跨域參與共治的社區照顧模式一屏東日間托老服務實驗方案之分析

Community-Based Care across Boundary Integration: A Day Care Center in Pingtung

研究背景：台灣人口老化速度拱、平均餘命延長、生育率下跌且家庭照護能 量縮小，日問照顧是政府積極發展的社區式照顧模式之一，惟實務上面臨硬體設 置法規門檻高、人事成本高等推廣困境。再者，老化是一個動態過程，在地老化 理念須有連續性照顧體主支持，屏東縣政府以提升社區照顧關懷據點的照顧能量 出發，發展日間托老中心實驗方案，以跨域參與共治的新型社區照顧模式，期望 長輩在社區中就能夠得到非營利、平價、社區化、參與共治的全人照顧服務。研究方法：本文將以屏東縣、日開托老中心的實驗方案為例，以評估性研究方式，量化分析照顧情形及服務長輩的狀況，並輔以質化分析管理委員會會議資料以及相 關文件，探討政策形成與執行階段的成效。研究發現：首先，社區照顧關懷據點 成功轉型為日問托老中心的主要優勢：(1 ）迅速回應社區老人的照顧需求﹔（2）非營利、平價、社區化與參與共治﹔（3）擴展照顧服務據點的能量﹔（4）發展多元日問照顧型態：（5）落實社區照顧理念﹔（6）整合資源、達全人照顧目標。其次， 在試辦計畫營運期間，主要面臨的問題以及方案修正如下：（ 1 ）民眾對日托中心認知不足，誤認日托中心為機構照顧﹔（2）失智長輩進入日托中心比例高﹔（3 ）使用者 付費機制建立與堅持﹔（4）堅持志工與照顧服務員的權貴分工﹔（5）協助照顧服務 員面對實務挑戰：（6）收素流程機制、請假制度、定型化契約、緊急事件處理流 程等制度建立。最後，雖然本方案為實驗性質， 未來希望能複製照顧服務模式並 成為照顧服務的給付型態之一，但仍有下列挑戰須面對：（ 1 ）民主過程需時間磨 合、凝聚共識再回應行動﹔（2）照護者家庭的整體性、個別化服務計畫﹔（3）成本 效益分析﹔（4）釐清專業服務的界線。

In recent years， the increasingly aging population， extended life expectancy， lower fertility rate， and a decrease of home care capacity have been important issues in Taiwan. Day care centers are one of the community-based caring models that the government is actively developing. But the high threshold of equipment regulations and labor costs cause difficulty in promoting day care centers. Currently， the local government of Pingtung promotes a cross boundary governance integration by providing a day care center. For the purpose of anticipating elderly care， a nonprofit， fair price， and community-based care service will be able to be provided in a community. This study investigates the effect of a pilot program based on a day care center in Pingtung. The subjects are elders with care service in a day care center. Quantitative and qualitative analyses were applied to analyze the service effect based on the documents from the day care center committee. There are three findings summarized for this current approach: First of all， the day care center is able to: (l)provide early response for the needs of elders in the community; (2)be a nonprofit community-based care service charging a fair price; (3)expand the capacity of care service; ( 4)offer multiple day care patterns; (5)implement community-based care; and (6)integrate care resources. Secondly， there are several problems under pilot operation and modification could be applied: ( 1 )most residents misunderstand the care service of a day care center as institutional care; (2)a high percentage of day care center users suffer dementia; (3)building up user pay mechanisms; ( 4)the division of responsibilities for volunteers and care assistants; ( 5)the struggles of day care assistants; ( 6)building up the mechanisms of the process of registration， leave policy， standard contracts and emergency response. Finally， although this experiment is a pilot program， several challenges are expected in the near future: (l)consensus takes time to be integrated; (2)individual and integral family care service plans should be taken into account; (3)cost benefit analysis should be applied; ( 4)the boundaries of the care services need to be identified.