，這意味著長達二、三十年的巨額房貸。光是想到每月需償還的房貸本息，就足以讓許多薪資有限的年輕家庭對「再生一個」的想法感到窒息。房貸不僅是經濟負擔，更是一種對未來數十年生活品質與財務彈性的長期束縛。  「不能輸在起跑線」的教育投資焦慮： 在極度重視教育與文憑的台灣社會，對子女教育的投入被視為父母的責任與期望。這份期望在資源有限與競爭激烈的環境下，演變成巨大的焦慮感，具體體現在： ・沸沸揚揚的「公私校之爭」： 這是近期（2025年）家長們最關切的話題之一。公立學校雖然學費低廉，但家長可能擔憂教學品質、師資、同儕環境或希望能進入明星學區；而許多私立學校雖然標榜小班制、雙語或特色課程，但其高昂的學費（一年動輒數十萬）與激烈的入學競爭，讓許多家庭望而卻步或備感壓力。這種教育選擇的兩難與其背後的巨大費用差異，成為壓在父母心頭的重石。 ・「軍備競賽」式的額外投入： 除了學校教育，為了讓孩子更有「競爭力」，從學前的全美語幼兒園，到學齡後的各種補習班、才藝班、程式設計課…彷彿永無止境。許多家長感到，若不跟隨這股潮流投入大量金錢，孩子似乎就會在競爭中落後。這種被社會氛圍推著走的龐大教育開銷預期，構成了對未來財務的巨大不確定性。 總結來說，壓垮生育意願的經濟主因，已不再僅是初期的養育成本，而更多是「房貸」與「長期教育投資」這兩座大山所帶來的、對未來數十年財務狀況的深刻憂慮與不安全感。 這種對未來的預期性負擔，使得許多若僅考慮當下或許還能負擔的家庭，最終選擇了「少生」甚至「不生」。 二、社會期待與職場枷鎖 即使勉強跨過經濟門檻，社會結構與職場環境也往往構成下一道關卡。  「爆肝」的職場文化： 台灣普遍存在的長工時、高壓力、「責任制」文化，讓許多上班族身心俱疲，下班後已無餘力再去應對育兒的挑戰。  看得到吃不到的育兒支持： 雖然法律保障育嬰假、產假等權利，但在實際職場中，擔心影響考績、升遷甚至被變相資遣的壓力，使得許多人（尤其是女性）不敢請、不敢請滿。父親請育嬰假的比例更低，顯示共同育兒的觀念與支持仍待加強。  傳統性別角色的桎梏： 社會文化中，育兒的主要責任往往仍落在女性身上。許多女性被迫在職涯發展與家庭照顧間做出艱難抉擇，這種「母職懲罰」顯然不利於提高生育意願。 一位剛休完產假重返職場的行銷經理苦笑：「白天在公司奮鬥，晚上回家繼續奮鬥。先生想幫忙，但公司氛圍讓他不敢請長假。我感覺自己像個陀螺，不知道能轉多久。」 三、最深的恐懼：信任的裂痕與失靈的安全網 除了上述長期存在的壓力，近年來最令人憂懼的，莫過於那道深刻影響「敢不敢生」的信任裂痕。第一篇提到的「陰影」，正源於此。 • 「剴剴案」敲碎的信任基石： 這起發生在社福體系眼皮底下的悲劇，其衝擊之所以如此巨大且深遠，不僅在於事件本身的殘酷，更在於它暴露了理應最值得信賴的體系的系統性失靈。它揭示了： o 社工訪視可能流於形式： 在人力不足、高案量壓力下，社工的訪視品質、風險評估專業性及後續追蹤機制備受質疑。 o 權威機構監督的盲區： 如兒福聯盟這樣具公信力的機構，其內部對合作保姆的篩選、管理、稽核流程是否存在疏漏？風險預警機制是否有效？ o 跨網絡合作的失能： 不同單位（地方政府、社福機構、醫療系統）之間，是否存在資訊壁壘，未能及時串聯起警訊？ • 信任危機的骨牌效應： 當一個環節出錯，引發的是對整個體系的質疑。父母們開始恐懼：我找的居家保姆安全嗎？托嬰中心的老師可靠嗎？萬一家中遭遇變故，需要社會局或相關機構介入協助時，我的孩子能得到妥善的保護嗎？「連『專業』、『官方認證』都可能出錯，我還能相信誰？」 這種瀰漫性的不信任感，讓尋找托育資源變成一場令人膽顫心驚的賭博。 • 壓垮生育意願的最後稻草： 對於許多原本就在經濟與社會壓力邊緣掙扎的年輕人而言，這種對孩子「基本安全」的深層憂慮，往往成為放棄生育念頭的決定性因素。這是一種「我無法承受任何萬一」的恐懼，是對現有保護網能否真正發揮作用的絕望。 總結： 2025年的台灣，年輕世代之所以「不敢生」，是經濟重擔、社會枷鎖與信任危機這三重壓力疊加、交互作用的結果。每一重壓力都足以讓人卻步，而信任體系的裂痕，更是往這 precarious (岌岌可危的) 平衡上投下了一塊巨石。理解了這些盤根錯節的原因，我們才能在下一篇中，更清晰地看到若不積極應對，這場危機將把台灣帶往何種令人憂心的未來。

When we look at Taiwan's demographic data, a deep chill can't help but strike. The alarm bells about fertility have not only not stopped, but have become even more shrill due to new changes in the social climate. This is not only a long-lasting "demographic winter", but it is also compounded by recent social events that have cast a huge shadow over the sense of security in the child-rearing environment. Fertility figures at new lows According to the latest official statistics released by the Ministry of the Interior at the beginning of this year (2025), Taiwan welcomed only 134,856 newborns in 2024, which is not only a record low, but also the ninth consecutive year of negative growth. This figure is not only a record low, but also the ninth consecutive year of negative growth. This translates into a crude birth rate of 5.76 per 1,000 live births in 2024. Although the final "total fertility rate" (TFR) for 2024 has yet to be officially calculated and released, it is almost certain that the TFR will remain at this very low level in 2024, placing Taiwan at the bottom of the global league, given the low level of 0.87 in 2023 and the bottoming out of the birth rate in 2024. Looking ahead to this year, the