心智障礙住宿型機構管理者制定老化服務模式之研究

The research for the managers' formulating aging service models for the intellectual and developmental disability in the lodging institution

黃憶湄(Yi-Mei Huang)

指導教授 ： 陳政智

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(2018年)

摘要

心智障礙者由於認知因素無法自我照顧，需要倚賴照顧者，隨著失能的程度加重，無法照顧的家庭就會把他們送入機構。隨著長年住在住宿型身心障礙福利機構的心智障礙者壽命延長、出現提前老化、退化的現象，又因為在地老化的服務概念，老化後的需求及服務成為機構面臨的挑戰。因此本研究以探索性質性研究方法，訪談國內已經執行老化服務模式的住宿型身心障礙福利機構，實際負責決策、管理老化服務模式的中高階主管，總共16間機構、18位管理者，探討從最初制定老化服務模式的契機、研擬過程的思考脈絡及轉折，以及對老化服務模式的想法。研究結果發現機構制定老化服務模式最主要是因為住民的改變、住民的需求增加、機構轉介困難及秉持在地老化的服務理念等原因不得不制定老化服務模式。目前機構實際執行老化服務模式後也發現國家的政策尚不明確無所適從、機構工作人員專業不足、人力不足，以及機構的經費有限等服務困境。若秉持在地老化的服務理念，未來機構必須提供不只是延緩老化的服務模式，更多以長期照護為導向的服務，落實服務的多元連續性。最後，依據研究結果提出：政府政策及規範應回歸機構住民的需求，重視心智障礙者老化的現況和機構專業能力、工作人力、經費等問題，機構也應具備老化的敏感度，正視住民老化的需求，及早思考老化服務模式，落實在地老化及多元連續性的服務理念等建議。

關鍵字

身心障礙者 ； 心智障礙者 ； 老化 ； 機構經營管理

並列摘要

Due to cognitive factors, the intellectual and developmental disabilities need to rely on caregivers because of being unable to take care of themselves. As the increasing degree of disability, the family, who cannot care them any more, are going to send them to the lodging institution. With the disability people's prolonged lives in the lodging institution, the phenomenon of the premature aging and the degradation, and the service concepts of the aging in place, the lodging institutions have great challenge for the needs and services after disability's aging. Therefore, in this study, I adopt the method of exploratory qualitative research, and interview 18 managers who are working in the 16 lodging institutions for the intellectual and developmental disability, and actually are responsible for the decision-making and the management of the aging service models. The purposes are to figure out their reasons for formulating the aging service models in the beginning, the thinking and transition processes, and the ideas of the aging service models. In the study, I find that the aging service models are formulated by the lodging institution mainly due to the residents' changes, the residents' increasing needs, the difficulties of the referrals, and the principles of the aging in place. After the institution actually implements the aging service models, it also finds out a couple of problems which are the facts such as, the national policy is not quite clear, the professional staff are insufficient, the institutional manpower is lacking in, and the funds of the institution are limited. If the lodging institution will adhere to the principle of the aging in place, it has to provide a service model which not only delays aging, but also provides a long-term care-oriented service, and implement a multi-continuity service as well. Finally, based on the results of the study, I suggest that the government policies and norms should be returned to the needs of institutional residents, and the government also should pay attention to the current situation of the intellectual and developmental disabilities, and value the professional ability of the institution, the manpower of the institution, and the funds of the institution…etc. In addition, the institutions should also learn the sensitivity of the aging, face the needs of the aging, early consider about the aging service models, and implement the service concepts of the aging in place and the multi-continuous services.

並列關鍵字

people with disabilities ； intellectual and developmental disabilities ； aging ； Institutional management

參考文獻

吳淑瓊、莊坤洋（2001）。在地老化：台灣二十一世紀長期照護的政策方向。台灣公共衛生雜誌，20(3)，192-201。

一、中文部分

內政部（2013）。中華民國100年身心障礙者生活狀況及各項需求評估調查報告。台北：內政部。

王守玉（2012）。簡介紮根理論研究法。護理雜誌，59(1)，91-95。

王國羽（2007）。居家中老年智障者的照顧問題：性別、居住安排與相關論述。身心障礙研究，5(1)，1-29。