機構式長期照護綜論

Overiew of Institutionalized Long-Term Care

10.29462/TGG.200605.0001

許佩蓉(Pei-Jung Hsu)；張俊喜(Jun-Hie Chang)；林靜宜(Ching-Yi Lin)；林壽惠(So-Huei Lin)；李世代(Shyh-Dye Lee)

長期照護 ； 機構式照護 ； long-term care ； institution-based care/institutionalized care/residential care

台灣老年醫學雜誌

1卷4期（2006 / 05 / 01）

198 - 215

繁體中文

人類自有歷史以來，即有『照護（顧）』之存在與發展，其中即含有長期性照護（顧）之部份，然後才逐漸發展成制度與體系，而在長期性照護其中即必然包含機構式及社區式之照護型態。隨著社會之整體進展，人類生活所需之生活、健康及安全三大方面需求的滿足、提供、施予與發展，乃為人類所必需面對的課題，亦是現代文明社會之重要議題。在人類社會的自然發展經驗中，因「人口高齡化」之必然走向，加上串連而來之「疾病型態的慢性化」、「健康問題障礙化」、「照護內容複雜化」、「照護時間長期化」等趨勢下，更為突顯，亦使得健康照護之體系須從單一走向涵蓋多層面照護需求周延複雜之體制，而機構式與社區式之照護即發展成型，並在各地以不同之樣貌出現或存在。從各先進國家之發展經驗來看，機構式照護雖比社區式照相對少得多，但兩者須為一體之兩面，相輔相成；而且毫無例外的，各均以機構式照護為先行之發展，再而發展出較大較多之社區式照護之型態，兩者約為三與七或二與八之比，此趨勢有其普遍性、終極性及必然性。然而，因本質屬性之差異，機構式照護所吸獲之重視與資源分配往往不成比例。就長期照護之整體性來看，機構照護擴展至最大，即接近社區之型態，而社區照護規模濃縮，即接近機構之型態。在積極強調落實「在地老化」之社區式照護目標的同時，機構式照護比例雖可能較少些，然不可或缺；且機構式照護亦為社區式照護之延伸或外展基礎，以及社區式照護之喘息服務平台，有其存在與發展絕對之必然性。

All through the history, care for the people has been present and developing. And long-term care had been always included any way, hence, the related system and scheme had been organized and formed gradually. Certainly, they always involved two parts, i.e. residential/institutionalized care and community-based counterpart. As the society went on their progressing, satisfying, providing & delivery of living, health care and security need would become the main and necessary issues, they must became the key themes of policy and strategy/tactics to deal with elsewhere. Based on the evolving experience of humans, the trends of population aging, accompanied with their chronic health conditions, impairment/disability/handicaps, and long term transition of care, became more and more remarkable as expected. The related system and scheme shifted from simpler one to more complicated, then institution-based and community-based care model had become well-set even if possessing different characteristics among them in each country. Based on the experiences of advanced countries, institution-based care model, with comparison to community-based one, was always less but prioritized in the progressing of long-term care, followed by more community-based care. Their ratio was around 3 vs 7 or 2 vs 8 universally, ultimately and necessarily. However, owing to the basic difference of their nature and characteristics, institution-based care had usually got prioritized status in general, and always calling more attention and resources. However they were one unity with two conjugated or inter-linked counterparts. As the institution expanded, it might gain access to the community, as the community shrinking, it might gain access to the institution. Under the actively target of ”Aging in Place”, even if with less percentage of institutionalized care, in addition to its essential importonce and necessity, rather, institution-based care could be regarded as the important basis for out-reach and respite care by community care or service.

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