被看見與不被看見：失智者服務使用與權益保障的困境與挑戰

我國失智症人口數量快速增加，政府近年也大力發展失智症的社會照顧服務，然而大多數的失智者仍未獲確診，或未接受適當的治療。既有文獻對於失智者「未獲服務」（non-take-up）的研究發現，有助於理解我國失智症者被遺漏在正式服務體系之外的現象。本文從微視、中介與鉅視等相關層面，來檢視失智者與其家屬提出申請、進入正式服務體系的過程與機制。本文深入檢視影響失智者是否提出申請與使用相關服務的重要因素，包括：社會烙印效果、就醫與診斷困難、完成身障鑑定的挑戰、長照服務申請與使用的障礙、以及執行監護或輔助宣告的限制等，以瞭解失智者及其家屬欲使用現行健康照顧、福利資源與法律服務所面臨的困難與挑戰，並提出具體的政策建議。

關鍵字

失智；服務輸送；長期照顧；輔助宣告；監護宣告

並列摘要

The number of people with dementia is increasing rapidly in Taiwan. The Taiwanese government has been making efforts to improve various services for them. However, a medical assessment service is still not available to the majority of them and they are yet to receive the social services they need. Findings from existing studies have offered valuable knowledge on the main reasons that lead to the exclusion of patients with dementia from the formal service system. This study consulted relevant literature for analysis. Individuals' motivations and the potential influence of micro, intermediary, and macro factors on the non-take-up of benefits were employed to analyze the process of applying for and receiving services. Issues related to social stigma, obstacles to assessment and health services, situations after being diagnosed with dementia, challenges in applying for and using formal services, and the pros and cons of applying for legal guardianship and assistance were all discussed. This study expands the understanding of problems and challenges related to health service, welfare resources, and legal services for people with dementia. Finally, this study offered policy recommendations for improving the service system for dementia patients.

並列關鍵字

Dementia ； Service Delivery ； Long-term Care ； Guardianship ； Curatorship

參考文獻

Vernooij-Dassen, M. J., E. D. Moniz-Cook, R. T. Woods, J. De Lepeleire, A. Leuschner, O. Zanetti, J. de Rotrou, G. Kenny, M. Franco, V. Peters, & S. Iliffe (2005). Factors Affecting Timely Recognition and Diagnosis of Dementia Across Europe: from Awareness to Stigma. International Journal of Geriatric Psychiatry, 20(4), 377-386. DOI: https://doi.org/10.1002/gps.1302

石又敏、陳玉敏、曾月霞（2010）。〈家屬陪伴失智症患者門診就醫之生活經驗〉。《長期照護雜誌》，14（1），43-56。