兩岸獨居老人生活需求與照顧模式異同之研究 －以台北市(台灣)和南京市(中國)為例

A Study on the Similarities and Differences Between the Needs of Life of and the Models of Caring for the Elderly Who Live Alone in Taiwan and China — Taking Taipei, Taiwan and Nanjing, China as Examples

林 小 圓(Shiau-Yuan Lin)

指導教授 ： 陳燕禎 博士 ； 施教裕 博士 ； 黃旐濤 博士

元智大學/資訊學院/資訊社會學研究所/碩士(2006年)

摘要

台灣地區65歲以上老人占10%，老化指數超過52%；大陸地區65歲以上老人已達7.7%，老化指數35.6%。兩地明顯都在加劇「老化」的速度。加上少子化家庭日益增加，使得老人照顧資源普遍發生不足的現象，尤其「獨居」老人的照顧資源不如一般家庭居住老人，當獨居老人生病或發生意外時，更顯晚景悽涼。因此，本研究以台北市和南京市作為研究場域，以質性研究的深入訪談方式收集資料，以瞭解兩地獨居老人的生活需求與照顧模式，並加以比較。研究結果發現：
一、兩岸老人獨居因素異同：(一)個人因素：多數獨居老人認為自己有住房，身體尚健康，可以獨居生活。少數因個人潔癖及喜歡安靜害怕被打擾而獨居。(二)家庭因素：多數因喪偶和子女成家後而獨居。(三)健康因素：南京市獨居老人比較能接受未來無法自理時住機構。(四)經濟因素：多數認為目前已經獨居習慣了，不會因個人生活經濟影響獨居選擇。
二、兩岸獨居老人生活需求及資源獲取：(一)住房需求：兩地獨居老人多數住無電梯公寓，南京市獨居老人有高樓層換低樓層的居住需求(二)緊急救援連線(安康通)需求：有使用者多數表示不能沒有它，未使用因素：兩地多數認為不需要，台北市少數認為有被監視的感覺、怕忘記戴緊急救援連線手錶造成困擾；南京市多數不知道有安康通。(三)保健預防與醫療照顧需求：獨居老人保健預防全身健康檢查、預防感冒注射：台北市免費；南京市須自費。需要照顧時：兩地獨居老人多數能獲得子女照顧。台北市無子女的獨居老人多數無人照顧，少數請看護；南京市僅少數子女在外地及親子關係不佳者無人照顧。(四)居家服務需求：台北市未使用者多數認為不需要；南京市多數不知道有居家服務。(五)機構養老需求：多數喜歡在家養老。台北市住進老人機構有補助；南京市除了低保戶中的三無老人之外，無任何補助。(六)文康休閒：台北市多數獨居老人喜歡參加旅遊休閒活動；南京市多數獨居老人對文康休閒活動不感興趣。(七)經濟需求：中階收入以下者認為若生病就會有需求。台北市低收入戶獨居老人認為尚夠用；南京市低保戶獨居老人認為不夠用，希望政府能提高扶助金。 (八)後事安排：兩地獨居老人已準備好塔位或墓地者，以有子女的居多。台北市以火化後安奉進骨灰塔的居多；南京市以火化後埋墓地的居多。
三、兩岸獨居老人照顧模式：台北市以自我照顧、家庭照顧、社區照顧等合併成「多元性社區照顧」，並依個案管理模式，由老人中心整合照顧資源，亦即健康時，自我照顧；生病或半自理時，自我照顧、家庭照顧、社區照顧；失能需要長期照顧時，則家庭照顧、社區照顧與機構照顧共同提供照顧服務等。南京市以「複合式」照顧模式為主，分為(一)A照顧套餐 (健康者)：自我照顧為主，家庭照顧為次，搭配使用社區老年大學、文康休閒活動服務。(二)B照顧套餐 (半自理者)：家庭照顧為主，自我照顧為次，搭配使用社區關懷問候、老年大學、醫療服務、安康通、居家服務等。(三)C照顧套餐(全護理者)：由家庭照顧為主，搭配鐘點工、社區醫療服務。 (四)D照顧套餐 (全護理者)：生活經濟及照顧需仰賴他人，以社區照顧為主，搭配醫療服務、機構照顧。
隨個人需求訂不同的照顧套餐。最後針對兩岸獨居老人照顧提出建議。

