| 摘要: | 本研究是從社會資本的角度，探討失能老人在社區照護與機構照護二種模式間之差異，包括組織結構、服務管理性質、服務對象屬性，及對社會照顧脈絡的研究發展潛力和新方向。現代人壽命越來越長，在家庭網絡與社會參與缺乏之下，重度失能者很容易被送入機構式照顧。目前台灣社區在地老化及機構式的兩種照顧模式，分立而並存，看似矛盾卻又共生，引發研究者的研究動機，試圖比較社區與機構兩者不同的照護模式的優劣及結構性條件。研究結果顯示，社會網絡權力結構等現象的反省與解釋，不論財團公私立長期照顧機構，家庭動力權力、溝通、互動、關係越高者，享受社會福利政策越低；反之，則享受社會福利政策愈高。因此，家庭有經濟醫療需求及各方面支持網絡時，服務對象才有可能獲得連續的照護服務，可使主要照顧者避免有沉重的身心與財務壓力負荷。 機構照護模式屬替代性服務，可完整取代家庭照顧及社區照顧；社區照顧模式屬協助性、支持性服務，需結合家庭支持才會完整。因此，社區式乃是支援性、協助性照顧模式；機構式是替代性照顧模式。無論財團法人、立案機構、私人機構照顧模式，三者內外環境特質皆兼具經營型式，同時具有社會型與醫療型兩者的功能。由優勢看來，財團法人機構則是落實公權力之執行，保障服務對象就養居住安全與權益、設備充足、專業團隊、補助費用、社會支持網絡及社會資源相互為用；至於私人養護機構則是豐富的照顧經驗，舒緩家庭照顧者之壓力、情緒、增進專業知能及具有在地社區機構化功能；而社區照顧模式較其他兩種經營優勢為社會支持網絡凝聚力高、家庭照顧者休息的機會、增進服務對象社會活動參與、課程多元化、保障生存權益、收費低廉、專車接送及市場投入者增多。在劣勢方面，財團法人機構則是面對家庭結構改變，家屬惡意遺棄增多的困境。私人養護機構與社區照顧模式皆缺乏醫療體系背景，而場地限制及私人機構給人的既定負面印象。本研究除了以上的比較發現外，也依據研究結果提出一些建議。
This study investigated the differences between two care models of debilitated elders, com-munity care and institutional care, from the perspective of social capital. The organizational structure, the nature of service management, the attribute of people who were served, as well as the potential and new direction in terms of the development of social care are mainly ex-amined in this paper. Nowadays, the life expectancy of people in Taiwan is on the increase; however, due to the lack of family network and social participation, those severely debilitat-ed persons are easily sent to institutional care. Currently both care models of elder people coexist without connection with each other in Taiwan. This motivates the researcher to compare the pros and cons, as well as structural conditions, between both different models of care in the community and institution. The findings show that those who have more family mobilization and power, communication, interaction, and relationship would have less ser-vices of the social welfare. Conversely, their counterparts have more. Therefore, families being lack of economic and medical resources would be able to obtain constant care services, preventing from heavy physical, mental and financial stress. Institutional care model is an alternative service that can completely replace family care and community care; community care model is an assistant and supportive service that is not complete until it incorporates with family support. Community care model is an assis-tant and supportive care model, while the institutional care model is an alternative care one. Regardless of the model types, all care models having social and medical functions are now more subjective to financial management. This paper examined three kinds of care organiza-tions: two institutional model-those of foundation organizations and private institutions, and one community care model. With respect to advantages, the foundation organization is able to enforce public power, guaranteeing the safety and rights, and interests of the clients who are served. It also has better adequate equipment, professional team, more subsidies, stronger social support networks and social resources utilized for each other. As concerning private caring agencies, they have more caring experiences in terms of relieving the pressure and emotion of home caregivers and enhancing professional knowledge. The community care model, better than the other two, is able to build up a social supporting network with the advantages of higher cohesiveness, providing opportunities for family caregivers to take rests, enhancing participation of the subjects in social activities, having diversified courses, pro-tecting the rights and interests of subsistence, lowering fees and charges, and increasing shuttle service and market investors. As regards disadvantages, the foundations are facing with changes in family structure and increased malicious abandonment by family members. Both private care service providers and community care modes are lack of healthcare system backgrounds, while the restricted space and private institution have negative presupposed impressions. In addition to the above comparative findings, this study also made some sug-gestions based on the research results. |
