『團體家屋』模式運用於失智症老人照護服務推動之探討

Discussion on the Implement of Group Home Service Model for the Dementia Elderly

莊秀美(Hsiu-Mei Chuang)

《東吳社會工作學報》 12期 (2005/06) Pp. 75-113

https://doi.org/10.29734/SJSW.200506.0004

摘要

由於失智症的不可恢復性，家屬照顧者在長期照護過程中，經常面臨經濟困窘、家庭失和、社會關係隔絕等生、心理之多重壓力而失去照護的信心及耐性，甚者精神瀕臨崩潰，或將個人情緒轉移至患者身上並憎惡老人的存在，而對患者施虐。另一方面，甚至專業照護機構的工作人員對於失智症的認識也顯得不足，經常覺得患者故意找麻煩而心情不悅，甚而誤解、衝突並排斥患者，以致照護品質受到莫大影響。總之，由於失智症狀的多變及難解，失智症老人照護的難度很高，成為家屬與機構的莫大考驗。沒有疾病像失智症一樣帶給照顧者如此沉重的負荷。現今，藥物尚未能完全治癒老人失智症，因此為失智症老人設計溫馨的居住境境及提供適合的照護模式，成為目前失智症照護的主流。實證研究也證實良好的照護確實可以減去許多因照護產生的衝突。近年來，日本發展失智症老人照護服務不遺餘力，極力推動「團體家屋」（group home），已成為照護失智症老人的主要照護服務機構型態。日本團體家屋的急速成長狀況亦引起國內行政當局、學界及實務界的高度關心。因此，本文特別以國內各界都感高度興趣的日本團體家屋為例，分析探討失智症老人照護服務的發展趨勢。本文之分析以文獻資料為主，輔以筆者多次實地參訪所得相關資料及所見，詳細說明日本團體家屋建構的歷史過程、制度法規等，以提供目前尚未確立失智症老人機構標準的國內當局擬訂相關政策之參考，這也是本文的主要意義與價值之所在。本文主要內容包括：失智症照護的原則，團體家屋的理念與要件，日本團體家屋的發展背景、設立標準與照護服務方式，日本團體家屋的發展現況及對長期照護模式的影響，日本團體家屋的設置標準與國內老人養護機構設置標準之對照，團體家屋的限制，及國內推動失智症老人照護服務發展方向之建議等。

關鍵字

失智症老人 ； 老人照護服務 ； 團體家屋

並列摘要

The staffs at the nursing homes as well as the family care-givers have few knowledge of how to rehabilitate and activate the dementia elderly, while the families have the responsibility to take care of the elderly in Taiwan. As a result, family care-givers caring for their demented relatives experience serious burden and stress. Therefore, dementia elderly make family care-givers and the staffs at the nursing homes depressed very much.The number of dementia elderly is increasing recently in Japan. In 2004, approximately two million elderly are suffered from dementia disease in Japan, therefore, the group home has become popular in caring the dementia elderly. By means of the literature and proof study document, the significant purpose of this article is to analyze the details of dementia elderly group home in Japan, including its background, process of development, and the contents of establishment-act, so as to give some advices to the care service development for the dementia elderly in Taiwan.In this article, the following issues of group home for elderly with dementia are mentioned: the principles of care services for the dementia elderly, the ideas of group home, the details of the group home in Japan, including the background and process of development, the contents of the law on establishment, the care service model and its effect on care service model for the dementia elderly etc., the comparison of the establishment act of Japan and Taiwan, the limitation of care service model of group home, the development direction of care services for the dementia elderly in Taiwan. This article will enhance the understanding toward the characters of group home in Japan, as well as benchmarking the implement of care services development for the dementia elderly in Taiwan.

並列關鍵字

ementia elderly ； care service for elderly ； group home

參考文獻

厚生勞動省公開資料

ミネルヴア書房編集部編(2003)。社会福祉小六法。日本:?????書房。

下村惠美子、三好春樹編著(1999)。介護保險がやつてきた－ケア現場の見方と使い方。日本:雲母書房。

小宮英美(2000)。痴呆性高齡者ケアーグループホームで立ち直る人々。日本:中央公新社。

小笠原祐次ほか編集(1997)。高齡者福祉。日本:有斐閣。