| 摘要: | 本論文主要探討台灣長期照顧政策中家庭照顧者的議題。人口結構高齡化和少子化為當前世界比較發達的國家共同面對的問題，這使得老人照顧問題變得日益重要，而照顧通常又以家庭為主，呈現出照顧家庭責任化的普遍現象。基於此，本論文以家庭照顧者支持服務方案為例，說明台灣長期照顧中家庭照顧者角色適應的問題，提出長照家庭照顧者友善之政策建議。
本研究以羅伊適應模式為理論架構，剖析家庭照顧者的困境及因應策略，並把長期照顧家庭照顧者當作一個適應系統，對其角色適應情況進行評估。具體來說，長期照顧家庭照顧者受到的主要刺激來自照顧失能老人，作為一個適應系統會產生應對上的問題，可以通過瞭解其在生理需求、自我概念、相互依賴、角色功能四個方面的適應程度來評估其行為是否適應照顧者角色及適應過程。
本研究首先訪談八位家庭照顧者，三位配偶、三位媳婦、一名女兒及一位孫媳婦，透過不同角度的訪談敘述勾勒八位家庭照顧者故事，探討及瞭解家庭照顧角色的照顧歷程及困境，歸納整理家庭照顧者角色適應情況。
其次，由研究結果整理出家庭照顧者七種主要特質，並繪製家庭照顧者角色適應的四角圖像，家庭照顧者之角色適應，受以下基本因素影響：家庭照顧者年齡、受教育程度、就業狀況、家庭型態、照顧狀況（照顧時間、替代人力）、照顧年資、與受照顧對象關係及受照顧對象身障狀況（病因類別、級別、自理能力）。並針對八位家庭照顧者身體狀況、自我效能、社會支持及照顧能力得分，評估其生理需求、自我概念、相互依賴及角色功能的狀況。
最後，從「以人為中心，家庭為基礎」，建構「長照家庭整合型照顧服務」，從整合照顧管理、整合服務體系及整合非正式體系三面向提出建議與省思；並針對研究對象、研究內容及研究方法三面向，提出後續研究與未來發展建議。
This paper focuses on the issue of family caregivers in Taiwan's long-term care policy. Aging population and declining birthrate are common problems faced by more developed countries in the world. This makes the issue of caring for the elderly increasingly important. Elderly care is usually family-oriented, showing the common phenomenon that the responsibility of elderly care is borne by the family. Based on this, this paper uses the family caregiver support service program as an example to illustrate the role of family caregiver in the long-term care in Taiwan and propose friendly policy for long-term family caregivers.
This study uses Roy's adaptation model as the theoretical framework to analyze the plight of family caregivers and corresponding strategies. It considers long-term caregivers as an adaptation system to assess the adaptation situation of their roles. Specifically, the main stimulus for long-term caregivers is from caring for the disabled. As an adaptation system, caregivers can have problems in corresponding interactions. We can assess whether it adapts to the role of the caregiver and the process of the caregiver's adaptation by understanding its degree of adaptation in four aspects: physiological needs, self-concept, interdependence, and role function.
This study first interviewed eight home caregivers, three spouses, three daughters-in-law, one daughter and one granddaughter-in-law. Based on the interviews and narratives of eight home caregivers through different perspectives, we explored and understood the history and dilemma of the role of family caregivers, and summarized the role adaptation situation of family caregivers.
Secondly, from the results of the study, seven main characteristics of home caregivers were sorted out, and four-corner images of the role adaptations of home caregivers were drawn. The role adaptation situation of family caregivers is affected by the following basic factors: age of family caregiver, education level, employment status, family type, care status (care time, substitute manpower), length of care, relationship with the care recipient and care recipient's physical condition (types of disability, degree of disability, self-care ability). We also assessed the physical needs, self-concept, interdependence, and role function of eight home caregivers based on their physical condition, self-efficacy, social support and care ability scores.
Finally, this research starts from the "people-centered, family-based" thinking and constructs the concept of "long-term family integrated care services". It puts forward suggestions and reflections from the three aspects of integrated care management, integrated service system and integrated informal system; and proposes follow-up research and future development suggestions according to the three aspects of research object, research content and research method. |
