台灣原住民族長期照顧之跨文化政策議題與省思

A Reflection on the Policy of Transcultural Long-Term Care for the Indigenous Peoples in Taiwan

長期照顧服務的政策推動需考量族群的社會文化與傳統信念。過去為了保障原住民權益，衛生福利機構在研訂長期照顧服務法時，已將不同族群的文化照顧需求納入法規之一。目前長期照顧服 務法與長期照顧保險法雖然已提出應將不同文化觀點納入未來實踐長期照顧的考量，但是相關政策、資源運用策略、人力分派與人員教育訓練，尚未具體擬定，導致長期照顧的普及率在原鄉仍有眾多的限制。文化照顧不僅是一種具有文化敏感性、文化合適性及文化能力的專業健康照顧，它更關心如何跨越文化障礙，並進入個案生活脈絡與激發健康意識的文化照護實踐工作，最終能讓個案獲得全然的關懷與安適。因此，本文從目前國內現行的長期照顧服務狀況，以及跨文化照顧的內涵與重要性，深入思考原住民長期照顧之文化獨特需求；並建議強化原住民部落的長期照顧服務資源，應依族群文化與部落自主性的不同，而有個別性的考量，最終能設計出具有文 化合適性的長期照顧服務，符合跨文化健康照顧的重要原則，以提升原住民族的健康照顧福祉與安適感。

Giving high-profile attention to socio-cultural and traditional beliefs in the promotion of long-term care policies enjoys strong, consensus support in the field of transcultural nursing. To protect the rights of indigenous people in Taiwan, the Ministry of Health and Welfare incorporated the concept of cultural care into the Long-term Care Services Act, which was approved by the Legislature in May 2014. However, the policies, resource strategies, manpower allocations, and staff educations and trainings related to this act are still await implementation in indigenous areas. Beyond the concept of professional healthcare, which considers cultural sensitivity, suitability, and ability, cultural care gives greater priority to crossing cultural barriers, integrating with the lifestyle of clients, and addressing their concerns in order to improve the well-being of target populations. The present article reviews current long-term care policy to highlight the importance of considering the cultural needs of the indigenous peoples of Taiwan in order to enhance the efficiency and impact of long-term care programs. Furthermore, the findings strongly recommend that additional resources be provided in order to meet the long-term care needs of indigenous communities. Finally, cultural-specific, long-term care service strategies should be promulgated in order to upgrade well-being in order to ease and comfort the feelings of indigenous people.