精神障礙雙老家庭照顧者使用福利服務之經驗

我國身心科就診人數，自民國90年170萬人逐年攀升到民國104年233萬人。而全國身心障礙總人數113萬人之中，慢性精神疾病患者為12萬人佔其中10.7%。其中約有九成居住在家中，而主要照顧者多為父母。研究者臨床實務看到，大多年邁祖父母、父母、手足在擔任主要照顧者，老人照顧提早老化的身障者。臨床實務工作中現行同樣的社會福利資源提供，卻有了不同的反應，此雙老照顧狀況下主要照顧者荷擔的壓力如千擔磚石，但精神疾病患者雙老照顧此概念能找到的資訊相當有限。本研究之研究目的在於精神疾病患者之主要照顧者在照顧過程中，當面臨到老年階段，所須面對的照顧負荷、福利資源使用經驗及障礙。藉本研究來了解雙重老化精神疾病患者家庭所需之社會福利服務與使用情形，以做為未來福利輸送之建議。依據本研究之目的採質性研究方法，以立意取樣找尋適合的研究參與者，經取得其同意後運用半結構式深度訪談、採全程錄音之方式蒐集資料，共完成5位訪談。研究結果發現如下：一、照顧現況所需要的社會福利資源：醫療資源服務-被動式就醫介入需求、工具性支持/照顧技巧指引資源需求、諮商輔導及支持性團體-安撫/傾聽的情感性支持、經濟資源補助-醫療費用負荷暨生計問題、宗教師或靈性關懷服務-靈性/精神上的需求、安養照顧服務-照顧者終身角色之承接。此六大項為研究所發現，精障雙老照顧者需要的資源。二、精障雙老照顧者於福利資源使用經驗：資源可及性低-資訊未普及、資源申請複雜度高-耗時費力/奔波繁雜的使用經驗、資源可近性不佳（地處偏遠）、福利體制的負面經驗-消極/不友善的專業人員、申請標準因地方而有異、福利體制互動的正向經驗、服務便利性提升、服務個別化考量可負擔性（可負擔、更願意協助的資源輸送），使用經驗有正向也有負向。三、精障雙老照顧者福利服務的需求與建議如下： (一) 對照顧政策規劃上的建議：跨團隊福利宣導與個案發掘、委任代理人制度之兩造保障、福利輸送人員之再教育、政府民間合作永續照顧服務、長照2.0應對精障雙老所須服務更完善。 (二) 對實務工作上的建議：增設宗教師或社工提供靈性關懷、廣辦精神障礙主要照顧者支持性團體、媒體社群對精神疾病汙名化之防堵、出院準備服務之公衛護理偕同介入、增強對精神障礙之認知、接受精神障礙家人日漸退化、功能不復以往之事實。 (三) 對未來學術及研究之建議：針對不同區域進行抽樣訪談或量化研究、進行不同程度/精神診斷別照顧者福利使用經驗之研究、進行不同照顧關係福利使用經驗之研究。

關鍵字

精神障礙者；雙老家庭；主要照顧者；照顧負荷；福利服務使用

並列摘要

The number of people in the physical and mental department in Taiwan has risen from 1.7 million to 2.33 million in 14 years. Among the total number of people with physical and mental disabilities totaling 1.13 million, the number of patients with chronic mental illness is 120,000, accounting for 10.7%. About 90% of them live in the home, and the main caregivers are mostly parents. The researcher's clinical practice saw that many years ago, the grandparents, parents, brothers and sisters were the main caregivers, and the elderly took care of the prematurely aging disabled. The same social welfare resources provided in the clinical practice work have different responses. The pressure of the main caregiver under the old care situation is very heavy, but the information that the mental illness patients can find in this concept is quite limited. The purpose of this study is to examine the care load, welfare resource use experience and barriers faced by the primary caregivers of mentally ill patients in the care process when faced with the elderly. This study is used to understand the social welfare services and use of families with dual aging mental illnesses as a recommendation for future benefits. According to the purpose of this study, the qualitative research method was used to find suitable researchers for the study. After obtaining the consent, the semi-structured in-depth interviews and the whole process recording were used to collect the data, and 5 interviews were completed. The findings are as follows: (1) Social welfare resources needed to take care of the current situation: medical resource services - passive medical intervention needs, instrumental support/caring skills guide resource requirements, counseling and support groups - emotional support for appeasement/listening, economic resource subsidy - medical expenses load and livelihood issues, religious teacher or spiritual care service - spiritual / spiritual needs, annuity care service - the caregiver's life role. These six items are the resources that the Institute found to be needed for the care of the elderly. (2) Experience of the use of welfare resources by skilled elderly caregivers: low resource availability - information is not universal, resource application complexity is high - time-consuming and laborious / rushing and complicated experience, poor accessibility of resources (remote location), negative experience of the welfare system - negative / unfriendly professionals, application criteria vary by region, positive experience of welfare system interaction, service convenience, service individualization considerations affordability (available resources that are more affordable and willing to assist), experience has positive and negative. (3) The needs and recommendations of the Dangerous Double Caregiver Welfare Service are as follows: (a) advice on care policy planning: cross-team welfare promotion and case study, two-party guarantee of appointing agent system, re-education of welfare providers, government private cooperation for sustainable care services, long-term care plan 2.0 should be better for the services needed by the elite. (b) advice on practical work: adding a religious teacher or social worker to provide spiritual care, more supportive groups for major caregivers of mental disorders, the media prohibits the stigma of mental illness, disposal of public health care for discharge preparation services, enhance awareness of mental disorders, accepting mental disorders, family members are deteriorating, and the social function is no longer in the past. (c) suggestions for future academic and research: sample interviews or quantitative studies in different regions, study on the use of caregivers' welfare in caregivers with different severity/psychotic diagnosis, study on the experience of using different care relationships.