看得到的照護政策、看不見的勞動差異：照顧工作者與勞動場域的檢視

Differences in Care Labor: Comparisons of Direct Care Workers' Quality of Performance in Different Settings

謝玉玲(Yu-Ling Hsieh)

《臺灣社會福利學刊》 10卷1期 (2011/12) Pp. 53-96

https://doi.org/10.6265/TJSW.2011.10(1)2

摘要

長期照護是國家邁入老年社會無法迴避的公共性議題，在照護供給是為了需求滿足前提下，過往研究在需求面部分有較高的關注，包括需求量多寡、評估機制、成本考量及品質維護等，而忽略照護服務提供的內在差異，尤其是照護工作者的勞動處境。長期照護的服務八成以上是由這群照顧服務員及外籍看護工所提供，這群被視為是半技術性專業人力的女性，她們在不同的場域中提供服務，其個別的勞動處境與負荷皆影響著長期照護服務品質的優劣。本研究檢視長期照護最主要、也是人數最多的直接照顧工作者之勞動處境，分析照顧服務員及外籍看護工二者在不同場域（機構、家庭）的照護勞動差異，從照護場域特性、薪資與福利、服務對象、工作內容與環境等進行比較。嘗試釐清照護勞動所涉及的照護工作者與勞動場域間的關係，這當中的勞動困境為何，希望藉由這些檢視對於這群有酬照顧工作者其承擔的照護勞動有更多闡釋與揭露，而照顧政策應該更能敏於回應當中的不同。研究發現居家照顧服務員的工作環境較少支援，服務特性更著重類家人關係（family-like relationship）的人際互動、工作內容較具模糊性、非典型勞雇關係及低薪資等條件，讓照顧服務員傾向選擇機構式照護工作。而外籍看護工的待遇於工時、工資、休假及福利制度等皆遠低於照顧服務員，於機構、家庭照護場域都處於不合理勞動處境的風險中。研究亦以穩定照護品質觀點，對二者在不同照護資格要件、教育訓練提出照護勞動可責性的可能，及對國內照顧服務員於照護勞動穩定性、外籍看護工於照護關係上情感的連結提出建議。

關鍵字

照顧服務員 ； 外籍看護工 ； 照護勞動 ； 照護場域

並列摘要

Long-term care policy has been one of the most critical issues in Taiwan, with population aging following close behind. Most researchers have focused on the need or demand for care, in addition to its assessment, costs, and quality. However, differences in the availability of care have been ignored, particularly the availability of a sufficient number of care workers. Nursing assistants and foreign care workers have been providing more than 80% of man power long-term care in Taiwan. Their heavy burden has adversely affected the quality of direct care.This article explores the circumstances faced by those who work as nursing assistants and homes care workers. The differences on their job descriptions, working benefits and care burden faced by these two groups of care workers with respect to the work environment (home vs. nursing home), salaries, benefits, service to clients, and job content are addressed. The findings indicate that the quality of care provided by those care worker who functioning as home-nursing assistants was negatively associated with poor support at private home, ambiguous job content, atypical employment relationships, and low wages. For these reasons, those foreign labor who works as nursing assistants tended to choose agency care rather than home care. In general, foreign care workers regardless whether works at home or nursing home, their working condition such as working hours, wages, vocation, and benefits are worse compare to local Taiwanese care workers. The policy on improving the foreign care labors' employment situation, it is suggest by author that more attention must be paid to their qualifications, education and training, and the nature of the care works they provide. The results suggest that future studies can enhance accountability in the health care industry and improve the quality of care provided by those foreign labors.

並列關鍵字

Nursing assistant ； Foreign care worker ； Performance of quality ； Care setting

參考文獻

王雲東、鄧志松(2009)。我國長期照護服務需求評估。臺北:行政院經濟建設委員會。

王增勇(2006)。外籍看護工政策省思與芻議。就業安全。5，96-102。

王潔媛(2009)。從適應觀點看老人長期照顧機構外籍監護工之運用及管理。社區發展季刊。125，472-484。

臺灣立報（2008）。《養護機構移工 做牛做馬學打針》。資料檢索日期：2011年03月28日。網址：http://www.lihpao.com/?action-viewnews-itemid-599

立法院（2010a）。《立法院公報第99卷第9期院會記錄》。99，52。