中高齡智能障礙者照顧機構轉銜與資源網絡之研究

本研究之主題聚焦於中高齡智能障礙者照顧資源銜接與運用的議題，基於轉銜與照顧資源網絡探討之重要性，本研究以照顧機構為主體進行研究，本研究以治理網絡的觀點探討服務運作與轉銜的困境與因應策略、進行討論分析。本研究之目的：(1) 瞭解台灣社會福利組織照顧中高齡智能障礙者之困境與因應方式；(2) 瞭解身障福利組織之照顧轉銜困境與因應方式；(3) 探討身障福利組織老化服務資源網絡之運用。本研究採取質性研究的方法，以半結構是訪談做為資料蒐集的方式，立意取樣針對台灣北、中、南部八家身障機構之工作人員進行訪談，受訪者包含了機構主管8位、教保組長5位、社工組長或社工5位、保健組長4位，共計22位。透過研究者視角及相關文獻理論檢視，主要的研究結論如下：(1)老化照顧面臨各構面之困境，組織治理有待突破；(2)家庭功能式微成為支持的缺口，老化照顧網絡，以「政府」、「社會」、「專業」為主；(3)中高齡智能障礙者老化照顧之資源網絡出現缺口；(4)身障福利機構的老化照顧，需要多元資源網絡之支持；(5)社會服務價值之網絡治理有待建構。研究者透過研究的省思，立基於研究結果的分析，主要之研究建議如下：一、政策面：(1) 健全老化照顧制度規範，建立連續性照顧服務；(2) 擴展中高齡智障者之照顧資源，建立無縫接軌銜接機制；(3)整合長照體系之福利制度，強化人員之職業安全與員工協助；(4)延伸中高齡智障者之專業支持，提升老化照顧之量能；(5)充實老化照顧知能，強化智障者核心專業；(6)推動智能障礙者權益制度，提高老化資源運用之可及性。二、實務面：(1) 檢視組織之使命願景，建立專業團隊共同的老化服務目標；(2) 建立跨部門間老化照顧之整合，形成開放學習的團隊；(3) 凝聚組織與服務使用者之共識，建立與資源平衡之服務目標：(4) 改善老化照顧人力資源缺乏的原因，並調整制度條件；(5) 強化家屬之信任，重新搭建親情橋梁；(6) 建構組織間合作機制，提升資源網絡的維繫；(7) 發展區域聯盟，促進資源交流、形成典範標竿向上學習之氛圍；(8) 落實網絡治理，提供更全面性整合服務。

關鍵字

身心障礙機構；老化照顧服務；轉銜服務；資源網絡

並列摘要

This study focuses on the issues of transition and utilization of the care resources for middle-aged and elderly persons with mental disabilities. Given the importance of exploring the transition and the network of care resources, this study is conducted on care institutions as the subject. This study explores the dilemmas to service operation and transition and responsive strategies therefor from the perspective of governance network, and makes discussions and analysis. The objectives are (1) to understand the dilemmas to the care for middle-aged and elderly persons with mental disabilities by Taiwan’s social welfare organizations and their ways of response; (2) to understand the dilemmas to the transition of care by physical disability welfare organizations and their ways of response; and (3) to explore how the network of aging services for physical disability welfare organizations is utilized. In this study, a qualitative research methodology is used, with semi-structured interviews as the mode of data collection. For purposive sampling, 22 staff members at eight disability institutions in the north, central, and south of Taiwan were interviewed;theywere eight supervisors of the institution, five heads of the education and health care teams, five heads of the social work teams, and four heads of the health care teams. The below conclusion of the study is presented through the researcher’s perspective and the theoretical review of the related literature: (1)Aging care faces predicaments in every construct, and organizational governance needs a breakthrough. (2)The diminishing function of families has become a gap in support, and the aging care network is primarily “governments”, the “society”, and the “professional”;(3) There is a gap in the resources network of aging care for the middle-aged and elderly mentally disabled; (4)The aging care by the disability welfare institutions requires diverse support from the resources network; (5) The network governance of the values of social services has yet to be established. From reflection on research and based on an analysis of the research results, the researchers represent recommendations as follows: A. Policy-wise: (1) Make sound specifications of aging care systems and establish continuous care services; (2) Expand the care resources for the middle-aged and elderly persons with mental disabilities and establish mechanisms of seamless transition; (3) Integrate the welfare systems of long-term care systems and strengthen the occupational safety and employee assistance in the personnel; (4) Extend the professional support to the middle-aged and elderly persons with mental disabilities and boost the energy of aging care; (5) Enrich aging care competence and reinforce the core professionalism of the disabled; (6) Promote the rights system of the mentally disabled and increase the availability of employment of aging resources. B. Practice-wise: (1) Inspect the mission and vision of the organizations and establish common objectives of aging services by the professional teams; (2) Organize the integration among inter-disciplinary aging care and form teams with open learning; (3) Bring together the common understanding between organizations and service users, and establish service goals that keep balance with the resources; (4) Deal with the causes of human resources shortage in aging care and adjust the system conditions; (5) Enhance family trust and rebuild the bridge of family affection; (6) Create inter-organizational cooperative mechanisms and enhance connection within the resources network; (7) Develop regional alliances, promote resources exchanges and form an ambience of learning paradigm up; and (8) Put the network governance into effect and provide more comprehensive integrating services.