老年照護與空間治理的雙重典範轉移：德國「失智症團體家屋」的啟示

The Double Paradigm Shift in Elderly Care and Spatial Governance: Implications from the German Dementia Group Home (Demenz WG)

臺灣的人口結構正以世界最快速度老化，但嚴重缺乏適切的失智症照顧服務。臺灣自2000年開始學習福利先進國北歐與日本的「失智症團體家屋」（group home）政策，並於2007年試辦，但迄2018年僅成立12所，發展極為有限。反觀德國，與臺灣同屬缺乏失智症服務的福利後進國，且約於同時開始向福利先進國取法。但德國從社會空間尋求解方，突破法規桎梏，故得以在用地、空間、人力與財源等方面皆充分實驗，迄2015年已成立2,500所失智症團屋（德文Demenz WG）。本研究論證德國發展失智症團屋之脈絡與照護模式，迥異於北歐與日本，而反映出德國近二十年來在人口高齡化壓力下，國土空間治理觀念之相應變遷。尤其是在照顧服務使用者之決策參與權的提升，與公私部門跨層級且跨部門之協調合作，構成老年照護與空間治理上的雙重典範轉移。其意涵包括都市計畫、長照機構、長照保險等法規之變革與帶給臺灣的啟示。

The recent development in Germany of dementia-care services based on groups has attracted little research attention. The so-called “Demenz WG” (in German) or “shared-housing arrangements” have a small-scale, home-like environment, resident autonomy, and family and community's involvement in decision-making. This form of dementia-care was originally developed in the Nordic countries and Japan decades ago, and has since evolved into a German version and rapidly spread all over Germany - from 300 in 2008 to some 2,500 in 2015. So far, few studies have examined the theoretical background (social space), conceptualization, content, particularities, legal frameworks, financing, evolution and implications of this German initiative. In contrast, Taiwan has also experimented with 'group home' programs since 2007 but has made slow progress, with only 12 such group homes nationwide in Taiwan in 2018. This study explores the development of the German “Demenz WG”, arguing that its particularities and implications constitute a double paradigm shift in both elderly care and spatial governance.