「無法盡責」的家庭照顧者？：家庭照顧者服務據點的發展與挑戰

Undutiful Family Caregivers?: Development and challenges of service centers for family caregivers

陳正芬(Chen-Fen Chen) ； 方秀如(Hsiu-Ju Fang)

《老年學研究》 1期 (2022/01) Pp. 1-42

https://doi.org/10.29703/JGS.202201_(1).0001

摘要

我國自2016年推動的《長期照顧十年計畫2.0》（簡稱長照2.0），服務項目擴大到17項，家庭照顧者服務據點（簡稱家照據點）是其中之一。本研究的目的是回顧與整理我國家庭照顧者政策及服務方案的發展及轉變。有別於先前以家庭照顧者為對象的研究，本研究是以承接家照據點的單位為研究對象，分析七個家照據點在2016至2018三年間服務情況，從家照據點服務提供現況探討家庭照顧者支持服務方案發展困境與挑戰。回顧家庭照顧者進入家庭照顧者支持服務的歷程，本研究發現家庭照顧者支持服務的推動障礙可歸納為二道關卡：（1）服務提供者的「不知」；（2）家庭照顧者的「知而不行」。我國雖已在各縣市成立家照據點，但各相關單位，例如醫院與服務提供單位對家庭照顧者及其需求的認識與否，係家庭照顧者能否實際進入服務體系第一個關卡。第二道關卡為家庭照顧者的「知而不行」，可分為「內在因素－知道卻不使用」與「外在因素－知道卻無法用」；即使家照據點評估為高負荷家庭照顧者，但受限於家庭照顧者本身對「照顧身分」認同與過往受挫的求助經驗，讓家庭照顧者「知道卻不使用」。又另一情境是家庭照顧者服務取得受阻，主要因素源於服務是以照顧接受者的需求為優先考量，讓家庭照顧者「知道卻無法用」。本文提出家庭照顧者的身分認同是過往研究少被關注的面向，家庭照顧者本身對身分認同，不僅是與自己原有家庭身分協商的歷程，亦是與他人互動和協商的過程中，不斷調整的現象且受到更大的社會脈絡的影響。廣設家照據點固然意謂政府部門對家庭照顧者的重視，但不同部會需同步調整，家庭照顧者方能覺察與認同自己的「新」身分。透過個管人員的陪伴，讓不使用長期照顧服務且照顧負荷高的家庭照顧者，從「沒辦法盡到責任」到看見「自己已經盡到責任」，看見自己負荷與侷限性，並試著去調整照顧安排，讓正式服務一起分擔照顧責任，應是預防危機的積極作為。唯有社會大眾、醫事單位與服務提供單位等共同關注此一新興服務對象，家庭照顧者的負荷才能真正被看見並獲得支持。

關鍵字

長期照顧 ； 照顧者 ； 身分認同

並列摘要

Since Taiwan's long-term care 2.0 plan was implemented in 2016, the service items have been expanded to 17, and family caregiver service is one of them. The purpose of this research is to review and analyze the development and transformation of family caregiver policies and service. Differing from research on caregivers and their experiences, this study focuses on caregiver support service providers and analyzes the situation of seven caregiver organizations in the years 2016-2018, and the developmental difficulties and challenges seen in caregiver support service programs. Looking back on the process of family caregivers entering care support services, this study found that the barriers to promoting family caregiver support services can be summarized on two levels: (1) the ＂perception＂ of the service provider; (2) caregivers' ＂knowing but not doing.＂ When family caregivers enter the family caregiver service system, through various channels, service providers' knowledge of family caregivers' services are the factors that determine whether a caregiver can actually enter the service system. The second hurdle is the caregiver's ＂knowing but not doing,＂ which can be divided into ＂internal factors-knowing but not using＂ and ＂external factors-knowing but not able to use＂; even if the service provider evaluates them as being a high-burden caregiver, the willingness of the caregiver to use the support service is low, limited by the caregiver's own identification of ＂caregiver＂ and the frustrating experience of having sought help in the past, so the caregiver ＂knows but does not use it. ＂ Another situation is that the availability of caregiver services is hindered. The identity of caregiver proposed in this article is an topic that has received little attention in previous studies. The identity of ＂caregiver＂ is not only a process of negotiating with one's original family member identity but also a phenomenon of constant adjustment during the process of interaction and negotiation with others. Only when the perspective of family caregivers moves from ＂I didn't fulfill my responsibilities＂ to ＂I already fulfilled my responsibilities＂ will family caregivers agree to use formal support services. Affected by the larger social context, only when the general public, hospitals, and long-term care service providers pay attention to this new service object together can the burden of caregivers be truly seen and lifted.

並列關鍵字

long-term care ； caregiver ； identity