探討失能老人家庭選擇長期照護福利服務之決策過程－老人自主權之分析研究

Investigation of the Decision-making Procession of How Disable Elders' Families Choose Long-term Care Welfare Services

劉雅文(Ya-Wen Liu) ； 莊秀美(Hsiu-Mei Chuang)

《東吳社會工作學報》 14期 (2006/06) Pp. 91-123

https://doi.org/10.29734/SJSW.200606.0004

摘要

本研究探討失能老人家庭選擇長期照顧福利服務的決定過程，瞭解老人與其家人的需求，並關注此決定過程中，老人自主權之運作狀況，以從老人與家人的權力角度，重新省思老人自主權的議題。本研究以質性研究深度訪談法進行資料蒐集，並參考Andersen模式之研究架構進行資料分析。本研究之訪談對象為目前使用居家照顧服務、日間照顧服務及養護機構服務之失能老人家庭，共訪談九個家庭，共19人（包括九位失能老人及十位家人）。
本研究發現，照顧選擇偏好，老人偏好選擇在家照顧，較抗拒機構照顧，家人則偏好機構照顧。影響老人自主權包括失能程度、經濟能力及家人關係等因素。然而，研究發現部分老人放棄自主權，以增進家人關係。關於家人照顧意願，發現老人過去對子女的照顧越多，子女的照顧意願越高。從家人的照顧意識結構來看，男性是照顧決策的權力中心，女性存有當然照顧者之意識。從具體行動來看，女性偏向從實質照顧者轉換成尋找照顧資源之主責者。而影響老人家庭選擇照顧的原因包括資訊取得能力、老人失能程度及老人經濟能力等。
基於上述研究發現，本研究提出以下建議。對家人的建議如下：相信老人的自主意識、早日規劃照顧安排。對照顧機構的建議如下：重視個別化活動設計、慎重處理老人間的衝突。對於長期照顧相關政策之建議如下：順應照顧需求，修正居家照顧服務型態，並調整補助費用及照顧項目。其次，多元化宣廣照顧服務資訊，讓失能老人家庭在照顧服務資源的取得上能更加快速與完整。

關鍵字

失能老人家庭 ； 老人自主權 ； 決策過程 ； Andersen模式 ； 長期照護福利服務

並列摘要

This research is to investigate the decision-making process of disable elders' families that choice long-term care welfare services, so as to understand the demand of disable elders and their families, and to inspect the function of disable elders' autonomy in decision-making process. This research uses qualitative research method to review the subject of elders' autonomy, especially from the angles of dominion possessed by elders and their families. We had interviewed nine disable elders' families (including 9 disable elders and 10 family members, 19 persons in total) which is using long-term care welfare services, maybe home care service, day care service, or institutional care service.
The following issues have been discussed in this research. About selection of welfare service, the elderly prefer home care services to institutional care services. On the contrary, family members prefer institutional care services to home care services. About elder's autonomy, the using of elder's autonomy is influenced by following factors: including the disable degree of elderly, the economic strength, and family relationships. And the higher of the level of elder's autonomy, the better adaptation on care services by elderly. However, the elderly may give up their autonomy in order to enhance family relationship and to increase sense of happiness. In other words, a higher autonomy can't make elderly higher sense of happiness. Regarding the care wiliness of family members, the more care the family member (children) have accepted from the elderly in the past, the higher wiliness of feedback to elderly in the present. About care responsibility, in the conscious level, men play the role of thinker and decision-maker, while women play the role of doer. But in action level, women tend to extend and reverse their roles from doer to seeker of care resources. Lastly, the choice of care services of elderly family member is influenced by following factors: the ability to obtain information, the disable level of elderly, and the economic ability, etc. When family members play the role of case manager, cohabite male families and the eldest son usually played the key role and use group decision-making approach.
According to above findings, the following suggestions are presented. For family members, it is necessary to respect elders' autonomy consciousness and pre-arrange care services. For care institutions, it is necessary to value individualization of activities design and handle elders' conflict carefully. For long-term care services related policies, in the first, enhance home-staying care services considering various care demands and adjust reimbursements expense and care items. Secondly, propaganda information of care services via multiple media, and allow disable elders' families to obtain care services resources more effectively and completely.

並列關鍵字

disable elders' family ； disable elders' autonomy ； decision-making process ； Andersen Model ； long-term care welfare services

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