以現金替代服務？家庭照顧關係中的選擇與政策芻議

Cash for care？personal choices and policy options in home care relations

陳柏婷(Po-ting Chen)

指導教授 ： 許雅惠

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2013年)

https://doi.org/10.6837/NCNU.2013.00195

摘要

本研究欲了解「以現金替代服務」的長期照顧方式，是否能提供家庭照顧不同的選擇安排，並對此提出政策芻議。選樣地區為中部縣市之山區城市南投縣、平原地區雲林縣、都會地區台中市，藉由三個不同類型地區，探討比較長期照顧資源可能之城鄉差距是否影響「以現金替代服務」之抉擇。同時為探討照顧與被照顧兩者雙方之意見，受訪對象為照顧者與被照顧者共23位(17戶家庭)，其中包含4位實際領取中低收入老人特別照顧津貼之照顧者，透過質性訪談方式得到受訪者之意見如下：
一、 照顧雙方的角色形成脈絡會影響「以現金替代服務」的抉擇，其中「單身」未婚、鰥寡者容易成為家族中照顧人力首選，也因此對照顧者老年經濟安全產生問題，期盼能有「以現金替代服務」的選擇安排，得以保障其部分經濟安全。
二、 照顧負荷與照顧關係影響「以現金替代服務」的抉擇。在長時間的照顧負荷下，「以現金替代服務」讓照顧雙方得以在照顧安排上擁有選擇權與自主權，得以藉此舒緩照顧而來的關係互動壓力。
三、 城鄉差距影響資源、照顧人力與正式服務支持不足，促使「以現金替代服務」的選擇。
四、 期盼更自主與彈性化的政策。服務與津貼僅能二擇一的絕對二分法，使得不同需求的長期照顧家庭無奈的被迫選擇單一服務，更彈性化可混合使用「以現金替代服務」的長期照顧政策會是更符合民眾需求的方式。

關鍵字

長期照顧 ； 家庭照顧 ； 以現金替代服務

並列摘要

This study uses “cash for care” as a concept framework to look at how people consider their care relations, how policy alternatives are recognized and how they make choices for their home care arrangements.
Designed as a qualitative research, depth interviewing is used as main methods for collecting dada and purposeful sampling is used to select the participants. People with long-term care needs, including both caregivers and care receivers, mostly live in Nantou County, Yunlin County and Taichung City are invited to participate in this study. In total 23 respondents from 17 families are interviewed, including 4 caregivers who are currently receiving cash for providing care for their family. The main findings include as followed:
1. When people are unmarried, widowed or unemployed, they are more likely to become unpaid caregiver within the family.
2. Based on experience of unpaid caregiving and lacking financial support, caregivers are more likely to choose ‘cash for care’ as the prior care arrangement for themselves.
3. Burden of caregiving and tense care relations seems to affect people’s choice for ‘cash for care’. As a policy alternative, both caregivers and care receivers expect to gain more autonomy to decide how to care by choosing ‘cash for care’.
4. The difference between urban-rural areas will make receives available for long-term care different, and will limit support and access to formal services. Therefore, it makes the "cash for care" option more desirable.
The study goes on to suggest that, firstly, autonomy and flexibility need to be considered more thoughtfully and more policy options should be offered while long-term care system is designed. Secondly, ‘either service or cash’ is not a good way to response to people in need, and it will make people helpless if they are forced to choose ‘either-or’ between service and cash. It will be more responsive to mix "cash” and “care” in long-term care policy.

並列關鍵字

Long-term care ； home care ； cash for care

參考文獻

宋麗玉（2006）。增強權能量表之發展與驗證。社會政策與社會工作學刊，10（2），49-86。

曾華源、黃俐婷（2006）。心理暨社會派、生態系統觀及增強權能觀對「人在情境中」詮釋之比較。東吳社會工作學報，14，63-89。

王增勇、陳淑芳（2006）。充權的理念與應用－以醫院就業輔導員為例。護理雜誌，53（2），18-22。

張麗春、李怡娟（2004）。賦權概念分析。護理雜誌，51（2），84-88。

馬先芝（2003）。照顧者負荷之概念分析。護理雜誌，50（2），82-86。