臺灣社區照顧的實施與衝擊－福利多元主義的觀點

The Implementation and Impact of Community Care in Taiwan-Perspective of Welfare Pluralism

黃源協(Yuan-Shie Hwang)

《臺大社會工作學刊》 5期 (2001/12) Pp. 53-101

https://doi.org/10.6171/ntuswr2001.05.02

摘要

本文旨在藉由福利多元主義的觀點，檢視台灣社區照顧發展脈絡中，政府、商業、志願與非正式部門所扮演的角色，並進一步藉以分析起步中的台灣社區照顧，在福利分工趨勢下所面臨的衝擊，及其在邁向福利多元主義所可能面對的難題與挑戰。研究發現，就人口與社經脈絡的發展言，台灣已逐漸面臨到高齡化社會的老年照護問題，但傳統提供照護的非正式系統也正面臨著轉型，使得正式部門不得不重視趨於嚴重的老人照護問題。在受到福利多元主義的影響下，社區照顧已經成為政府因應的重要策略之一。社區照顧福利供給的四個部門－政府、商業、志願和非正式部門，在老人長期照護的服務輸送脈絡裡，也因而處於一個轉型的年代。對政府部門言，其角色已漸從有限的直接提供者，轉為補助者、購買者、規範者、監督者和某些服務的供給者。為健全社區照顧的發展，明確制訂政策和實務導引，並扮演好財務提供、規範和監督的角色，是政府所應有的作為。商業部門作為照護提供的一份子，如何確保並提升服務品質，以及提供家庭照顧勞務的穩定性，為其所需肩負的社會責任。對志願部門言，隨著契約委託而來的服務範疇與規模的擴展，如何要處理契約與其傳統性格間的兩難，以及如何以「責信」作為服務提供的導引和基礎，將是福利多元主義目標能否真正實現的關鍵因素。對非正式部門言，社區照顧提供支持、補充並強化了傳統家庭照顧的功能，但其理想能否實現且延續，則需端視服務使用者對付費與不付費間的拔河，以及充權能力的養成。

關鍵字

社區照顧 ； 福利多元主義 ； 民營化 ； 志願部門 ； 非正式部門

並列摘要

This paper aims to review roles of state, commercial, voluntary and informal sectors in the context of community care development by using the approach of welfare pluralism. Further, this paper also wants to look into the challenge and dilemma of community care on the way toward welfare pluralism in Taiwan. The demographic and socio-economic trends suggest that it has become more difficult to expect that family should continue functioning as main provider of caring for the elderly, therefore, caring issue has been and will be a matter of great concern for society. Under the influence of welfare pluralism, community care has become one of main strategies of coping the problem. In the context of community care provision, the four parts including state, commercial, voluntary and informal sectors are now in a period of transition. For the state sector, its role is shifting from provider of limited and fragmented services to subsidizer, regulator, monitor and provider in some fields. For commercial sector, as an element of providing care, its responsibility is to improve and guarantee service quality and accountability, and provide a stable source of foreign carers. For voluntary sector, the introduction of contracting out social services has resulted in extension of welfare service's category and scale. The problems needing to be tackled are the dilemma between traditional mission and contract requirements. In addition, whether voluntary organizations can view and take the 'accountability' as their guideline or basis in providing services is a necessary condition for carrying out the ideas of welfare plural-ism. For informal sector, provision of community care provides supporting, supplementing and strengthening family's function in caring elderly people. However, whether the idea can be carried out or not is dependent on a tug of war between the government capability and family's willingness on paying for services.

並列關鍵字

community care ； welfare pluralism ； privatization ； voluntary sector ； informal sector