機構式失智症照顧中社會工作的執行

A Case Study of Social Work Practice in Dementia Care Institutions

楊培珊(Pei-Shan Yang)

《社會政策與社會工作學刊》 4卷1期 (2000/06) Pp. 199-236

摘要

隨著老年人口、尤其是老老年人的迅速增加，台灣罹患失智症的患者人數亦將隨之增加，而失智症症狀的特殊性亦使得失智症照顧成為困難度很高的一種照顧，所以目前台灣亟待開發多元化的服務方案來滿足失智症患者及家屬的需要。本研究以專業社工的角度來檢視社會工作人員在失智症機構式照顧中實際的工作內容、角色與功能、及工作中面臨的助力與阻力。期望能增進機構式失智症照顧團隊中社工人員之專業發展，並促進專業間之合作。本研究屬田野調查，研究地點為台灣目前規模最大的失智症安養院「寧園」，研究設計包含資料檢閱、直接觀察、參與觀察、深入訪談、及非正式談話等多種方法，訪談內容經受訪者同意後錄音，再利用逐字稿進行資料的分析，資料分析採質性的取向。本研究結果發現社工員不但扮演機構對外的門戶角色，更提供多樣性、且性質截然不同的許多服務。而在工作助力方面，主要是與老人的感情、工作經驗累積、工作的成就感、與適當的休息。工作中的阻力則來自於督導系統的缺乏、失智症照顧特殊的挫折感、以及工作內容繁雜。在社工員現已執行的各項功能中，評估及人力資源開發的工作是明顯地心有餘而力不足。為使失智症照顧能更有效地進行，社工員必須對相關服務對象（一般民眾、政府、家屬）進行不斷的失智症教育，才能較順利地克服服務情境中的許多困難。研究者並建議政府應儘速檢討改善失智症照顧相關之補助辦法，使服務提供者能在合理的條件下提供更好的專業服務。

關鍵字

失智症照顧 ； 社工專業角色與功能 ； 質性研究 ； 個案研究

並列摘要

With the fast increase of the aging population in Taiwan, especially that of the oldest old, the number of people with dementia is increasing as well. Dementia care is highly demanding to the caregivers due to the characteristics of dementia patients, which indicates the great need for various care models. This study looks into the institutional dementia care with the perspectives of the social work profession. The actual contents of care, strengths and weaknesses of social work provision are analyzed through a field research in the largest specialized dementia care facility in Taiwan, Ning Yuan. Research methods used include document analysis, direct observation, participatory observation, depth interview, and informal conversations with the Ning Yuan employees. A qualitative approach was adopted to proceed the data analyses. Findings of the study showed that social workers play the role of door keepers for the facility, besides many other tasks related or unrelated to social work professional identity and training.. Strengths of the social workers came from the ties established with the elderly persons being cared, the experiences and a sense of accomplishment they accumulated over time, and appropriate rests. However, the lack of professional supervision and possible burn out due to the difficulties of dementia care were threats to the social workers. Evaluational functions and volunteer management are two areas that were neglected due to the shortage of social workers and their low ranking in the facility. Government is also advised to change the reimbursement regulations for dementia care in order to facilitate further development of specialized dementia care.

並列關鍵字

dementia care ； roles and functions of social workers ； qualitative study ； case study

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