失智照顧「男」不難？男性照顧者之照顧歷程與日照 服務使用經驗

The caregiving experience and day care service utilization experience of male caregivers

張安瑜(An-Yu Chang)

指導教授 ： 趙曉芳

國立臺灣大學/社會科學院/社會工作學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701516

摘要

罹患失智症的機率隨著年齡增加而變大，而人口老化的趨勢使失智症疾病與照顧議題備受關注。回顧照顧者相關文獻，發現研究對象多以女性為主，但隨著社會環境的改變，男性照顧者逐漸出現在非正式照顧領域卻鮮少被提及。據此，本研究欲探討失智症長者的男性照顧者的照顧歷程，包含發現親人失智、承擔照顧者角色及適應與學習的過程。

近年來政府積極推動長照政策，並將社區式服務列為重點，研究者以日間照顧服務為例，欲瞭解失智症患者的男性照顧者服務使用的經驗，從決定使用服務到與正式服務間的分工，以及服務使用的正向經驗與困境，期待能透過研究結果瞭解男性在服務使用與照顧經驗上的獨特之處，以提供第一線的實務工作者對男性照顧者有更高的敏感度。

由於照顧歷程與服務使用經驗是相當個人化的議題，因此本研究以半結構式深度訪談10位男性照顧者，其中包含8位兒子照顧者與2位丈夫照顧者，研究發現簡述如下：

一、成為男性照顧者的動態歷程：從發現長輩失智開始，到擔任照顧者的原因與意義，以及適應與學習照顧者角色的過程，其中以兒子照顧者的照顧分工為歷程中最大的困境。

二、日照服務使用經驗：在使用日照的決策上，丈夫照顧者多半較為被動，決定權多在子女手中。在家庭與日照服務間的分工中發現，日照主要提供各式活動與社交機會，為家庭示範一種新的照顧安排方式，也為男性照顧者帶來規律穩定的生活。而使用服務上的困境則是在於被照顧者失智症逐漸嚴重時，日照服務會考慮退托，使男性照顧者感到被專業權威拒絕。

對應上述研究結果，研究討論著重於：1.男性照顧者的出現不再只是沒有可替代的女性人選，而是女性在家中有無可取代的地位，如經濟能力，以及觀念的轉變，男性照顧者認為照顧應由自己執行，不再受到傳統性別分工的束縛；2.當被照顧者病程變嚴重，男性照顧者也更需要喘息，面對被退托的結果感到相當沮喪和焦慮，應重新思考日照服務收案的標準與服務主要的目的。

基於上述，針對男性照顧者提出的建議包括，提供專屬於男性的支持團體，可區分出兒子與丈夫照顧者不同的討論主題，並破除照顧性別女性化與照顧者犧牲奉獻的迷思；針對正式服務體系的部分，除了增加日照的設置以為應需求外，建議強化社區式服務的連續性。

關鍵字

失智症 ； 男性照顧者 ； 兒子 ； 丈夫 ； 日照服務

並列摘要

The risk of diagnosis dementia increases with age, and the trend of population aging calls attention to dementia care. In reviewing caregiver's literature, the subjects were mostly female, but with the change of the modern society, male caregivers gradually appeared in the field of informal care with rarely mentioned. Accordingly, the study aims to explore the care process of male caregivers who take care of the elderly diagnosed with dementia, including finding out the elderly has dementia, taking responsibility of being caregivers, adapting and learning to be a caregivers.
In recent years, Taiwan Government has been actively promoting long-term care policy and has focused on community-based services. Researcher take day care services as an example, try to discover day care service utilization experience of male caregivers, including who is the decision maker of day care service and division of labor between formal services and informal care, also positive and negative experience. It’s expected to be able to understand the unique aspects of male caregivers experience in the use of formal services and caring experience through the study, and provide first-line social workers with greater sensitivity to male caregivers.
Care and service utilization experience is a personal issue. Therefore, the study employs a qualitative approach, including semi-structured, in depth interviews with eight son caregivers and two husband caregivers. The findings are as follows:
First, process of becoming a male caregiver. The process includes finding out the elderly diagnosed with dementia, taking the caregiver role, adapting and learning to be a caregiver. The most challenge thing in the process is son caregivers need to cooperate with his sibling.
Second, day care service utilization experience. In the decision making process, husband caregivers are passive, his kids are the keyperson to interact with formal service. In the division of labor between family caregivers and day care services, day care services provide daily activities and the chance for the elderly to socialize. Also, day care service demonstrates a new way for how care arrangements could be, and benefits a stable life to male caregivers. But there still some dilemma when the elderly’ dementia is getting worse, the day care service will consider to end up providing service. Then, male caregivers feel frustrated to be rejected by professional authority.
Correspond to the findings, research discussion focus on: 1. the reason why male caregivers emerge is not because there are no female caregivers can substitute, but because those female got the irreplaceable position in the family such as financial ability, also traditional gender division of labor is no longer regarded as a standard. 2. When the recipient dementia illness becomes serious, male caregivers need more respite, but face to the result which is refused by the day care service, male caregivers feel depressed, we need to rethink about the acceptance criteria and the purpose of the day care service.
Based on the above, suggestions for male caregivers include providing male caregivers support group which can divide male caregivers from sons and husbands, and break away care-feminization and the myth that caregivers must sacrifice themselves. Suggestions for formal service include not only increase the number of day care centers but also strengthen the continuity of community services.

並列關鍵字

dementia ； male caregivers ； sons ； husbands ； day care service

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