我國家庭照顧者支持網絡系統

本文試從臺灣孝道文化、家庭照顧者運動、家庭照顧者支持性服務立法等社會脈絡，說明家庭照顧者支持網絡系統。由於深受儒家文化影響，家庭照顧被過度美化、簡化為愛的表現、孝道反哺，而忽略其中過勞、負荷超載的殘酷性，導致近年來「照顧悲劇」頻傳。家庭照顧者的壓力與負荷包括身體負荷、心理負荷、工作負荷、社交負荷、經濟負荷、家庭關係負荷等六大面向。此外，約五分之一勞動人口受照顧責任影響，每年約13.3萬人因此離職。國家必須正視社會變遷與需求，不能再將家庭照顧者視為服務資源或提供者，而是服務對象，打造一個「支持家庭照顧者」的友善照顧環境。2015年「長期照顧服務法」立法，第13條「家庭照顧者支持性服務」規範政府必須提供「長照資訊及資源轉介」、「長照知識及技能訓練」、「喘息服務」、「情緒支持及團體服務」、「其他有助於提升家庭照顧者能力及其生活品質之服務」等。衛生福利部委託中華民國家庭照顧者關懷總會陸續建置「0800-507272家庭照顧者關懷專線」及各縣市支持服務據點近六十處，並自2018年起推動「家庭照顧者支持性服務創新型計畫」鼓勵縣市政府盤點在地需求、整合在地資源，發展因地制宜的家庭照顧者支持網絡。為提升對高風險家庭照顧者個案之發現與管理，訂有「高風險家庭照顧者初篩指標」，提升社會辨識照顧風險的知能，鼓勵轉介個案予各縣市支持據點追蹤服務，另有「家庭照顧者個案負荷評估量表」協助社工評估與處遇，提供照顧安排諮詢、照顧訓練課程或到家指導、紓壓活動、支持團體、心理協談、志工關懷、連結喘息服務等，並基於照顧者與被照顧者可能產生利益衝突，倡議「雙案主／雙個管」之工作模式。展望未來，完整的家庭照顧者支持網絡仍待努力，因此提出服務對象樣態與需求掌握待加強、專業人員服務再進化、家庭照顧者支持性服務再增加、高風險家庭照顧者發現場域再擴大等四項建議。

關鍵字

長期照顧；照顧悲劇；照顧負荷；照顧不離職；家庭照顧者支持性服務

並列摘要

This article aims to outline the support network for family caregivers in Taiwan from the social context of filial piety, social movement, and legislation. Deeply influenced by Confucianism, family caregiving in Taiwan has been romanticized and at the same time oversimplified as an expression of love or giving back to one's parents; however, many have neglected the harsh reality that family caregivers are often overworked and overburdened, the fact of which has led to frequent ＂caregiver tragedies＂ in recent years. There are six types of stress and burdens on family caregivers, including that of the physical, psychological, work-related, social, economic, and familial. About one-fifth of the workforce is affected by caregiving responsibilities, and every year, as a result around 133,000 people leave their jobs. The state must recognize these social changes and needs. It cannot continue to regard family caregivers as resources or service providers -- these are people to whom services should be provided and for whom a friendly and supportive environment should be established. In terms of support services for family caregivers, Article 13 of the Long-Term Care Services Act, promulgated in 2015, requires the government to provide long-term care information and resource referrals, training in long-term care knowledge and skills, respite care, support group services, and other services that help enhance the capabilities of family caregivers and their quality of life. The Ministry of Health and Welfare commissioned the Taiwan Association of Family Caregivers (TAFC) to establish the 0800-507272 family caregivers' hotline and close to 60 service locations across Taiwan. In 2018, a project was launched to encourage local governments to identify local needs and integrate local resources for the development of networks adapted to support local family caregivers. In order to increase discovery and management of high-risk family caregiver cases, TAFC established a set of screening indicators in order to raise awareness about and enhance identification of relevant risks, as well as to encourage referrals of cases to service locations across Taiwan. TAFC also rolled out an evaluation scale to assist social workers with evaluating the situation of family caregivers, apart from offering consulting services for care arrangement, on- and offsite training, stress relief activities, support groups, counseling, volunteer outreach, and referrals to respite care services. Due to potential conflicts of interest between caregivers and care receivers, TAFC has also been advocating for a ＂dual client/dual case management＂ approach. Looking forward, more work needs to be done in order to complete a comprehensive support network for family caregivers, to which end TAFC calls for identifying the needs of different demographics that require support, improving on existing services provided by professionals, increasing support services for family caregivers, and expanding the areas in which high-risk family caregivers can be identified.