從服務提供者觀點探討臺灣北部原鄉長期照顧服務輸送

Delivering Long-Term Care Services to Indigenous Communities in Northern Taiwan: Perspectives of Service Providers

原鄉偏遠地區受限人力與資源不足，難以發展符合在地需求長照服務，尤其缺乏從原鄉長照服務提供者的視角探討服務輸送經驗。本文從原鄉長照服務供給者角色探討文化照顧經驗。研究採立意取樣，深度訪談11位原鄉長照專業人員，結果顯示原鄉面臨醫療照顧、專業人力聘用與留任、交通車量能不足多元困境，影響原鄉整合性照護之發展。在制度層面，長照2.0「滾動式」決策影響共識，原鄉居服員嘗試融入族群文化，自行「裁剪」跳脫制式服務框架回應需求。顯示原鄉文化照顧實踐，仰賴長照團隊之協作與裁量。然在強化照顧管理制度下，影響原民共同照顧的精神與文化實踐，研究建議提升長照服務提供單位之文化覺察，以能實踐文化安全，展現原鄉文化照顧之主體性。

In remote Indigenous regions, the development of long-term care (LTC) services is limited by insufficient workforce and resources. This study examined the perspectives of 11 service providers toward the delivery of LTC to indigenous communities. In-depth interviews with service providers revealed that insufficient medical resources, difficulties in recruiting and retaining professional staff, and limited transportation capacity hinder the delivery of integrated care in Indigenous regions. At the policy level, the“rolling”decision-making model in LTC 2.0 complicates consensus building. Indigenous home care workers have attempted to incorporate cultural elements and tailor services beyond standardized frameworks to better respond to local needs. The study suggests that implementing culturally responsive care necessitates collaboration and discretionary judgment within care teams. However, increasing managerial control over service delivery undermines the collective and culturally grounded principles of Indigenous caregiving. This study suggested that importance of enhancing cultural competence to promote culturally safe of LTC services.