Last month, a daughter called our care center in panic. Her mother, who lives with early dementia and mobility problems, needed support immediately. She had already contacted five agencies. All of them gave the same answer: “We have caregivers, but they are not allowed to work here.”
Not because the workers lacked skills. Not because the families were difficult. But because recent regulations now restrict long-term care workers to a single registered employer, limiting their ability to support other homes even when they are willing and available.
The daughter asked me the question no system should force a family to ask: “What are we supposed to do if the system has workers, but won’t let them help my mom?”
I had no comforting answer.
A system that protects caregivers by limiting them
Taiwan is aging faster than most countries, and caregivers are the backbone of our long-term care network. Yet a new rule, intended to clarify employer responsibility and prevent worker overload, now requires caregivers to be registered under only one facility. Any additional work, even temporary, is heavily restricted.
For many frontline workers, this has meant:
- Fewer shifts.
- Reduced income.
- Lost relationships with long-term clients.
- Increased stress on remaining staff.
Even worse, families are now turned away not because caregiving has become less needed, but because the system has boxed workers into rigid administrative boundaries. Protection was the goal. Paralysis has become the outcome.
The opposite extreme: when flexibility becomes danger
While caregivers face tight constraints, another group of frontline workers (food delivery drivers) live in the opposite reality.
They enjoy ultimate flexibility, yet carry nearly all the risk themselves. Algorithms decide their assignments, income, and even contract termination. When accidents occur, many face the consequences alone.
In Taiwan, the two groups symbolize a troubling contradiction: One essential service is overregulated to the point of immobility. Another essential service is underregulated to the point of danger.
Both extremes hurt the people they serve.
What these two worlds reveal about how we value care
At first glance, caregivers in elder care and gig workers delivering meals seem unrelated. But viewed together, they expose a deeper issue: We have lost a coherent sense of how society values care.
Caregivers support families through the most vulnerable chapters of life. Their work requires training, trust, emotional labor, and physical endurance. Yet their autonomy is shrinking, and bureaucracy often dictates where and how they may help.
Delivery workers meet modern families’ needs for convenience, flexibility, and efficiency. Their work is visible on every street corner. Yet their protection is minimal, and we accept risky working conditions as part of a “flexible” economy.
If one group is overprotected and the other is abandoned, it is not because either group deserves such treatment. It is because society has not clearly decided what care means, and whom it should protect.
Why this matters to clinicians and health systems
As someone who works in elder care and studies health systems, I worry that long-term care is being squeezed from both ends:
- Workers who want to help are prevented from doing so.
- Workers who need protection are left without it.
The result is an unstable ecosystem where families cannot reliably access care, and workers cannot reliably build a livelihood.
In health care, we discuss burnout, staffing shortages, and system fragmentation. But long-term care often sits at the edge of visibility, essential, yet structurally overlooked. When regulations unintentionally reduce the availability of caregivers, the consequences fall directly on patients:
- Longer waiting times.
- Increased caregiver turnover.
- Disrupted continuity of care.
- Unsafe home environments for older adults.
These are not small administrative issues. They erode the foundation of elder care.
The lesson both workers teach us
From opposite ends of the labor market, both caregivers and gig workers are sending the same warning: A system that does not balance protection with autonomy will fail the people who rely on it.
Caregivers need safety, fair wages, and manageable workloads, but also the freedom to serve more than one family when they choose. Gig workers need flexibility, but also the security of basic protections when they face unavoidable risks.
Both groups remind us that dignity in work is not created by rules alone, nor by markets alone. It requires thoughtful design, and a society willing to ask: What kind of care do we want to value? What kind of workers do we want to support?
If we do not fix this now
One day, many of us (or our parents) will need help getting out of bed, bathing safely, or simply having someone nearby who cares.
On that day, the question will not be about regulations or platforms. It will be heartbreakingly simple: “Is anyone available?”
Right now, families are already hearing the answer: “There are workers, but they are not allowed to come.”
A sustainable care system cannot afford that silence.
Gerald Kuo, a doctoral student in the Graduate Institute of Business Administration at Fu Jen Catholic University in Taiwan, specializes in health care management, long-term care systems, AI governance in clinical and social care settings, and elder care policy. He is affiliated with the Home Health Care Charity Association and maintains a professional presence on Facebook, where he shares updates on research and community work. Kuo helps operate a day-care center for older adults, working closely with families, nurses, and community physicians. His research and practical efforts focus on reducing administrative strain on clinicians, strengthening continuity and quality of elder care, and developing sustainable service models through data, technology, and cross-disciplinary collaboration. He is particularly interested in how emerging AI tools can support aging clinical workforces, enhance care delivery, and build greater trust between health systems and the public.
