我國長期照顧制度變革下小型養護機構之轉型與發展-以屏東縣為例

The transformation and development of small-scale long-term care facilities under the reform of domestic long-term care system in the southern Taiwan county of Pingtung

許書剛(Shu-Gang Xu)

指導教授 ： 林東龍

高雄醫學大學/人文社會科學院/醫學社會學與社會工作學系碩士班/碩士(2021年)

摘要

隨著我國平均餘命不斷延長，老人照顧議題更顯重要。就整體照顧需求而言，小型養護機構扮演的照顧角色和承擔的照顧能量不言可喻。不過，小型養護機構的發展軌跡亦與政府法規變化息息相關。因此，本文擬探究小型養護機構在相關長照政策法規脈絡下的發展情形，並分析小型養護機構的因應作為。
本研究採焦點團體訪談方式，邀請屏東縣小型養護機構負責人、院長、或主任等具決定機構未來方向者參與，共辦理2場次焦點團體、17名訪談對象參與。研究結果如下：1.小型養護機構轉型法人化意願低，主要受設立標準嚴峻、轉型獎助金額不足及轉型成本高昂等因素影響；2.受訪者對政府長照政策的看法包含長照資源挹注不均、居家及社區照顧無法滿足民眾照顧需求等情形，同時，也認為面臨人力聘請困難、持續受相關法規限制影響，以及經營成本持續上揚等挑戰和困境；3.面對長照政策變革，小型養護機構採行因應作為有3類，包含「積極調整」、「順應被動」及「固守本業」型等；4.形成小型養護機構不同因應類型的脈絡因素包含經營者對機構發展風險承擔的意願、對發展相關長照資訊的掌握，以及受小型養護機構不同的發展條件等。本研究建議政府宜提出適性的長照法人化制度、並再放寬小型三不原則；小型養護機構宜朝多元及精緻化的服務方向發展。

關鍵字

屏東縣 ； 小型養護機構 ； 長照機構法人化 ； 長照政策

並列摘要

With national life expectancy becoming continuously extended, the topic of care for the aged has become increasingly significant. For the requirements of entire care, small-scale long-term care facilities play an important care role while providing large care capacity; however, the developmental trace of small-scale long-term care facilities is closely related to changes in governmental regulations, so this article investigates the developmental situation of small-scale long-term care facilities under long-term care policy and regulation while additionally analyzing their coping actions as well.
In this study, a focus group interview methodology was adopted, and the president, dean or director of small-scale long-term care facilities of Pingtung county who have the right to decide directions of future development were invited to participate, and a total of two focus group interview sessions were held with 17 interview targets participating. The research results show that: 1. Willingness toward turning small-scale long-term care facilities into legal entities was rather low, with major reasons being that setup standards were strict, grants for transformation were too low, and the cost for transformation was too high; 2. The viewpoints from persons interviewed on governmental long-term care policy included insufficient investment for long-term care resources, home and community care being unable to satisfy care demand from the public, etc.; meanwhile, there were also problems such as the difficulty of employment of labor, the continuous limitation and influence from related regulations, and the challenge and dilemma of continuous rise in operation costs; 3. Facing reform of long-term policies, these facilities should undertake three coping actions such as “aggressive adjustment”, “conforming and inactive” and “adherence to original business”, etc.; and 4. Contextual factors for forming different coping actions by such facilities included willingness from the business owners for taking on any development risk, the business owner becoming acquainted with related long-term care information, and the different development conditions of such small-scale long-term care facilities. In this study, it was suggested that government should propose appropriate Institutional long-term care juridical entities systems; meantime, small scale three no-policies should be broadened and furthermore, these facilities should ultimately aim towards the development of diversified, discreet and discriminative services.

並列關鍵字

Pingtung County ； small-scale long-term care facilities ； Institutional long-term care juridical entities ； long-term care policy

參考文獻

參考文獻

外文部分

Choi,Y.C.(1999).The dynamics of public service contracting:the British experience.Bristol:The Policy Press.

Johnson,N.(1987)The welfare State in Ttansition:The Theory and Practice of Welfare Pluralism.Brighton,Sussex:Wheatsheaf Books.

中文部分