近來衛生醫療與長期照顧政策均傾向社區照顧模式,強調去機構化的概念,改以支持家庭與社區為基礎的照顧形式。但這類模式的發展卻是依靠家庭照顧者相當程度的貢獻與犧牲來成就,這些個人才是現今長期照顧體系的核心骨幹(backbone)。然而,當這類模式正強加壓力在家庭成員與親友等照顧角色的同時,卻未曾思考可能帶來的負面效應。家庭照顧者儘管承受相當程度的財務、情緒與生理負荷,卻仍須持續家中失能成員的照顧工作。儘管政策制定者與實務工作者覺察到他們在長期照顧中扮演著重要角色時,卻未能系統化地評量他們的處境與需求,協助決定所需的協助與服務。因此,提供家庭照顧者評量是協助家庭照顧者獲取維持健康與福祉服務重要的第一步。此項評量工具的重要功能在協助實務工作者瞭解家庭照顧者日常照顧狀況、其壓力與負荷來源和背景,以規劃出適切的支持性服務。評量的運用不僅可決定照顧者支持性服務的使用資格,也可作為家庭照顧者照顧服務計畫成效之實證基礎。本研究的主要目的在於闡述家庭照顧者多面向評量的重要性與功能,以及家庭照顧者評量與支持性服務之關連性。最後,本研究將探討規劃家庭照顧者評量工具的理論架構與內容,以及執行上的相關議題,作為未來相關立法與實務建議的根據。
Recent shifts in long-term care policies have move away from hospitalization to care in the community and emphasize deinstitutionalization in favor of home- and community-based care options. Success often depends on the essential contribution of family and informal caregivers, who are the backbone of the long-term care system. However, this progress continues to put pressure on family members and friends to take on caregiving roles, despite the risk of negative consequences. These caregivers-generally wives and adult daughters-bear most of the financial, emotional, and physical strain of locating, organizing, and providing care to family members and friends. While policy makers and practitioners increasingly recognize the central role that families play in coordinating and providing long-term care services to frail elders and people with disabilities, these professionals have dedicated little effort to systematic assessment of the situation and the well-being of family members or informal caregivers to determine what assistance they may need. Therefore, an assessment can be the first step toward helping caregivers obtain the information and services they need to maintain their own health and well-being in the face of the caregiving tasks before them. Caregiver assessment may determine eligibility for caregiver support services and can serve as a basis for a care plan and services to support and strengthen family caregivers. This article focuses on assessment from a new perspective, that of the family caregiver. It also justifies the connections between caregiver assessment and supportive services for family caregivers. This article also discusses implications for policy, practice, and further research.
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