長期「照顧」還是「照護」服務——我國長期照顧服務法的定位困境與省思

Long-Term “Care” or “Nursing Care” Services: Positioning Dilemma and Reflections on the Long-Term Care Act in Taiwan

面對高齡社會與少子化之海嘯來襲，國安危機幡然再起，超齡臺灣無可避免，我國長期照顧服務法在2017年正式施行，為我國長照發展重要之法令依據，長照體系邁入新里程。生老病死乃生命的輪迴，因應高齡化之挑戰，長期照顧勢必將更為嚴峻，其內涵逐漸從「照顧」移轉至「照護」。隨著家庭結構變遷、經濟型態改變，「照顧」從家庭內的責任轉變成為社會共同的責任。護理人員同時肩負著長照體系文化革新的使命，整合性的長期照護是目前的共識，如今面臨的挑戰，乃是強調照顧與照護必須結合、成為一個連續的體系，長期以來制度規範與護理訓練的限制，讓照顧與照護領域變成兩個斷裂的體系，護理專業人力也需未雨綢繆，建議落實醫療分級與轉診後送制度，醫療與長照整合照護是刻不容緩的對應，長照議題不僅是牽涉到照護層面的供給平衡，更是迫在眉睫的社會危機，是以，本文分析論述我國長期照顧服務法之基本內涵，期盼對長期照護制度提出初步的檢討。

Taiwan's ageing society and rapid diminishing birth rate have already become a national security crisis and Taiwan will become a super-aged society. The Long-Term Care Services Act, enacted in 2017 to regulate longterm care services, serve as the important legal grounds for the development of long-term care. The long-term care system moved toward the new milestone. The circle of life is from cradle to grave. The challenge of an ageing population led to a greater austerity whereas its connotation gradually shifted from “care” to “nursing care”. With the transition of family structure, change of economic formation, the “care” was thus changed from responsibility for the household into the joint responsibility for the society. The nursing staff also carried the important mission of cultural revolution of the long-term care system. The integrated long-term care is the current consensus. The present challenge was to combine care with nursing care to become a continuous system. Care and nursing care had become two fracture systems due to the restriction of systematic specification and nursing training for a long time, whereas the numbers of the nursing professional personnel were required to be got ready. We suggested implementing the Medical Care Classification and the Medical Referral System. Both the medical and the long-term integrated health care which brook no delay were corresponding. The long-term care issue was not only the balance of supply but also the looming social crisis, therefore, this paper aimed to analyze and discourse the basic implications of the Long-Term Care Act and propose the initial review of the long-term nursing care system.