大臺北地區居家服務區域劃分與居家服務組織定位的歷史分析

Organizational Attribution of Home Care Service Institutions in Taipei and New Taipei Municipalities-Focusing on the Issues of Service Area and Management

我國老人福利法明文規定地方政府應提供或結合民間資源提供居家服務，地方政府委託之服務機構多限於財團法人以及福利機構附屬的居家服務單位；然而，隨著居家服務單位的數量增加，與政府部門投入資源觀念的轉變，居家服務組織本身的定位，組織與政府部門之間的互動關係，以及居家服務組織彼此之間的互動都逐漸產生轉變。據此，本研究立基於新制度主義觀點，選擇發展居家服務最成熟的臺北市與新北市進行分析，探討居家服務組織如何因應地方政府委託條件改變，以及外部競爭環境的改變，決定服務區域與跨區域經營。本研究發現居服單位因「區域規模」分為「以居家服務為主的組織」與「複合式、多元老人相關組織」，前者必須透過擴大地盤來擴大服務規模，後者則透過承接多項服務模式而僅於單一地理區域發展服務。本研究主張政府應扮演「服務整合、規範與創新者」的角色，以提供更多樣的服務選擇，一則鼓勵更多服務提供單位加入服務行列，另一則應重新定位非營利組織在服務提供過程中扮演的角色與功能，此種既創新又彈性的模式方能符合服務使用者的多樣性需求，同時也創造出市場機制的競爭效率。

In an aging society, elders' demand for long-term care (LTC) services is increasing. As a result, how to satisfy the growing demand for the related LTC services has become a key issue of policy debate in many industrialized countries. In Taiwan, the home care system has limited non-profit enterprises to provide services. We are very much concerned about the dynamic status among those home care organizations, and the relationships between home care organizations and local governments. In order to understand the strategies and influence factors of organizations choosing service regions, as well as how they decide to either stay or move to another region, this study applies New Institutionalisms to analyze the strategies and influence factors of organizations choosing service regions, which includes data from interviews of managers in home care organizations, in Taipei City and New Taipei City, both having the largest population and the organizational density in Taiwan. This study found region arrangement is a powerful policy tool. If asking every provider to have the same sized service area, we are unavoidably to remove the differences between donative and commercial NPOs. These policies affect not only each home care provider's management ability and strategies, but also the NPO's characteristics. The policy suggestion from this study is that government should control care quality; however, should not require every home care provider to serve an area based on its number of clients.