正式與非正式照顧的協作：探討家庭外籍看護工進入護理之家的現象

A Study on the Practices of Formal Care and Informal Care: Why Entering a Nursing Home Requires Having an Independent Foreign Care Worker

家庭外籍看護工的工作場域應在家庭，現有護理之家卻出現許多家庭外籍看護工。本研究採取建制民族誌，運用參與式觀察法勾勒護理之家照顧服務員與家屬自聘外籍看護工每日照顧工作，訪談家屬與相關服務者，探討家屬自聘外籍看護工背後的社會編派。研究發現，機構將部分照顧工作轉嫁家屬，無法承接的家屬再轉嫁給外籍看護工；家屬不同的協作雖是受限不同經濟能力，但這一來一回所產生的變化，卻又衍生自聘額外人力的照顧者並未獲得雙重照顧資源的奇特發展。本研究揭露治理代理人與家屬藉由自聘外籍看護工，以符合建制現實的自主行動固然是單一機構透過對規約性認可，進而透過重新編寫文本而來的在地特殊個案，不僅揭示特定的建制型態，也因此開展文本使用者，包括護家主管、醫療體制內各式服務提供者與家屬多方之間互相連結的真實性，唯有建制真實性與斷裂經驗被真正看見，制度與文本及人們日常生活的斷裂方可能被改變。

Family migrant care workers’ workplace must be the family home. However, their appearance in nursing homes is becoming common. Using institutional ethnography as my research approach, I observed the daily care schedule of care workers (both Taiwanese and foreign) and interviewed institutional managers and their care workers, as well as family members serving as caregivers with and without hired in-home foreign care workers. The texts for Taiwan’s nursing home system were also collected to discover how they make for the imbalance between space and care needs, and also why nursing homes, even those very near hospitals, require family caregivers to take clients to rehabilitation and other medical appointments. The truth is that from the hospital to the nursing home, the family has to assume all care responsibility, and when the family can’t handle said responsibility, hiring a foreign care worker is the only alternative. This study’s analysis shows multiple silhouettes of the ruling relations in a nursing home as well as their influences on the disjuncture experiences and institutional actions. One major finding of this study is how institutional managers distribute their care workers according to the number and placement of family-hired foreign care workers stationed in nursing homes, in effect balancing care needs and staff ratio. In addition, although it seems that a seamless care system is in place, the real issues behind the system have yet been illuminated.