外籍看護聘用政策評析與建議

臺灣於2025年正式邁入超高齡社會，65歲以上人口比例突破20%，長期照護需求急遽上升。由於家庭照顧人力不足，外籍看護工成為臺灣長照體系重要人力來源。現行聘用政策主要依據「就業服務法」及相關規範，申請者需經醫療機構開立「病症暨失能診斷證明書」，並以巴氏量表評估日常生活功能，確認失能程度是否達申請標準。2023年起，針對持續使用長照服務6個月以上、失智症病人及特定中重度身心障礙者，實施多元免評制度，申請外籍看護工時無須強制進行巴氏量表評估。2025年「就業服務法」第46條修正案通過放寬申請條件，並自2025年8月1日上路，80歲以上長者及70至79歲癌症二期以上者皆可免巴氏量表直接申請外籍看護工。然而，此政策雖簡化申請流程、縮短等待時間，卻也可能帶來多重影響，包括加劇外籍看護工供需失衡、排擠重症家庭照護資源、加速長者身體功能退化、壓縮本國籍看護就業空間以及增加外籍看護工管理與照護品質監督的困難。因此，本文評析政策可能影響，並提出三項建議：（一）加強外籍看護工職前訓練與語言輔導；（二）建立照護品質監督回饋機制；（三）設置整合性單一窗口以提升申請效率。

Taiwan is expected to cross the threshold and become a super-aged society in 2025, with over 20% of the population aged 65 and above, leading to a sharp rise in long-term care needs. Due to inadequate family caregiving resources, foreign care workers have become a vital component of Taiwan’s long-term care system. Current policies governing the employment of foreign caregivers are based primarily on the Employment Service Act and related regulations. Applicants must present a medical certificate and disability assessment issued by a healthcare institution, and their functional status is evaluated using the Barthel Index to determine eligibility. Since 2023, Taiwan has implemented an assessment exemption policy for certain groups, including individuals who have used long-term care services for more than six months, patients with dementia, and those with moderate to severe physical or mental disabilities, with these groups exempted from the otherwise mandatory Barthel Index assessment when applying for a foreign caregiver. Also, an amendment to Article 46 of the Employment Service Act implemented on August 1, 2025 extends the Barthel Index assessment exemption to foreign caregivers of individuals aged 80 and older and patients aged 70 to 79 with Stage II or above cancer. While this policy simplifies the application process and shortens waiting times, it may also produce unintended consequences. These include exacerbating the imbalance between supply and demand for foreign caregivers, diverting resources from families with severe care needs, accelerating the functional decline of older adults, limiting employment opportunities for local caregivers, and increasing the challenges of managing and supervising caregiver quality. In this paper, these potential impacts are analyzed, with the results pointing to three recommendations. These include: (1) strengthening pre-employment training and language support for foreign caregivers; (2) establishing a quality monitoring and feedback system; and (3) creating a centralized and integrated application platform to enhance efficiency.