嘉義縣社區整體照顧 ABC 模式──民雄、溪口

Chiayi County Comprehensive Community Care ABC Model: Minxiong & Xikou

臺灣於2007年4月核定「長期照顧十年計畫」，期待以此計畫來建構一個符合多元化、社區化（普及化）、優質化，可負擔及兼顧性別、城鄉、族群、文化、職業、經濟、健康條件差異之長期照顧制度。歷經十年後，已發展相關服務輸送體系與服務供給。2016年12月「長期照顧十年計畫2.0」正式上路，並徵選全臺各縣市試辦ABC社區整體照顧模式單位。截至2016年9月底，筆者所在之嘉義縣65歲以上老人人口比率已高達17.72%，縣內多數鄉鎮市的老人人口比例均超過世界衛生組織所定義14%老人人口的高齡社會，是個典型老化的縣市。人口老化衍生之身體功能退化與慢性病隨之增多，導致失能、失智個案不斷增加，加上社會結構及家庭結構急遽轉變，由家庭來負擔照顧責任的傳統亦逐漸消失，縣民對於長期照顧的需求日益增加的狀況下，如何有效地結合家庭、社會、民間與政府的力量，建構完善的老人安養照護與長期照顧體系，一直是嘉義縣積極推動的重點縣政目標之一。因此，「長期照顧十年計畫2.0」嘉義縣試辦區域，最後擇定為本縣老人人口數及長期照顧需求人數均最多的民雄鄉，並結合鄰近的溪口鄉規劃為小區域長照服務體系，由財團法人私立天主教中華聖母社會福利慈善事業基金會擔任A級社區整合型服務中心，負責整合、協調及連結區域內長照資源。本文將對嘉義縣社區整體照顧ABC模式計畫內容、架構、目標、理念，以及目前已進行及服務的階段、困境作簡略概述。

In April 2016, Taiwan government has approved the 'long-term care plan', looking forward to this project to build a long-term care system that can meet the requirements of diversity, community (universal), quality, which is also affordable, covering all genders, urban and rural differences, ethnic groups, cultures, occupations, economic status, and health conditions. After ten years, it has developed the service delivery system and service supply. In December 2016, the 'long-term care of the 10-year plan 2.0' is officially launched, also the government seek and elect the ABC pilot community overall care-mode units from all the countries and cities in Taiwan. At the end of September (105), in Chiayi County, the 65 years old population ratio has reached to 17.72%, which means the 65 years old population ratio of the majority of townships in the county is higher than the definition by the World Health Organization (14%). In other words, undoubtedly, it has become a typical aging county. The degradation of physical functions and chronic diseases follow the population aging and increase, resulting in the increasing cases of disability and dementia. What's worse, because of the rapid changes in social structure and family structure, the tradition of taking care responsibility by the family has gradually disappeared. As the requirement for long-term care keeps increasing, it's been one of our top priority and policy objective to effectively combine the family, the society, the strength of the people and the government together to build a well-established old-age care and long-term care system. Therefore, Minxiong Township is finally selected as the pilot area in Chiayi County, due to the largest number of elderly population and the most long-term care needs. What's more, it's combined with the adjacent Xikou Township, organized as a small regional long service system, and Sisters of Our Lady of China Catholic Charity Social Welfare Foundation serves as the A-level community-based integrated service center, who is responsible for integrating, coordinating and linking resources within the region. This paper will give a brief overview of the contents, structure, objectives, ideas and stages and difficulties of the program.