社區照顧關懷據點轉型巷弄長照站關鍵影響因素研究

中文摘要本研究旨在探討社區關懷據點轉型巷弄長照站關鍵影響因素。為因應人口老化及多元照顧需求，長期照顧政策遂成為臺灣重要發展方向，當前長照2.0政策的施行，希望透過以社會福利為基礎的社區照顧關懷據點，轉型為巷弄長照站，建立社區整體照顧模式，以提供連續性及在地化的照顧服務。然而，由於當前相關研究仍然薄弱，實務經驗也探討不足，難以真正落實長照2.0政策目標。基於此，本研究希冀梳理關懷據點與巷弄長照站政策發展軌跡；其次，分析組織轉型過程中可能面臨的財務、人力及治理問題與挑戰，檢視其中影響因素；第三，根據研究結果提出學術、政策及實務單位建議。本研究採取深度訪談為主要資料蒐集方法，共計訪談3位具社區照顧關懷據點輔導經驗之督導，所得訪談資料則以MAXQDA進行分析。研究結果發現，社區照顧關懷據點轉型為巷弄長照站，可提供更多元照顧服務，政策也能相對節省成本，是在當前制度下合理的選擇結果。在財務方面，補助增加勢必成為據點轉型誘因，但相對也可能因補助抽離或退場後而影響服務。在人力方面，偏鄉地區因文化與適應問題而使照顧人力流動率升高，成為推展巷弄長照站的隱憂；另方面，志願服務人力可能因為政府補助，引發補助與志願性質之間的衝突，甚至出現崩解危機。在治理方面，組織內部的選舉可能衍生治理斷層問題，不利於長遠政策發展；外部社區整體照顧系統則因補助來源不一，以及缺乏實際監控機制，難以落實服務垂直整合目標，限縮巷弄長照站資源網絡；此外，在政府補助下，可能影響社區自主、自治與互助功能，創新發展機會恐受到侷限。研究建議方面，後續研究者可針對政府補助的雙面性質進行討論，以及深入非營利企業治理與決策機制。在實務工作者方面，可於轉型為巷弄長照站過程中增加組織自我評鑑指標，以平衡補助誘因，並增加自我監督機制改善治理問題。政策規劃者可規劃治理指標，作為補助之參考；以及提出長期照顧產業活化政策，避免政府補助所衍生的依賴及干預問題。

關鍵字

政府補助；巷弄長照站；社區照顧關懷據點；長照2.0政策；長期照顧

並列摘要

英文摘要 This study aims to explore the key factors influencing the transformation of community care stations into LTC stations. To cope with the aging population and diverse care needs, long term care policy has become one of the important development trends. Now the implementation of LTC 2.0 policy is expected to set up the community whole-care model through transforming the community care stations into the community care bases built upon social welfare, and at the same time can offer continuous and localized care service. However, the policy goals of LTC 2.0 are hardly carried out due to the lack of related research and practical experience. In view of these, this study aims to look over the development courses of community care stations and LTC stations. Secondly, the possible financial, manpower, and management problems and challenges during the process of the organization transformation are analyzed and the influencing factors are inspected. Third, some suggestions to the academic, policy-making, and practice agencies are made according to the research result. This study employed in-depth interview as the primary approach. Three supervisors with counseling experience on the community care stations were interviewed, and the data was analyzed with MAXQDA. The study result found that diversified care service can be offered once community care stations are transformed into LTC stations and this policy can relatively reduce the cost. This should be a reasonable choice under current system. In the financial aspect, the government subsidies inevitably become the incentive to this transformation. Comparatively, the service might be affected while the subsidies stopped. As for the manpower, the turnover rate of the care givers in the rural area might get higher because of the culture and adaptation problems, and this is the potential problem in promoting LTC stations. On the other hand, those volunteers may confront the conflict between subsidies and the nature of volunteering, and this can even lead to the crisis of disintegration. In the management aspect, the election within the organization might result in the problem of managing gap and is unfavorable to the long term development. The exterior community care system has trouble reaching the goal of vertical integration of caring service for the diverse sources of subsidies and the lack of monitoring mechanism. And this limits the network of resources for LTC stations. Besides, the community autonomy, spirit of mutual assistance, and innovative development might also be restricted with the government subsidies. As for research recommendation, this study proposes the following research can explore the dual nature of government subsidies and go deeper into the management and decision mechanism in the NPO. And for the practitioners, organization self-assessment indexes should be established during the LTC stations transformation process and thus balance the incentive factor of subsidies. At the same time, the self-monitoring mechanism should be set up to improve the managing problems. The policy planners can develop managing indexes as the reference of subsidies and propose activation policy for the long term care industry, avoiding the problems of dependency and interference resulting from the government subsidies.