居家式照顧服務使用者的服務輸送經驗

Experiences of Home-care Service Users

本研究旨在探究居家式照顧的服務使用者，其接受服務時對服務輸送的經驗，以提出合適的輸送體系設計，增進服務品質以及公民參與。本研究方法為質性研究，深度訪談14名服務使用者。研究結果顯示：（一）服務使用者身分常被標籤、需求評估模式過於僵化；（二）按其身分、權力行使、角色等不同，可歸納為「雙重弱勢型」、「飲水思源型」、「積極參與型」、「主流福利資訊排除型」四種類型；（三）在服務輸送體系設計方面，服務使用者對政策制定、服務類型認知貧乏；（四）認為政府委託民間提供各種服務，但彼此是不認識的夥伴；（五）認同專業與感恩在地服務人員，但無參與服務制定的權力。在服務品質方面，服務使用者認為在回應性、適當性、參與、給予選擇訊息、整合服務的指標缺乏。因此，本研究建議：1.接受服務者可稱為「服務使用者」；需求評估以「綜合評估模式」為之；依研究發現的服務使用者類型，設計不同的政策宣導方式；2.服務輸送體系方面，政策實施朝跨域合作模式；掌握需求，擴展服務項目；重視提供服務單位的合作與協調，強化專業人力培植、篩選和在職訓練；建立公民參與機制；3.服務品質方面，將服務品質六項指標納入，才可以評估服務對使用者產生什麼影響和改變。

This study aims at understanding the dynamics between the home care service delivery system and the experiences of its users. By doing so, the authors tried to propose a design suitable for delivery systems, which may enhance quality of service and increase citizens' participation. Fourteen service users participated in in-depth qualitative interviews of this research. The results are as follows: (1) There are labels to service users, needs assessment is too rigid. (2) Based on their status, power, and roles, the users can be divided into four categories: double disadvantaged, those with gratitude, those who actively participated, and those being excluded by mainstream welfare information. (3) For the design of the service delivery system, users were ignorant of the policy-making and service type. (4) They experienced weak system link among various service projects. (5) Users showed gratitude to the service personnel, and lack of power in the development of service. Regarding service quality, it is inadequate in terms of responsiveness, appropriateness, user participation, providing service information, and service integration. This study recommends: (1) clients may be called 'service users'; service evaluation may be changed to 'integrated assessment model'. According to the research findings, design policy promotions in accordance with characteristics of different types of service users. (2) For the service delivery system, policy implementation should be coordinated among different districts, grasp the needs, expand service, value the collaboration among different service units, select and train professional manpower, and establish mechanisms for citizen's participation. (3) The six service quality indicators should be included to measure the influences and resultant changes of the service on the service users.