失能老人與成年子女照顧者對失能老人遷居的歷程與解釋：從家庭到機構

Abstract

國外失能老人晚年的遷徙中，以「與子女同住」和「住進長期照護機構」較多。在台灣，失能老人留在社區裡與成年子女同住的比例一直很高。除此之外，另一個可能做的選擇是住進長期照護機構。留住在社區不免有一些影響因素；住進長期照護機構考慮的因素也很多。本研究想了解親子兩代如何決定失能老人要住在家裡，或是入住長期照護機構？有哪些因素會影響他們這樣的決定？老人在這決定過程中的掌控力有多少？ 深度訪談有成年子女且居住在機構或社區家裡65歲以上的失能老人或其子女。受訪子女必須在二十歲以上，並且曾經或目前與老人居住。以立意抽樣取得樣本。訪談內容以了解老人及子女在決定居住安排的考量及如何面對老年的居住照顧安排為主。 研究發現，「健康」、「親情」、「經濟」、「安全」、「子女有意願照顧」、「養兒防老觀」、「較自在」、「對機構團體生活適應的擔心」以及「可請外傭、有一對一的照顧」是失能老人及子女兩代對老人留在社區中的解釋。顯示出社區失能老人對「自主性」的要求較高，而子女也願意配合滿足。然而當失能老人及子女發現老人「健康」「經濟」、「安全」仍出現問題，例如：「失能更趨於嚴重」、「經濟的效益不划算」、「安全維護仍出現問題」，而且「子女可以接受機構照顧」時，失能老人就會遷居到機構。對於進住機構的失能老人，其會以一些理由來說服自己，安於所居，而產生承命生根的看法；多數老人因為照顧的急迫性而進住機構，符合衝鋒陷陣的決定和導火線事件的決定模式；但也有許多是所謂的被動同意者。至於子女方面，子女在「參與」決定居住的安排時，不會單以失能老人的需求為出發點，也會考慮自己的需求。根據客觀的理由來做決定，會讓子女覺得決定更具有正當性。 本研究建議未來家庭及專業人員在做老人長期照護計劃時，鼓勵老人及家屬開放而坦誠的溝通，以利未來雙方的適應。另一方面，長期照護保險或居家照顧的提供更可以提供「在地老化」、「社區化照顧」的選擇。因此，整體性、連續性照護服務資源網絡的建立與互動及社工員在照顧管理的工作現況及角色也都是未來值得進一步探討的。

It is common for the disabled older people to live with adult children or to transfer to long-term care facilities in most industrialized countries. In Taiwan, however, the percentage of living with adult children for disabled older adults was high. Still, another option was to move into long-term care institutions. The factors affecting their decisions were complex. This study intended to investigate how disabled older adults made their own decisions and how much of their locus of control they possessed in the decision-making process. Interviews were arranged with the disabled older adults who either lived in the homes or institutions. Because most adult children were also caregivers, their decisions were taken into consideration most of the time, some adult children were interviewed too. The samples were purposively selected; however, they were diversified in terms of age, education and district. Twenty-six subjects were interviewed including 17 older persons and 9 adult children. The study found that health, affections among family members, economic condition, safety concern, being more comfortable, children`s willingness to care, being worried of group life and one to one care of foreign caregivers would be reasons for these older people to decide to stay at homes. Degenerated health, inefficient cost, safety problem, and children`s attitude would be concerns of which caused them to move into institutions. The study showed a strong need for autonomy among the home-dwelling older adults. Those who moved to institutions would rationalize their decision-making. Due to an imperative care need, these older adults were forced to move into institutions. This pattern was like scramblers and wake-up call in Maloney and Finn`s research (1996). However, most of them were reluctant consenters in their decision- making. Finally, practice and policy implications were also discussed.