關鍵字

兩岸 ； 獨居老人 ； 生活需求 ； 照顧模式

並列摘要

In Taiwan, ten percent of the population are over 65 years old, with the aging index being over 52% while in China, up to 7.7% of the population are over 65, with the aging index being 35.6%. The aging of population on both sides of the Taiwan Strait, namely Taiwan and China, is obviously accelerating. On top of that, more and more families are having only one child or no children at all, so that generally speaking, there are insufficient resources to care for the elderly. The elderly who live alone may obtain even fewer resources than those who live with their families. When a senior citizen who lives alone falls ill or has an accident, his life becomes even more miserable in this old age. This study chose Taipei City and Nanjing City as its research fields, adopting a qualitative research approach. Information was gathered by means of in-depth interviews in order to understand the respective needs of life of and the models of caring for the elderly who live alone in these two cities, and then a comparison was made. The findings are as follows:

I. Reasons for living alone:
1. Personal factors: Most of the home-alone senior citizens think that they can afford to live alone because they have their own houses and they are still healthy. A few of them choose to live alone because of personal preoccupation with cleanliness, a preference for quietness and fear of disturbance.
2. Family factors: Most of them live alone because their spouses have passed away and/or their children have got married.
3. Health factors: The idea of moving to an institution when they become unable to look after themselves in future is more acceptable to the home-alone senior citizens in Nanjing City.
4. Financial factors: Most of them think they are used to living alone, so their choice to live alone will not be affected by personal financial conditions.

II. Needs of life and obtaining of resources:
1. Housing: Home-alone senior citizens in both Taipei and Nanjing mostly live in apartment buildings that have no elevators. Those in Nanjing need to move from higher floors to lower ones.
2. Emergency hot line (An-Kang-Tong): Most of the users of this device say that they cannot do without it. The major reason why other home-alone senior citizens in both cities are not using it is that they think they don’t need it. Besides, a few of those living in Taipei say that they feel like being watched or that they are afraid to cause trouble by forgetting to put on the emergency hot line watch. On the other hand, many of those living in Nanjing do not know that there is such a thing as An-Kang-Tong.
3. Disease prevention and medical care: Home-alone senior citizens living in Taipei don’t need to pay for a medical or a vaccination against flu while those in Nanjing do. Children of most of the home-alone senior citizens in both cities would care for them when necessary. Most of the childless home-alone senior citizens in Taipei have nobody to look after them while a few of them hire caretakers. In Nanjing, only a few whose children live in a different town or city or whose relationship with their children is poor would have nobody to look after them.
4. Home care service: In Taipei, most of those who do not use this service think that they don’t need it while most of those who live alone in Nanjing know nothing about home care service.
5. Institutions for the elderly: Most senior citizens prefer to spend their later years at home. In Taipei, those who live in a nursing home will receive a benefit while in Nanjing nobody receives any benefit except for those who are from low-income families and are in an extremely difficult situation.
6. Leisure activities: Most of the home-alone senior citizens in Taipei like to take part in tours and other leisure activities while most of those in Nanjing are not interested in these activities.
7. Finances: For those from families whose incomes are below average but not low enough to get a benefit, they feel they would need a benefit if they become ill. Home-alone senior citizens from low-income families in Taipei think their benefits are enough while those in Nanjing think their benefits are insufficient and hope that their government may increase them.
8. Funeral arrangements: If a home-alone senior citizen in either Taipei or Nanjing has reserved a place in a cinerary tower or a cemetery, it is most likely that he or she has a child or children. In Taipei, most of them choose to be cremated and kept in a cinerary tower after they die while in Nanjing, most of them prefer to be cremated and buried in a cemetery.

III. Models of caring for home-alone senior citizens:In Taipei City, “the multiple community care” model consists of self-care, family care and community care. And the senior citizens centers will integrate all of these resources of care and operate by a case-by-case control model. To be more specific, when a senior citizen is in good health, he will look after himself. When he is ill or can only be partially responsible for looking after himself, then there will be a combination of self-care, family care and community care. When he is dysfunctional and needs long-term care, then the family, the community and an institution together will provide care for him. On the other hand, in Nanjing, the “compound” caring model is prevailing, including four “set-meal” types of care: 1.Set-meal type A care (for the healthy ones): The “main course” is self-care while the “side dish” is family care, coupled with community colleges for the elderly and leisure activities.2.Set-meal type B care (for those who can only be partially responsible for looking after themselves): The “main course” is family care while the “side dish” is self-care, coupled with visits by the community, colleges for the elderly, medical service, An-Kang-Tong, home care service, and so on.3.Set-meal type C care (for those who need nursing care 24 hours a day): The “main course” is family care, coupled with workers paid on an hourly basis and community medical service. 4.Set-meal type D care (for those who need nursing care 24 hours a day): For those who need to rely on others for finances and care, the “main course” is community care, coupled with medical service and institution care.

Thus, based on the various needs of each individual, different set-meal types of care are provided. In conclusion, suggestions are made with respect to the care for the elderly who live alone in Taiwan and China.

並列關鍵字

both sides of the Taiwan Strait ； the elderly who live alone ； needs of life ； care model

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