晚年照顧關係的敘事分析

Narrative analysis of the relationship between the elderly people and the caretaker in the long term care.

徐偉昀(Wei-Yun Hsu)

指導教授 ： 楊文山

國立臺北大學/社會科學學院/社會學系/碩士(2009年)

摘要

本研究透過敘說多位老人、家人和正式照顧者的真實經歷，與「在地老化」政策進行多重向度的對話。生命敘事的特色在於其流動性，本研究依循著老化轉折的時間順序與場域變遷，分為四個主題：老年的生命歷程；照顧關係的社會脈絡；社會福利的角色；在地老化政策的探討。
首先，是老年的生命歷程。在資本主義社會中，老人失去了勞動生產力便沒有社會位置，家庭的權力關係也出現了轉移。老人從退休後的「無身份」，到喪失自我照顧能力之後的「無意志」。當身體日漸衰弱後，老人必須接受去人性化的科層照顧，他們的處境艱難：現代人群的最後旅途，終究是在各個專業照顧機構之間隨處飄泊。
其次，是照顧關係的社會脈絡。在標準程序、紀錄考核，及科層管理的照顧模式中，專業照顧所服務的對象並非老人，而是體系自身，照顧行動違背了最初的照顧動機。由於缺乏對象主體為老人的管理規定與考核辦法，許多平等對待老人的照顧經驗無法得到傳承與發展。
第三，社會福利政策的角色。社會福利由上而下的分配方式，脫離了社會交換中的互惠元素，也脫離了社會關係裡的真實連帶。社會福利體制下的正式照顧者將工作重心放在書表記錄的績效考核，其目的是以更節約的成本照顧更多的老人，福利政策的執行者逐漸喪失了對於「人」的尊重與關懷。
第四、「在地老化」政策偏失於物理空間的地域定義，忽視晚年社會網絡的存有及意義，更忽略了老人的主體性和行動力。老人失去發言的權力，更不可能有自主權，甚至成為福利巨靈（Welfare Leviathan）下的被剝削者。面臨到照顧關係的斷裂，流浪在社區人群中，老人成為在地陌生人。
本研究結合參與觀察、敘事分析及社會網絡分析等不同面向的資料，試圖再現晚年照顧關係的社會與文化脈絡。研究者認為，老人照顧不是在哪裡及由誰照顧的問題，而是老人和照顧者彼此之間如何自我調適與充分溝通的議題。

關鍵字

照顧關係 在地老化

並列摘要

This research keeps a multi-perspective dialogue with the ‘aging in place’ policies by narrating the real experiences of many elderly people, their families and professional caretakers. The emphasis of life narrative is fluidity. Following the time sequence of age transition and the field metamorphosis, the research is divided into four subjects: the life trajectory of seniors, the social contexts for the relationship between the cared and the caretakers exist; the role of social welfare policy; the discussion of ‘aging in place’.
Firstly, the elderly people lose their social position when they lose their working ability in a capitalist society; as the result, the power structure in the family also changes simultaneously. The elderly move from the lack of identity after retirement to the lack of will after losing the ability to self-nurse. As they get weaker physically, the elderly are forced to accept the nursing service that could be somewhat dehumanizing. Hence, their situation is rather difficult. In this sense, modern people’s final journey in their life trajectory is drifting between different eldercare organizations. Second, under the nursing pattern of standard procedure, record inspection, and in bureaucratic management, the professional eldercare organizations do not serve the elders but the institution itself. The action of caretaking has contradicted from the initial motive of nursery. Due to the lack of an elderly-centered management guidelines and assessment approach, many caretakers’ experience that treat the elderly properly and equally cannot be passed down and develop.
Third, the tripling down type of distribution in social welfare system is separated from the reciprocity in social exchange, as well as the real connection in social relations. Under this kind of social welfare system, the formal caretakers put the focus of their work to the assessment in papers in order to use lower budget to take care of more elderly people. The execution of welfare policies gradually loses the respect and care for the ‘person’. Finally, the ‘aging in place’ policy ignores the definition of space and neglects the existence and meaning of the social network of the elderly as well as their subjectivity and agency. When the elderly lose their right to speak, they also lose their autonomy or even become the exploited under the Welfare Leviathan. Facing the disconnection of the care relations and roaming among the community crowd, they become the local strangers.
This research integrated different data from participant observation, narrative analysis and the society network analysis in attempt to reconstruct the social and cultural patterns of the relationship between elderly people and their caretakers. The researcher argues that old age care concerns not only where and who are the caretakers but also the issues regarding how the elderly and their caretakers interact.

並列關鍵字

relationship aging in place

參考文獻

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