老人非正式和正式照顧體系關係之初探：從家人和日託中心工作員協助項目的比較分析出發

Abstract

本文試圖從家人和日託中心工作員對老人提供協助項目的比較分析，來檢證有關老人非正式和正式關係之三種理論模式：層級補償模式(hierarchical compensatory model)、職務取向模式(task specific model)、及補充模式(supplemental)。資料的蒐集方式為面訪問卷調查，計訪問了六所日託中心的92名老人使用者。 研究發現可歸納為下列四項結論：（一）使用日託服務的老人仍從家人獲得許多協助，這也意味著日託中心工作員不能完全替代家人，故「正式服務會取代家庭照顧」是一種迷思，此一發現駁斥了層級補償模式所主張的”各要素之相互替代性“。（二）非正式照顧體系（家人）的照顧和正式體系（老人日託中心工作員）的協助項目不是「全然分工」，也不是「完全重複」，而是「部分重複相同、部分分工不同」，故較符合補充模式的理論。此一發現可能因本研究的正式服務係以日間照護服務方案為例，而日間照護方案的目的原就具有補充家庭照顧的意含。（三）當老人可從家人和工作員獲得相同項目的協助之同時，老人接受家人的協助感到較自在，此一發現證實家人仍是老人支持要素中的優勢偏好。（四）家人和日託中心工作員提供相異的工作項目之比較分析顯示：家人提供的協助項目是非技術性的，且這些協助要求地理上的鄰近性及長期的時間投入；反之，日託中心工作員所提供的服務是可預測的、例行化的、需要技術性知識，此一結果也部份支持職務分工模式的主張。本文最後並針對研究發現提出老人福利政策和未來研究方向的建議。

The purpose of this paper is to examine the relationship between informal and formal care systems for the elderly. An interview survey of 92 day care users was conducted to collect data. The conclusions can be drawn from the findings: First of all, although elderly people use day care service, they still receive lots of assistance from family members. That is, day care workers can not completely substitute family caregivers, and therefore the assumption that formal services will substitute family care is merely a myth. Secondly, the tasks provided by day care workers are not completely different from the assistance given by family caregivers, neither are they totally the same. In other words, the finding suggests that the relationship between informal and formal care is supplemental. In addition, the comparison of different tasks indicated that family members tend to give help which require only everyday knowledge and face-to-face proximity, while day care workers are more inclined to provide predictable tasks which require technical knowledge. Thirdly, when elderly people can receive the assistance both from day care workers and family caregivers, they feel more comfortable with family assistance. The finding, to some degree, support the hypothesis that family is the most preferred. Finally, policy implications and future research directions are discussed.