在地老化：台灣二十一世紀長期照護的政策方向

Aging in Place:the Direction of Taiwan Long-Term Care Policy in the 21st Century

吳淑瓊(Shwu-Chong Wu) ； 莊坤洋(Kun-Yang Chuang)

《台灣公共衛生雜誌》 20卷3期 (2001/06) Pp. 192-201

https://doi.org/10.6288/TJPH2001-20-03-05

摘要

邁入二十一世紀，台灣人口立即飛快老化，老人的長期照護問題將嚴重挑戰我國公共政策。從國際經驗可知，世界主要國家的老人照護政策，均以在地老化(aging in place)為最高指導原則，認為老人應在其生活的社區中自然老化，以維持老人自主、自尊、隱私的生活品質。因此不論國家體制為何，其資源發展、服務提供、組織管理、財務支持等策略，均支持社區長期照護體系的建構，希望以『在地』的服務滿足『在地』人的照顧需求，盡可能延長他們留住社區的時間。反觀我國在行政院1998年核定的兩個三年計劃之下，機構式服務資源大量成長，但是，支持老人留住社區的服務資源卻依然十分欠缺。顯示我國的發展趨勢如不立即調整，將嚴重背離去機構化之世界潮流，將使我國不但必須負擔機構昂貴的照顧成本，又無法滿足我國民眾『在地安老』的願望。因此，我國的老人長期照護政策應全面目標『在地老化』發展，需要努力的方向包含：(一)評估地區長期照護需求，設定發展目標；(二)發展多元的『在地』服務，服務當地民眾；(三)連結資源建構社區照顧網路，提升服務成本效益；(四)優先提供居家支持服務，降低對機構式服務的依賴；(五)建構財務制度，支持社區式長期照護體系之發展。

關鍵字

長期照護 ； 在地老化 ； 政策

並列摘要

In the 21st century, long-term care has presented serious challenges to public policy as the elderly population in Taiwan increases rapidly. Many developed countries have used ”Aging in Place” as the guiding principle for devising elderly care policy. Aging naturally in the community has been a key ingredient in maintaining independence, self-respect, privacy and quality of life. Thus, to be consistent with the concept of community-based care, many countries have started a reform in long-term care resource development, service provision, management, and financial schemes, regardless of political systems. The focus is to develop supportive services locally with the intention of helping the elderly stay In the local community for as long as possible. Contrary to the developed countries, supportive services to help the elderly staying at home are seriously lacking in Taiwan. Two three-year projects, funded by the Executive Yuan in 1998, have led to the dramatic growth of institutions, while community-based care resources remained scarce. Such trend is in the exact opposite direction of ”Aging in Place” principle. If continues, it is expected the society will have to pay for the high cost of institutional-based care, and many elderly will be deprived of the opportunity to age naturally in the community. Therefore4 the elderly care policy in Taiwan needs some adjustments. To be consist with ”Aging in Place” principle and to achieve the goal of staying in the community, reforms and researches are needed in the following areas: (l) Perform need assessment for elderly care in the community level, in order to project resource development, (2) Develop various long-term care resources locally to serve local residents, (3) Integrate service network and to Improve efficiency of services, (4) Encourage home care and other supportive services to prolong time spent in the community, and to reduce the use of institutional care, and (5) Devise a financing scheme consistent with the development of community-based long-term care system.

並列關鍵字

Long-term care ； Aging in place ； Policy