原住民長期照顧管理服務之研究：照顧管理者的服務處境與困境

Services of Long-term Care Management forthe Indigenous Population: Challenges andPerspectives from the Public Care Managers

在高齡的社會環境中，健康的維持與照顧的持續乃重要的議題，但對於身處健康、經濟、地理等不利條件的原住民而言，將加重長照的負擔，且其長照需求亦較主流社會要高。長照十年計畫以照顧管理為理念，照管專員有行政法定權威且扮演著關鍵性角色，但照管專員也面臨勞動條件限制等困境，故其處境與困境值得被探討。本研究目的係探究原住民長照管理服務，並以照管專員的處境與困境為研究目標，期待本研究給予政府當局及照管中心政策與服務建議，且能對原住民的長照福祉做出貢獻。本研究採取質化研究，針對中北部某兩縣市之照管中心之照管專員及照管督導進行六場個別訪談與一場焦點團體訪談，共收集10位受訪者的資料。研究發現，受訪者認為需求評估及評估工具並未針對原住民之特有文化加以考量，服務上也難以滿足原住民的需要；計畫擬定上的阻礙則是原住民難以支付部分負擔。至於服務輸送上，機構式照顧成本偏高，原住民難以負荷；而原鄉社區式照顧因幅員廣闊、交通不便等因素影響難以普及，居家式照顧相對而言較為可行，惟原鄉交通與人力的限制也讓居家服務的提供遭逢困境。綜上所述，本研究提出以下建議：一、需全面檢討照顧管理之需求評估表單對於原住民之適用性，重要的是原住民長照服務體系需以原住民文化思維來提供服務。二、明確界定照管專員的角色，並能賦予其實質職權。三、對於處於弱勢經濟條件的原住民，應能針對其經濟能力、現金需求等來設計靈活的服務供給項目。四、需積極引導與建構社會資源成為長照資源，且政府應投入更多資源並發揮整合協調的功能。

The maintenance of health and continuum of care for all are importantissues in the aging society, however, the indigenous people are morelikely to encounter disadvantageous health, economic and geographicstatuses resulting in heavier long-term care needs and caregiving burdencompared with the people in mainstream society. In the current longtermcare system in Taiwan, care managers may be given professionaland official roles, however, they may simultaneously face a limitation ofjob stability. The purposes of this study are as follow: First, to explore thechallenges and working situations of the care managers when providinglong-term care services for the indigenous population. Secondly, topropose constructive suggestions on policy and practice in order to develop better long-term care services as well as social welfare servicesfor the indigenous population. The methodology this study adopted wasqualitative approach. A total of ten care managers from two countieswere invited to participate in one focus group and 6 individual in-depthinterviews. The results of the study found that care assessment　andthe assessment tool did not consider the cultural characteristics of theindigenous population; many indigenous users could not afford the costof institutionalized care or the co-payment of the care plan designedfor them. On the long-term care delivery system, the vast geographicarea to cover for the indigenous population limited community-basedcare and transportation, thus making home-based care more doable.However, finding enough human resources and care workers to providehome-based care was a challenge. Based on the research findings, foursuggestions were proposed. First, the care assessment and evaluationtools need to be culturally sensitive which fit indigenous lifestyle.Secondly, the care managers should take the role of authority while theywere given responsibilities. Thirdly, the long-term care services could beprovided more flexibly that the indigenous people who were economicdisadvantageous could be benefited. Fourthly, the government could takea pro-active role and invest more resources to establish a comprehensiveservice system for long-term care.