自1993年9月底,我國65歲以上老人人口比例已達高齡化社會指標,人口老化已是鮮明的公共政策問題,它所帶來的影響,除需耗費龐大的醫療服務及急需建構完整的社會福利外,其對家庭的衝擊所產生的社會問題,也是老人相關議題之一個重要的焦點。 老人的照護,在過去是家庭問題,也是家庭的傳統職責之一,我國歷來崇尚孝道,奉養父母是為人子女必須恪遵的社會規範,但隨著家庭結構變遷,家庭照護人力逐漸減少的趨勢,家庭能否持續老人照護的功能則不無疑問。龐大的需求市場卻無法解釋自1999年至2003年間,台閩地區各種老人長期照護機構於未能足額提供社會所需之情況,卻仍然存有許多未進駐床位造成資源閒置,究係何因肇至的市場失靈,國內則未見有探討其中原因的相關文章。 本研究係以計畫行為理論(TPB)之觀點,作為家庭決策者將失能而待照護之成員送入長期照護機構動機因素的觀察依據。依該理論之三個構面,即「態度」、「規範」及「控制」並結合前人過去之研究,各自發展影響因素。研究發現,足以解釋「態度」面之主要因素為「避免不利流言」及「維持家庭正常功能」;足以解釋「規範」面之主要因素為「權威服從」及「親友支持」;而對於所在客觀環境的可控制力、支配力之認知即足以解釋「控制」對於行為意向之影響。各構面之因素強度自強而弱分別為「避免不利流言」、「控制」、「維持家庭正常功能」、「權威服從」及「親友支持」;構面因素本身則又受所處環境、經濟水準、年齡、社會地位等人口統計、社會變項之影響有強度及方向不等之相關。 然則,本研究係在照護者明顯感受到照護工作對自己、家庭等的不利因素下完成,若能排除所感受到的不利如完善之社會福利、社會支持等,所觀察的結果是否將另有發展,則值得另行探究。在機構式照護與政府的在地老化的精神相左時,政府及營運機構當如何互相適應,實為未來的重大挑戰。
In Taiwan, the elder population had developed as the aging society index since September 1993 and the aging population is a stark public policy problem. The aging population need great amount of medical service and social welfare, moreover, it take a big strike to family values. In traditional Chinese society, that’s family’s responsibility to take care of elders, but the function became more weak in virtue of family structure variation. In the period of 1999 to 2003, the long-term care facilities had a large surplus of service while the market had great demand. However, we can’t find any research to discuss the real reasons about the market failure. This research base on the Theory of Planned Behavior (TPB) view to identify the motive of decision makers who might let their elder familiar go to long-term care facilities. According to the theory, three main dimensions are attitude toward the behavior, subjective norms and perceived behavioral control. We follow the main dimensions to develop the factors. As research results show that “avoid disadvantageous rumor” and “maintain proper family function” could explain the attitude dimension; “obey authority” and “relatives and friends support” might interpret the norm dimension; “cognition about control force of environment” would elucidate the control dimension. The degree from strong to week is following as “avoid disadvantageous rumor”, “control force”, “maintain proper family function”, “obey authority” and “relatives and friends support”. All dimensions will relative to environment, economic, age, and social position etc. This research accomplished under the caregivers who feel detrimental about social welfare and social support. The research outcomes might be different if the detrimental factors could be eliminated from caregivers. It will be a great challenge in the future for government and long-term care facilities to accommodate each other while their policy and operation spirit isn’t the same.