老人長期病患照顧者對取代方案之考量：潛在需求與困境之分析

Alternative Care Choices Regarding the Chronically Ill Elderly: Implicit Needs and Barriers

10.6288/CJPH1996-15-04-01

胡幼慧(Yow-Huey Hu)；郭淑珍(Shu-Chen Kuo)；王孝仙(Shaw-Shain Wang)

居家照護需求 ； 長期照護 ； 取代方案 ； home care need ； long-term care ； alternative care

中華公共衛生雜誌

15卷4期（1996 / 08 / 01）

275 - 288

繁體中文

慢性重症老人的照顧，除了治療部份外，特殊生活照顧及面臨疼痛、死亡、生存意義的心理照顧，更是老人醫療照顧體系的主要挑戰。台灣目前患慢性重症或行動極不便的老人，絕大部份仍留在社區向家人照護。不少研究已指出，居家照護由於普遍缺乏專業介入、缺乏設施及人手不濟，這些問題不但影響醫療品質，亦對老人及對家人產生了很大的社會心理負荷。如果再加上老人與照顧者（特別是媳婦或怨偶）已經存在長年人際衝突，則問題更為複雜。然而取代方案的缺乏和文化上的「標籤」一如居家安養代表子媳孝順的意義，送安養院代表了被家人遺棄的意義，同樣影響了抉譯及需求內涵。本研究從對安養院及看護工的潛在需求出今，探討結構因素（如財力困境、服務市場素質問題）與建構過程（文化象徵解釋及行動抉擇的說辭）所扮演的角色。根據262位出院慢性重症病家的半結構訪談結果之分析，我們要現將近八成病患採「居家家人照護」，僅8.4%雇看護工，13.7%送安養院。但如繼續探問病家，有五成考慮過採用取代方案，但都因「經濟上「品質」因素而打退堂鼓。「文化」反對因素並非唯一考量，且在「雇看護工」考量中，極少成為隙礙因素。此外，考量安養院者往往面臨病人意顯上困境，而採用「送安養院者」雖曾考慮用雇護工方式來取代，但雇護工花費更高，負擔不起而作罷，至於病患的失能程度雖對「取代方案」的考量程度上有所影響，但解釋力相當有限。因此，安養院與看護工之經濟與服務市場結構之困境與文化角色之障礙應將是未來長期照護體系發展政策考量重點。

This study applies a structural constructivist approach to clarify the ways in which the care needs for the chronically ill elderly are made meaningful and socially organized. Today, the quality and the coverage of the elderly's long term care are in questions. The families dealing with the needs, are facing these daily difficulties which may create significant stresses and may require extensive emotional, physical, and social supports for the elderly and their caregivers. These difficulties are intensified in complicated real-world relations within the families, especially in longstanding and troubled relationships such as tensions between in-law. Since home care embodies the social meaning of filial piety (hsiao) as well as the symbol of success of the family, these cultural constraints may be reinforced by practical difficulties in obtaining affordable and quality alternative cares. In this study, we have examined these constraints and their effects on caregivers' psychosocial burdens. Based on the semi-structured interview, two hundred and sixly-two patients traced from one regional hospital released files were identified, and their caregivers were interviewed. The results indicated that only 22% of the elderly have used alternative forms of care. And more than fifty percent of those using primarily family care have actually looked into alternatives but have been discouraged due to financial problems and service quality. uurthermore, we have found that when family care was the sole care resource and when lacking of on-hand care supports from formal and informal networks, the caregivers (mainly women) will experience various forms psychosocial burdens. We also found that patient's physical conditon may have slightly effect on caregiver's sense of burden. The main effect is from the problems that are related to the service market. The policy considertion for such structural constraints were also discussed.