長照社工在日間照顧服務中對照顧場域的反思與實踐

Reflections and Practices on Care Settings and Environments in Adult Daycare Centers: Perspectives from Social Workers in Long-Term Care

隨著我國長期照顧政策近年來的進展，長期照顧服務與老人社會工作的發展亦逐漸受到重視。本研究旨在了解社工於日間照顧中心的工作內涵與看待現有照顧服務，以及探究社工如何在其中實踐專業精神與照顧價值。最後對現行長期照顧體制下日間照顧服務中的社工實務，提出反思及未來實踐的可能。本研究採用質性研究方法，結合建制民族誌的精神對長照社工進行深度訪談收集資料。訪談六位曾任或現任職於日間照顧中心一年以上的專職社會工作者。研究發現如下：一、日間照顧中心社工的日常充斥行政文書評估與活動規劃：社工需在行政文書工作與長者的照顧需求間尋求平衡，他們除了需要負責規劃團體活動，長者評估、家屬支持、跨單位資源聯繫等，平時也需協助與社工專業非相關的用膳護理照顧等日常事務。二、社工直接服務專業在日間照顧中心受限不被重視：日照社工因肩負大量業務，而難有足夠時間與機會，投入對長者的直接服務，專業能力無法充分施展，此點亦讓社工質疑自我專業角色定位價值。三、社工覺察照顧現場無法滿足長者的心理及社會需要：照顧現場難以兼顧長輩個別需求，部分長輩在團體中會被忽視，且活動內容缺乏變化與人際關係的促進。四、社工鑲嵌以人為本的精神於日常工作的隙縫中：社工雖受限於當前的實務困境，但他們仍嘗試在現有條件下落實以長輩為中心的人本精神，於夾縫中透過人本關懷等具體展現其對長輩需求的理解與尊重，且即便超時工作亦甘之如飴。
本研究針對以下四個面向進行探討：一、社工在日照服務對長輩多元需求的回應與全人照顧的實現；二、社工在日照服務中與其他人員進行跨專業合作的必要性；三、社工在日照服務中理想與現實的衝突；四、社工以人為本的照顧理念實踐在於突破既有框架。最後，根據研究發現與討論結果，呼籲各日照單位與主管應肯定社工在直接服務中的專業能力，且需建構跨專業的合作與照顧共識，與其他照顧專業人員交流如何在日常照顧工作與活動中落實以人為本的服務內涵，透過團隊為長者提供所需的全人照顧；此外，社工亦需具備反思與行動的能力，在困境中尋求新的實踐路徑，將以人為本的專業精神與照顧價值在日間照顧場域中延伸，為長輩創造有溫度的照顧及晚年生活。

With the recent advancements in Taiwan’s long-term care policies, the development of long-term care services and gerontological social work has gradually attracted growing attention. This study aims to understand the roles of social workers within daycare centers, their perspectives on existing care services, and how they enact professional ethics and caregiving values in these settings. The study offers critical reflections on current daycare social work practice under the long-term care system and outlines possibilities for future implementation.
A qualitative research design was adopted, incorporating the spirit of Institutional Ethnography to conduct in-depth interviews with six full-time social workers who had served or were currently serving in daycare centers for more than one year. The key findings are as follows. 1. Administrative paperwork, assessments, and activity planning dominate the daily routine of social workers at daycare centers. Social workers must balance administrative responsibilities with addressing the care needs of older adults. In addition to organizing group activities, conducting assessments, supporting family members, and coordinating with interprofessional, they are also expected to assist with daily routines such as meal assistance and personal care. 2. Social workers’ professional capacity for direct service in daycare centers is restricted and undervalued. Due to heavy workloads, social workers have limited time and opportunities to provide direct services to older adults. This limits their ability to fully use their professional skills, often causing them to doubt their professional identity and the value they contribute to their roles. 3. Social workers perceive that the care setting fails to address older adults’ psychological and social needs. Addressing each individual’s unique circumstances is challenging, which may result in some older adults being overlooked during group activities. Moreover, the limited variety of activities restricts the development and promotion of interpersonal relationships. 4. Social workers embed the spirit of person-centered care into the gaps of their daily work. Despite numerous practical constraints, social workers strive to uphold a person-centered philosophy by demonstrating empathy and respect for the needs of older adults. Even though they frequently work overtime, they remain dedicated to providing humanistic care. In conclusion, based on the findings, this study calls on daycare centers and administrators to recognize social workers’ professional capacity for direct service and foster interprofessional collaboration and a shared vision of holistic care for older adults. Additionally, social workers should cultivate critical reflection and take proactive measures to discover new pathways for practice, thus extending person-centered professionalism and caregiving values in the daycare setting. Through these efforts, they can offer genuinely person-centered care and enhance the quality of later life for older adults.