「合作式競合」抑或「衝突性競合」－從日間照顧推動困境評析「長期照顧十年計畫」照顧服務

Co-opetition or Competition? Discussing the Dilemma of the Day Care for the Aging with "Long Term Care 10 years Project" in Taiwan

林明禛(Ming-Chen Lin)

《台灣健康照顧研究學刊》 10期 (2011/03) Pp. 17-35

https://doi.org/10.29750/TJTHCA.201103.0002

摘要

老人日間照顧服務，長久在台灣若有似無的發展，無有明顯區隔不同需求程度的服務經營方式，擺盪在社福與衛生兩個不同行政體系下各自運作，一路走來始終踉蹌，看似分工卻無交集。老人長期照顧需求是多元，「長期照顧十年計畫」的實施後，檢視歷年不同照顧服務項目使用率，該計畫似乎圖以現行使用數占失能者老人10%的「居家服務」，成為未來十年主要照顧方式，此般假設無疑有著風險，更與日間照顧產生衝突競合(competition)。長期照顧呈現的是光譜性服務供給概念，不同子項照顧服務項目間應該彼此互補，形成便於轉換的「合作式的競合」；而「衝突性的競合」卻可能產生失能者照顧選擇的障礙。十年長照的照顧服務內容規劃思慮不足；包括：（1）關注於失能者的居家照護，忽略高齡者照顧光譜上需求、（2）簡化原即不夠敏感的量表，評估過程趨於粗糙與信效度銳減、（3）居家照顧經費補助標準，忽略偏遠地區居家服務者使用習慣、（4）宣稱長期照顧，內容卻似居家服務、（5）曲解日間照顧的品質組成要素可與居家照顧的可互換性（6） 家庭托顧推動陷入難產，源自照顧自家失能者的不合理前提規定。日間照顧多年來未能有較高比例成為照顧老人方式，除價值觀作祟，更可能因資訊不對稱；而十年長照規劃不周，似將社區式照顧阻擋於高牆之外。從居家式照顧、社區式照顧到機構式照顧呈現的是長期照顧形式的光譜；而無要忽略不同照顧形式功能，以及考量照顧之間的互補內涵；長期照顧十年計畫對於老人才有可能產生更大的效果及效益。

關鍵字

日間照顧 ； 長期照顧 ； 長期照顧十年計畫大溫暖社會福利套案

並列摘要

The needs of caring way for the aging in long term care are multiple. In Taiwan, there are less than 10% of the aging using domiciliary care, but it was schemed that becoming the main way to caring the aging for the future in the ”Long Term Care 10 Years Plan” (LTCP). First, evidently, it might be at the risk and conflict to the day care because of competition. Well, any new programs initiation influencing the other ones for the care, are not considerate. Service user surly has to pay the charge in the LTCP. The domiciliary care service hours decided after examination by care manager, may be changed into day care with the same quota. It was meant, that the quality component of day care for the aging is same with that of domiciliary care from the perspective of service users. This misunderstanding is a big issue and pretty serious, and the whole project with the content is all almost focus on domiciliary care only. Second, The official revised edition of Barthel Index (ADL, IADL) have lower content validity and discriminant validity, and it has huge influence on user of needs. The third, as said before, the idea to combine social welfare dep. with public health dep. in long term care, is still un-concrete in the LTCP.The most proportion (66.9%) of the user in Taiwan were cared by foreigner from the Asian. Well, its main reason was might be not the favor for the aging, but because of extra service for the whole family, which is illegal. As the caring ways of the spectrum in long term care for the aging, the domiciliary care should be not designed to ascribe in one attempt to satisfy the need for all kinds of the aging in long term care.

並列關鍵字

day care ； long term care ； domiciliary care