台灣身心障礙者個人助理服務制度的實踐與反思：瑞典及日本札幌市經驗的借鏡

本文從檢視自立生活理念出發，透過瑞典及日本札幌市個人助理服務制度經驗，提出我國個人助理服務制度未來發展相關討論及建議。研究發現，瑞典及日本札幌市在歷經相關實驗計畫及改革後，個人助理制度設計以「選擇、主導、彈性及自我負責」為主要核心概念，透過「直接給付」制度的實施，使障礙者握有服務的購買權，進而從服務接受者的消極角色轉變為購買服務的消費者身份。在需求評估方面，瑞典以開放性訪談為主，再由評估人員與障礙者進行需求時數的討論；日本札幌市則是在「身心障害支援區分」制度基礎架構上，以兼備量化及質性資料的方式進行評估。本文建議未來台灣個人助理服務制度應朝向賦予障礙者更多「選擇、主導、彈性及自我負責」方向發展，例如設計居家照顧與個人助理選擇轉換機制。由於現行個人助理服務評估面向及方式的不足，在「多元評估面向」及「平衡障礙者主觀想法及評估人員客觀評估」考量下，本文建議未來可以「身心障礙者權益保障法」架構下的「身心障礙者福利與服務需求評估訪談表」為主要評估工具。最後，有鑑於服務市場化帶來的可能侷限與風險，本文建議政府未來可先採行小規模試辦計畫方式，邀集身心障礙團體及相關民間單位，就居家照顧與個人助理服務制度的轉換機制或給付制度等議題進行討論，從而擬定符合「選擇、主導、彈性及自我負責」精神的個人助理服務制度。

關鍵字

自立生活；個人助理；直接給付

並列摘要

The purpose of this article is to explore strategies for implementing personal assistance (PA) for persons with disabilities (PWDs) in Taiwan, based on the experiences in Sweden and Sapporo, Japan. After conducting pilot projects and reform, choice, control, flexibility and self-responsibility are the four core elements of PA for PWDs in Sweden and Sapporo, Japan. Direct payment is a key feature, which turns PWDs from passive service recipients into those with the power to purchase services. In terms of needs assessment, assessment professionals in Sweden conducted open interviews to gather information, then had discussions with PWDs to determine the amount of time of PA needed to meet their fundamental needs. By contrast, the needs assessment for PA in Sapporo was conducted with a quantitative and qualitative assessment tool, which is as a welfare evaluation tool for PWDs in Japan. The implications for the PA policy in Taiwan are as follows: first, it is necessary that the PA policy progress towards providing more choice, control, flexibility and self-responsibility. For example, the policy could focus on building the infrastructure to transition between home care service and PA. Second, Taiwanese policy should consider ＂the tool for the needs assessment of welfare services for PWDs under People with Disabilities Rights Protection Act＂ as a major needs assessment tool. It is based on multiple dimensions and balances the subjectivity of PWDs against the objectivity of the assessor. Finally, in order to draft the PA policy with provision of choice, control, and flexibility, Taiwan needs to conduct pilot projects; disability groups and other related organizations are invited to discuss the transition infrastructure between home care service and PA and the way PWDs should receive payment to purchase PA.