社區組織參與老人社區照顧之研究：以台南市長榮社區為例

An Analysis of Community Organization Participation in Community Care for the Elderly: A Case Study of Zhang Rong Community, Tainan, Taiwan

陳世明(Shih-Ming Chen) ； 陳柏宗(Po-Tsung Chen)

《社會政策與社會工作學刊》 10卷1期 (2006/06) Pp. 49-113

https://doi.org/10.6785/SPSW.200606.0049

摘要

在推動社會福利社區化中，對社區組織的參與有極大的期待。而過去社會福利社區化的推動中多是輔導團體或機構主動規劃、社區被動配合的關係，此常使社區組織因動機與能力不足而致有參與的困難。相關文獻對社區組織參與的檢討較是在被動配合的社區組織的運作問題檢討，從專業者的期待提示社區組織參與的問題，做為實際推動的參考上是有相當的貢獻。但是另一方面若是能從參與意願強且有社區營造經驗的社區組織，在社會福利社區化的實際推動中具體做到的成果進行分析，則應可提供更明確社區組織參與的參考經驗。
因此本研究乃以具社區組織運作經驗且有參與老人社區照顧服務意願的台南市長榮社區為研究對象，以其接受社區營造中心輔導過程的紀錄資料與對社區組織主要幹部的訪談，從社區組織的老人社區照顧服務能力特性、社區組織參與所呈現的老人社區照顧服務內容特性、社區組織自主主動的老人社區照顧服務運作特性等角度，提出志願服務專業性、照顧服務連續性與連帶性、照顧服務的社區自主性等社區組織參與老人社區照顧的原則。依此原則分析長榮社區的社區組織推動老人社區照顧服務的過程經驗，期望藉此呈現社區組織參與老人社區照顧的積極意義與內涵，以提供其他社區組織參與老人社區照顧服務的參考。
研究發現，社區營造中心提供社區組織主動提案的機制，以及在計畫形成與執行過程中從旁提供意見，協助社區組織自己針對問題調整計畫提出對策的輔導方式，確保並強化社區組織對老人照顧服務的參與意願、主動性與自主性。此參與意願、主動性與自主性促使社區在志願服務專業性方面，除主動進行社區志工培訓外，亦藉與社造中心的互動討論以及與外來培訓專業者形成的非正式彈性諮詢機制中獲得專業知識的成長。同時社區組織亦主動藉志工進行社區老人基礎資料調查，並藉在不同的照顧服務提供中掌握老人的動態資料。相對於一般由機構的正式服務尋求與社區接軌的推動模式，此案例形成由社區主動與正式服務接軌的推動模式，而呈現了非正式服務與正式服務互補運作的較完整的社區照顧服務專業特性。
在照顧服務連續性與連帶性方面，一般機構服務是有特定條件的對象與服務項目，此常不易形成連續性的照顧服務。然而在社區組織的主動與彈性運作下，使社區能對不同健康階段的老人提供包括對可行動的較健康老人的社區據點服務、對不便外出的老人的到宅服務以及對重症老人的轉介服務的連續性照顧服務。另一方面，彈性對應問題的能力使社區組織在提供老人照顧服務時，不會僅侷限在固定單一的社會福利服務項目，常會針對老人需求附帶提供相關複合形式服務，使老人社區照顧服務能更貼近於日常生活的需求並呈現多樣的意義價值。
在照顧服務的社區自主性方面，組織自主運作促使志願服務專業性的提升，並促成連續性與連帶性照顧服務的提供。同時亦主動掌握老人健康資料，尋求機構、公私部門資源的支援，媒合老人照顧服務的需求與供給，而形成社區自主的照顧服務輸送模式。因而社區組織除具最基層的照顧服務輸送，一般被期待扮演機構服務「分身」的角色外，此案例提示了社區組織實亦具有「本身」不易被取代的老人在地老化相關服務提供者的角色扮演。

關鍵字

社區組織 ； 社區營造 ； 社區照顧 ； 老人社區照顧

並列摘要

In the past, the promotion of community-oriented social welfare was based mostly on the active participation of counsel groups or professional institutions, while the community organization coordinated the program with these institutions. However, the community organization encounters difficulties in coordinating with these institutions regarding their lack of motives and incompetence. In addition, the literature merely discussed the inactive participation of community organization. However, the literature review helps us to understand the professionals' point of view of the participation of the community organization. For those organizations that are willing to participate, and have substantial participation in community empowerment help to promote community-oriented social welfare, and serve as a reference.
The present research focused on the community care for the elderly program in Zhang Rong community. Depth interviews and participant observation are used to analyze the characteristics of the operation system and content service of organizations that are willing to participate, and have substantial participation in community empowerment. This analysis helps to determine their role in providing community care for the elderly.
The results showed that the community organization takes the initiative to propose a new elderly care program. However, the counsel groups or professional institutions simply provided the community organization with professional and relevant advice, but were not involved in implementing the program. The whole system enhances the participation willingness, initiatives, and autonomy of the community organization. This also gives the community organization an opportunity to provide volunteer training, obtain advice from professionals, improve its professional competence, and grope for the possibility of collaborating with other professional institutions. Most importantly, the community organization tries its best to form a complementary relationship with these professional institutions, which promotes the nurturing of professional community service volunteers.
With respect to the attributes of initiatives and autonomy of the service content, they empower the community organization to offer flexibility in catering to the specific needs of the elderly. On the one hand, nutritious meals, visiting the elderly and health management are given to satisfy the different needs of the elderly. Moreover, the community organization can work with these institutions to provide proper services for the elderly. On the other hand, offering flexibility in elderly care services is not the only goal or service content, but to enable the provision of other relating services to the elderly. As a result, this system adds various meanings and values to the provision of elderly services.
In conclusion, the attributes of initiatives and autonomy improve the professional expertise of the community organization, in which a continuous system of care and relating services are provided. The community organization not only plays a part in providing basic services for the elderly, but also plays an irreplaceable role of offering a variety of integrated services to assist the elderly age in place.

並列關鍵字

community organization ； community empowerment ； community care ； community care for the elderly

參考文獻

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