照顧趕工：當「專業化」遇上「能力」──以長照機構為例

“Making Out”in Care of the Elderly: When Professionalization meets Capability in the Context of Long-Term Care Institutions

無論是國人的照護選擇還是長期照顧政策的規劃，機構式照護均敬陪末座。然而人口老化與少子化的趨勢未來將使機構照護的需求增加，集體式照護將更面臨照顧人力供給與服務品質不確定的挑戰。既有長照相關論述著重提升照顧人力的素質與職能培訓，然而專業化邏輯傾向將照顧責任個人化，並結合Care蘊含的規範性價值以便規訓照顧勞動者，卻遮蔽了照顧實作所鑲嵌的具體社會脈絡。本文立基於在臺灣兩間長照機構的田野調查，輔以我親身參與的照顧服務員訓練實習觀察，從勞動社會學的視角提出「照顧趕工」概念，探討此一常見於老人住宿式機構的照護實作。本研究避免將照顧勞動本質化為一必然蘊含「關懷倫理」，即關懷、傾聽的情感／道德／身體實作，而採Amartya Sen的能力理論（capability approach）分析機構的照顧勞動過程，指出照顧勞工的照顧能力如何受限於現實情境中各種可及或不可及的資源與轉換因素，從而限制了他們生產出理想照顧的自由，甚至有可能危及受照顧者的福祉。本文對長期照顧政策與照顧專業化論述提出積極性批判，建議審視長照的集體責任分配，以為長期照顧品質尋求可能的出路。

Institutional care is always the last choice in Taiwan, no matter whether it is family members making decisions about the care for elders, or the government drafting long-term care policies. With the population aging rapidly as well as the decline in birthrates in recent years, collective care will inevitably face the challenges of insufficient supply of labor and unstable care quality. Existing studies on long-term care mostly emphasize the training and the competency of the nurse aides, while the underlining logic of professionalism in care personalizes the care responsibilities and mobilizes normative values to discipline care workers, while at the same time ignoring the social context where the care practices are embedded. Combining field investigations of two long-term care institutions for the elderly with her personal experiences and observations in participating in the training and practices of the care work, the author proposes the concept of“making out”(Burawoy, 1979) in care work, taking the perspective of the sociology of work to explore the reality of such care institutions. Instead of insisting on the philosophical perspective of the ethics of care and presuming that care work is an emotional, moral and physical practice that essentially requires a caring disposition, this study adopts Amartya Sen’s capability approach to analyze how the capability for the care of others is limited by the available and unavailable resources and the social conversion factors. As a result, real freedom to create ideal care is restricted, resulting in possible damage of the well-being of the care receivers. This research is aimed to provide constructive criticism on the government’s long-term care policies and to critique the usual approaches to care professionalization. It further reviews the distribution of collective responsibility for long-term care, in the hope of finding potential solutions to maintain the quality of long-term care.