家庭托顧長照服務在原鄉部落發展的優勢與困境－以南投縣為例

家庭托顧服務屬於長期照顧政策中的一環，在原住民族部落地區扮演重要的照顧服務提供單位，家庭托顧輔導團在家托站與政府之間作為「轉譯者」與「阻尼器」的角色，以落實長照政策「在地老化」的目標。同時，在其貼近原住民族長者的生活環境，以及與既有社群網絡結合的特性，使家庭托顧成為長照政策中最能提供「文化安全」照顧的服務單位。然而，部落中的家托站卻也受到政策法規上的限制，嚴格與不合適的土地建物要求、忽略部落社群觀與人際網絡的規定、金源不穩定、地方裁量權的脆弱等因素都造成家托站在提供服務時所處在不友善的環境中，這樣的不友善來自於政策規劃的想像與原鄉地區的服務樣態存在著斷層，這個斷層可能來自於場域地理環境與照顧關係的不同。政府以主流的照顧知識所設計的規定壓迫了原鄉在地的照顧，複製了原漢之間的殖民關係，形成一種新形式的福利殖民。基於以上經驗，呼籲當前之政策因針對土地法規鬆綁、人數限制彈性化、金源流動優化三個方向前進。

關鍵字

原鄉長照；文化安全；家庭托顧；福利殖民

並列摘要

＂Adult Foster Care＂ plays a significant role of LTC service in indigenous villages in Taiwan because of the shortage in long term care. In order to facilitate the development of adult forster care, NGO serves as ＂tutoring group＂ to support care workers to start the service at their home by functioning as ＂translator＂ and ＂shock absorber＂ between fosters and local government. The strength of adult foster care lies in the fact that it is located closest to indigenous elders, within existed social network, which enables adult foster care to provide care with ＂cultural safety＂. However, the development of adult foster care has encountered constraints, which include strict and unsuitable criteria of land and architect, rules ignoring the view of community and social connection, unstable income, and unpredictable discretion. These constraints put foster care workers in an unfriendly policy environment, which came from disjunction between policy and local cultures. The disjuncture between LTC policy and indigenous communities reinforces the colonial relationship between indigenous people and Han-driven government, which can be considered as a new form of ＂welfare colonization＂. Three policy recommendations are proposed: revising the rules of land using, increasing flexibility in number of users, and ensuring stability of income flow to improve the adult foster care environment.