National Development Council (NDC), in its latest population projections, forecasts that the total fertility rate (mid-projection) in 2025 will also be only 0.89 - an extremely dangerous signal, well below the 2.1 needed to maintain population stability. The twin faces of the crisis: economic pressures and the spectre of security For a long time, we have been used to attributing low fertility rates to the heavy pressures facing the younger generation: high housing and childcare costs, freezing salaries, long working hours, inflexible workplace culture, and changing personal values. All of these factors undoubtedly continue to have a profound impact on people's reproductive choices, creating an economic and social barrier that is difficult to overcome. However, even more chilling than the cold numbers and traditional pressures is the new shadow of "insecurity" that has been cast over the path of parenthood in recent years. The recent spate of horrific child abuse cases, especially the "Be Kindness Case", reveals a shocking gap from personal negligence to institutionalized loyalty, which is like chiseling a deep crack in the cornerstone of social trust. When nannies and childcare organizations, which are supposed to provide professional care and a safe haven, and even the social welfare referral system, which is supposed to be the last line of defense and has been entrusted with credibility (as in the case of the Alliance for Children's Welfare, the roles and responsibilities of which have been widely questioned), are all revealed to be potentially risky and malfunctioning in their supervision, a strong sense of mistrust spreads rapidly. This has led countless families considering having children, or who already have young children, to ask repeatedly, "Can my child be safely cared for? and "Who else can I trust? Can this social system really protect the most vulnerable of lives? Defining the core dilemma: In addition to "not being able to afford to have children," there is also the dilemma of "not daring to have children and not being able to trust them. Therefore, the fertility crisis in Taiwan in 2025 is no longer just a problem of "not being able to afford to have children or raise them" in terms of resource allocation and economic burdens. It has profoundly evolved into a double dilemma that overlaps security anxiety and trust crisis - a critical situation in which the young generation, even after crossing the economic threshold, may not dare to have children or trust the system due to deep-seated fear and distrust. This shadow under the freezing point is a reality that we cannot avoid. It warns us that if we do not fundamentally understand and resolve these intertwined pressures and crises, the future of Taiwan's society will face unimaginable challenges. In the next article, we will dismantle these multiple shackles in depth and explore what economic and social factors, as well as the magnified "trust crisis", have woven the net that makes the young generation "afraid to live".

