The Ministry of Health and Welfare will implement the "Inpatient Integrated Care Plan" starting from 2022, arranging nannies or caregivers and nurses to jointly care for patients, reducing the burden of accompanying patients and reducing the financial burden on family members. However, several medical groups pointed out today (22nd) that the Ministry of Health and Welfare did not clearly define the nurse-to-patient ratio, hospital hiring model, etc., which resulted in the policy putting the cart before the horse and increasing the burden on front-line medical staff. For this reason, they requested that the hospital should "directly hire" nurses or attendants, and clearly establish a "nurse-patient ratio" of 1:4, and that hospitals should not cross wards or floors.
Democratic Progressive Party legislators Lin Yue-qin and Wang Zhengxu, together with the Taiwan Federation of Medical Trade Unions, jointly held a public hearing on the implementation effectiveness of the Inpatient Integrated Care Plan at the Legislative Yuan today. Groups including the National Federation of Nurse Practitioners and Nurses Association of the Republic of China, the Family Caregivers Association of the Republic of China, the Women's New Knowledge Foundation, the Taoyuan City Home Care Workers Professional Union, as well as the Nursing Department of the Ministry of Health and Welfare and the Labor and Development Administration of the Ministry of Labor participated.
Lin Yueqin pointed out that 60% of hospitalized patients are cared for by their family members, and about 75% of them have family members who take leave. About 120,000 to 150,000 people choose to leave their jobs every year because of this. In order to avoid the situation where "one person is hospitalized and the whole family accompanies the patient", the Ministry of Health and Welfare has promoted the "Inpatient Integrated Care Service Plan". However, the plan currently covers only 7.4% of hospital beds, which is far behind the government's 50% target. In addition, the central government has set flexible standards, resulting in some hospitals having uneven implementation of nursing ratios, education and training, and appointment types of caregivers. The central government should supplement the current system to allow caregivers to work with peace of mind and patients to receive care with peace of mind.
"Nursing attendants are not equal to nurses." Chiayi City Nursing Attendant Professional Union explained that nursing assistants mainly assist nurses at nursing stations, while nursing attendants provide patients with daily care and, more importantly, observe the condition. Therefore, the nursing care ratio is very important, but currently it is not There is a situation of 1:12, where the patient pays 1,050 yuan every day, and it is unknown who pockets the middle price difference. Therefore, their position is "nurse-patient ratio 1:4", and must be in the same ward, not across wards or floors, and reasonable working hours and wages are given.
Kuo Lianying, vice-president of the Taiwan Federation of Medical Trade Unions, pointed out that currently, when hospitals hire nurses or care attendants, the Ministry of Health and Welfare does not limit the appointment form, resulting in models including "direct employment, outsourcing, special contracting," or even direct employment plus outsourcing or a combination of the three. Not only is it difficult to manage staff salaries, but it is also difficult to attribute responsibility for patient accidents. They hope to "hire directly". After all, they are taking care of lives, and direct hiring is the best way to control manpower and ensure quality.
Cai Zhongjie, secretary of the corporate union of Taipei City United Hospital, pointed out that taking Taipei City United Hospital as an example, the hospital adopts a "care outsourcing" model and has signed a contract with an outsourcing company for a 1:6 care ratio. If one of the patients is discharged first, the nurse must "boost performance" and try to find waiting patients to join the "inpatient integrated care plan." In order to have 6 people, there may be patients from internal medicine, surgery, and miscellaneous medicine in the same ward at the same time. The care methods are completely different, and the outsourced personnel must be retrained and adjusted, which is a problem.
Li Shaofen, an assistant professor at Yang Ming Jiaotong University's David Ford Institute, proposed that the government should establish a formal "NA" system, unify education, internship and certification, provide subsidized resources for nurse education and training, and support direct employment by hospitals through health insurance or public budgets; all foreign NAs should receive the same training and certification, and enjoy working conditions of equal pay for equal work. The government should review whether the current subsidy amount of 750 points is sufficient to support hospitals in promoting integrated care services and establishing nursing systems, and take into account differences in hospital levels and regions.
As for the opening of foreign manpower for the Integrated Hospital Care Plan, Wu Jingru, a researcher at the Taiwan International Labor Association, said that if migrant caregivers are to be hired, the hospital should hire them directly instead of outsourcing or dispatching them. They should provide sufficient pre-employment and on-the-job training. No salary deductions should be allowed during the training process, and the ratio of work content to reasonable care should be clearly defined. In addition, Article 84-1 of the Labor Standards Law must not be applied. Responsibility systems should not be applied to migrant workers. Wages, allowances and promotions should be consistent with those in the home country, so as to prevent migrant workers from filling low-paying and bad jobs.
