長照2.0政策落實與實踐問題:以高雄巿從業人員之經驗為例

本文就高雄巿老年人長期照護的現況與政策面進行研究分析。在研究的過程中：(1)使用文獻分析法及參考國內外對長期照護的成熟經驗與做法，進而瞭解臺灣與高雄巿老年人長期照護歷史、居家照顧狀況、以及政府在公共政策上，對長期照護及居家照護事業政策與施行內容。(2)以深入訪談法與焦點團體訪談法，召集政府與民間組織（高雄巿政府社會局及相關長期照護單位人員、長期照護機構負責人、護理人員及長期照護相關科系教授）一同參與座談，針對政策面進行長期照護制度與問題之探討，讓我們更加瞭解，高雄巿老年人長期照護之各種面向執行情況、面臨之問題與未來改進的方向。最後，依據研究的結果得出結論並提出實際的建議。主要研究結論為：(1)社會與經濟方面：照服員就業意願低、照服員人力不足、社會教育需要加強、大眾對“照服員”認知不足，且對“機構”缺乏社區認同感、政府對長期照護的預算不穩定。(2)政策與法治方面：雙軌制無法兼顧長期照護政策、政策朝夕令改、長期照護資訊宣導不周。(3)服務供給方面：各單位分工職責不清、服務供給不足、無法滿足服務需求。由結論提出的建議： (1)社會與經濟方面：建立照服員之專業知識與形象、改善照顧服務員勞動條件、加強社會大眾對照服員的尊重、多元財源方式，減緩長期照護經費壓力。(2)政策與法制方面：建議廢除”長期照護雙軌制”且成立外籍看護監控系統、運用社區化服務，提高長期照護使用率。最後，對臺灣未來長期照護的期望與省思：包括健康促進、延長“健康餘命”及強化自我照顧的能力；做好慢性病管理與提升照護效率及推動醫療與照護連攜服務機制等。

關鍵字

長期照護；老年人；居家服務

並列摘要

This research is a study of Long Term Care policy implemented in Kaohsiung City.It analyses from both policy aspect and practical aspect. In the course of the research , it applies the methods as follows: (1) document analysis survey method and the practice of long-term care both domestic and overseas (2) depth interviews and focus group interviews – discussion and further improvements. Finally, based on the research, it will offer practical suggestions for improvements. The conclusions of the research are as follow: (1) social and economic aspect : low willingness to work as home care workers, the shortage of workforce, lack of the knowledge of long-term care in public, and government’s unsteady budget for long term care policy (2) political and legal aspect: the details of Long-Term policy are often revised and citizens are not efficiently well-informed (3) service aspect: unclear duties between various departments, insufficient supplies of service and lack of reaching the demand of the citizens. Practical suggestions are as follow: (1) establish professional skills and strengthen image and public respect of home caregivers as well as the working conditions (2) abolish the “Long-Term care dual-track system” and establish a foreign care monitoring system in order to increase the rate of utilization of Long-Term care (3) set up the quality supervision to monitor the satisfaction of service Finally, expectation and reflection on Taiwan’s Long-Term care in the future: (1) Prolong “ Health Life” and strengthen self-care ability (2) Improve the management of chronic disease and care efficiency (3) Promote medical and care connectivity services.