A few months ago, a heartbreaking long-term care tragedy occurred in New Taipei City. A 73-year-old retired architect, who had been taking care of his wife, who suffered from hydrocephalus, was physically and mentally exhausted and could not cope with the pressure, so he let his wife fall from the 14th floor and then gave himself up. This incident has shocked the community, and what is even more concerning is that in eight similar cases of long-term care tragedies last year, the victims were all men. Behind these tragedies are revelations about the enormous pressure faced by male caregivers and the lack of social support. ‍Male caregivers: the invisible bearers of stress‍When we think of "caregivers," many people's first thought may be of women. However, as the social structure changes, more and more men are taking on the responsibility of family caregiving. According to statistics, the proportion of male caregivers in Taiwan is increasing year by year, but they often face greater psychological pressure and social expectations. ‍The source of stress for male caregivers is not only the physical burden of caregiving, but also the psychological isolation and cultural shackles. Due to traditional expectations of men as "strong and not tired," many men choose to hold back and not ask for help, leading to accumulated stress that may even lead to extreme behaviors. Psychological studies have also pointed out that men tend to be more "problem-solving oriented" than "emotionally expressive" when facing stress, making it more difficult for them to speak up when they need help. ‍ Social Welfare Support in Taiwan: A Life Circle for Male Caregivers ‍ To help male caregivers reduce their stress, the Taiwanese government and local authorities have provided a number of social welfare measures, which are listed below as some of the key resources: ‍1. Long-term Care 2.0 Policy ‍ Taiwan's Long-term Care 2.0 Policy, which provides a diversified range of services to caregivers. Long Term Care 2.0 Policy‍ Taiwan Long Term Care 2.0 Policy provides a wide range of services to support caregivers, in particular: ‍ Respite Services: Caregivers can apply for short-term substitute care, where a professional can take over for a short period of time to help the caregiver get some physical and mental rest. In-home service: professional care service workers come to the home to help with daily care tasks, such as cleaning, mobility or bathing, so as to alleviate the burden of caring. Day care centers: Family members who need long-term care can receive professional care in day care centers so that the caregivers can have time to work or rest. ‍2. Counseling and Support Groups ‍Male caregivers often have mental health problems due to long-term stress. To address this, the government and local agencies provide the following resources: Counseling Services: Through the Department of Health and Welfare or local mental health centers, male caregivers can receive free or low-cost professional counseling to help them release stress. Support groups: Social welfare agencies and community centers have "caregiver support groups" that provide a platform for male caregivers to share their experiences, help them learn caregiving skills, and build a community of mutual support. ‍3. Financial support and subsidies Financial pressure is a major challenge for caregivers, especially when they are unable to work full-time due to their caring responsibilities. The following financial support is provided by the government: Living Supplement for the Physically and Mentally Challenged: If the care recipient meets the qualifications of being physically and mentally challenged, the family can apply for a living supplement to alleviate the financial burden. Caregiver's Allowance: Some local governments provide a caregiver's allowance to subsidize families who are unable to work full-time due to caregiving responsibilities. Long-term care service subsidy: Depending on the family's financial situation, it is possible to apply for a partial or full subsidy for long-term care service fees to reduce the cost of care. ‍4. Specific programs for male caregivers‍In recent years, some local governments and non-profit organizations have launched specific programs for male caregivers, such as: Courses for male caregivers: Provide training on basic caregiving skills, so that male caregivers can have more confidence in coping with challenges. Psychological support programs: Workshops or activities to help male caregivers learn stress management skills and provide psychological support. ‍5. 24-hour hotline for caregivers ‍Taiwan has a number of 24-hour hotlines to provide immediate assistance: 1966 Long-Term Care Hotline: Answers questions related to long term care and helps to link to available resources. Peace of Mind Line 1925: Provides psychological support to help caregivers relieve stress. Why do male caregivers need more attention? ‍ Male caregivers experience stress not only from physical and financial burdens, but also from psychological isolation and cultural expectations. Because men are more likely to feel shame or discomfort when asking for help, they often choose to bear the burden in silence, leaving them unable to release the stress, which can lead to anxiety, depression, and possibly even extreme behavior. Therefore, support systems designed for men should focus more on mental health maintenance and provide resources and services that suit men's needs. ‍ Act with us to support male caregivers! ‍Male caregivers are an important part of family caregiving, but their stresses and challenges are often overlooked. If you have a male caregiver in your life, give them the care and support they need. If you are a male caregiver yourself, remember that you are not alone and there are many resources in the community to help you. ‍We at Sunyu Academy are committed to promoting relevant information and providing professional social work services so that every caregiver can get the help they deserve. Come and interact with us to create a friendlier environment for male caregivers!