不務正業?財團法人老人養護機構推動社區照顧工作經驗之分析

社區照顧是實踐老人長期照顧「在地老化」理念的重要基礎。目前臺灣老人養護機構在政策引導和自身機構生存需要等脈絡下，提供老人社區照顧服務。究竟老人養護機構提供的社區照顧服務，如何體現社區照顧內涵，為本研究主要探究焦點。本研究藉由國內外社區照顧文獻資料，耙梳社區照顧相關核心概念與變遷，並作為與養護機構實際執行社區照顧服務的對話基礎。本研究以屏東縣兩家財團法人老人養護機構為分析對象，資料來源包含以深度訪談法收集機構內主管和服務人員等執行社區照顧的經驗、機構內部社區照顧服務計畫和相關會議紀錄，以及屏東縣居家照顧服務計畫。主要研究結果有三：第一，養護機構提供社區照顧服務的考量包括看見社區居民的需要、能與社區分享機構資源、為擴展客源，以及渴望佔有一席之地等因素；第二，公部門提供經費委託養護機構辦理社區照顧服務，但因行政監督強調標準化原則，造成機構落實個人化服務的困難；第三，養護機構運用當地人照顧當地人、服務輸送零距離、以服務對象生活經驗和文化為優先等方式，突破契約委託服務的困境，讓個案在家亦可獲得重視人性尊嚴的社區照顧服務。本研究建議，政府單位應修正現有以契約委託養護機構提供社區照顧服務之方式，轉而協助養護機構扮演培力社區照顧網絡的角色，不僅可避免社區照顧服務商品化的趨勢，亦可鼓勵養護機構發展垂直式延伸的服務模式，開啟養護機構企業化經營的另一條路。

關鍵字

社區照顧；養護機構；居家服務；在地老化；財團法人

並列摘要

The most essential basis of realizing the idea of “aging in place” is community care. Currently in Taiwan, the senior citizen nursing institutions provide the welfare services of community care for the elderly because of the policy guidance and maintaining the organization itself. This research is focused on how the service, provided by the senior citizen Nursing institutions, practices the connotation of community care. The reference results of preliminary studies about relevant core concepts and changes in community care can be contributed to purpose the nursing homes practice community care. Taking two nursing homes in Pingtung County as the objectives in this research, the reference resources included are as follows, collecting the experiences about practicing community care from the persons in charge and the welfare institutions staff through Intensity interview, analyzing the plans about community care service, transcribing the relevant meeting minutes, and developing a project of home care services in Pingtung County. This study has three major findings: First, the considerations of providing the community care by the institutions include finding out the community residents’ needs, sharing nursing institution resources with the community, expending its markets, and having a share in social welfare. Second, though the government supplies funds to entrust the agencies with the community care services, there have difficulties for the Nursing institutions in realizing personalized services on account of the administration emphasis on the standardized principles. Third, investigating the ways locals take care of locals, the zero distance between the services delivery, and how their clients’ life experiments and cultures as viewed as a priority can break through the predicament of the services according to the contracts, and make the case for obtaining community care to attach importance to personal dignity. The research has suggested the government should modify the present way that the nursing homes provide services of community care via signing a contract and help the nursing homes play roles of community empowerment practicing community care. It can not only avoid the trend that the community care is commercialized but also encourage the nursing homes to develop extension in vertical direction service mode; that is another way for nursing homes to practice the business operation mode.