本文主旨在於由少年家庭照顧者的觀點，詮釋自身之照顧歷程。透過敘事研究法深入少年家庭照顧者的內心世界，探討少年家庭照顧者角色形成因素、照顧歷程之主觀感受與經驗詮釋、承擔照顧責任對少年發展的影響、因應壓力方式以及社會福利層面及個人之需求，並根據研究結果提出對國內家庭照顧者服務及少年福利服務之建議。 本研究共訪談四位有效受訪者，經過整理分析研究結果發現，少年家庭照顧者角色形成的因素，包含「文化規範」、「交換的報答回饋」、「情感性因素」、「潛在照顧者的缺乏」及「家庭系統分工考量」五個層面。 少年照顧者的感受可歸納為以下幾點：1.少年失去了童年與少年時期應享有的福利；2.成年家屬花費許多時間和精力在失能家屬身上，忽略了家中其他成員；或因轉而對少年照顧者產生過份的期待；3.永無止盡的工作常令少年家庭照顧者感到疲累不堪；4.失能家屬往往會有突發狀況發生，照顧者必須隨時隨地陪伴在失能家屬左右，沒有自己的時間與空間；5.少年家庭缺乏足夠的經濟支持，除了負擔家務照料失能家屬外，少年仍必須工作賺取薪資。 照顧角色對少年發展的助益包括：少年照顧者會建立出一套個人對生活、責任、情感的架構，將負面情境視為對生命的正向考驗，且較其他同儕更為實際與成熟的思考態度與挫折容忍適應程度，且因未來的規劃而產生自我督促的力量。另外少年照顧者較具同情心與利他主義，對於自身存在的價值有高度的評價，亦更具有關懷弱勢者與體恤他人的能力。 對少年發展的限制方面，少年家庭照顧者不易保有自我的自主性及獨立性。受訪者產生心理分離的矛盾與衝突，既渴望保有自我獨立性，卻又無法放下家人的負擔。而日以繼夜的制式化生活，可能有礙個體發展自我獨特的心理社會價值觀。另外，角色逆轉導致少年照顧者承受角色衝突，出現焦慮、怨恨的情緒。 照顧責任對少年家庭照顧者生活的影響包括：家庭凝聚力與成員間親密感增進；唸書時間與照顧時間互相擠壓而無法兼顧學業與照顧；照顧工作影響少年參與社交活動的時間；對未來的考量安排必須符合現實生活的所需。 少年照顧者感到一般壓力情境包括：遭遇到生活事件改變或接踵而來的事件；人際關係的壓力以及課業成績的壓力；因照顧責任所衍生的壓力則包括受照顧者的不合作與責備、父母不合理的期望、家庭經濟壓力，擔心未來沒有人照顧失能家屬，社會他人的異樣眼光、及外人與社會道德期待也都是少年照顧者因為照顧者角色所必須額外面對的壓力。少年照顧者因應壓力所採行的策略包括：透過傾訴宣洩情緒、轉移注意力，找其他的事作、暫時離開現場、積極地強調正面意義，或以快速轉換念頭的方式調整負面情緒。最後研究分析少年家庭照顧者所使用的社會資源及其需求，少年家庭照顧者的人際支持網絡十分薄弱，使用的資源有限。絕大多數的社會支持均以經濟層面的協助為主。少年照顧者的需求包括：替代性照顧服務、期待社會以平等的眼光看待失能家屬、充足的資訊和心理輔導以及能夠獨處喘息的時間。 因應研究結果，研究者提出政策及實務上之建議，首要保障少年照顧者身為 少年的人權，提供符合少年照顧者需求之福利服務，並結合所有相關單位共同合作滿足少年照顧者的獨特需求。 / The purposes of this qualitative research include: (1)Analyze the factors of young carer’s becoming. (2) Understand young carer’s feelings about care experience. (3) Understand what kind of influences when teenagers must care for disabled family members. (5) Analyze young carer’s pressures and how they coping with. (6) Accord to research findings to propose welfare organizations and government some suggestions. Four young carer have interviewed. The research discovered the factors of young carer’s becoming are including culture standard , exchanging to pay back, emotions with family members, lacked potential carer and family system factors. Young carer’s feeling about care experiences are including they lost their childhoods, their parents have excessive hopes to young carer, too many works made young carer feel tired, and they have no time to play with their friends or to do other things. The influences about teenager care for disabled family members are including the positive and the negative sides. The positive side is young carer have more eympathy and maturation than other same generations. The negative sides are they lost decision-making powers and institutionalized life style will let them feel depressed. Young carer’s pressures are including teenager’s and carer’s pressures. The way that they cope with the pressures are leading off feelings, transfering attention, doing other things, impermanent leaving or to find front meanings. Finally this research discovered young carer with weak support . They need rest time, enough information, and psychology counseling etc. According to research discoveres, researcher propose three suggestions about policy and welfare organzations. ◆ To ensure young carer’s human rights , remember they still are teenagers. ◆ Providing welfare services which fitting in with young carer. ◆ Connecting with all related units to satisfy young carer’s individual needs.

性別與家庭照顧議題在當今已越來越受到重視，現代化改變了傳統家庭照顧的模式與內容，家庭照顧如今已非理所當然能負荷之能力。照顧工作究竟該交由社會機構正式照顧或者是家庭非正式照顧，受限於資源缺乏和傳統觀念、社會壓力下，一直是照顧者左右為難的問題。許多與照顧議題相關之文獻也反映出，照顧工作會出現壓力與疲勞問題，就業與勞動形式是其中影響重大的變項，與多數針對照顧者所進行的研究調查相較，本文的研究對象係我國之受僱者，使用次級資料分析法，進行量化統計分析，對受僱者承擔照顧責任之疲勞與壓力狀況作一真實呈現。本研究發現，主要照顧者較非主要照顧者有工作壓力的機率較高、疲勞程度也較大；照顧對象的不同對主要照顧者而言，工作壓力和疲勞程度沒有顯著不同。最後本文依據研究結果提出改善家庭照顧者工作壓力和疲勞的幾點建議。

我國面臨高齡化社會的趨勢，為因應老人照顧需求快速增加，家庭作為老人照顧支持體系的一環，有關老人家庭照顧者的議題得到來自各種專業領域的重視。檢視國內外既有文獻的討論，對於家庭照顧者的照顧經驗及困境，已累積有豐富的研究成果，然而，相關研究成果基本上著重於日益增加的照顧需求如何影響女性照顧者的生活。有鑑於前人研究發現，兩性在照顧工作方面的投入與影響確有差異，因此，為求對我國家庭照顧者有更全面性及完整性的思考，確有需要對從事家庭照顧的男性加以瞭解。本研究立基於國內既有研究成果及國外相關研究的啟發，透過性別關注的角度切入家庭照顧議題，以我國佔三至四成的男性照顧者為對象，瞭解我國男性家庭照顧者的獨特照顧經驗。本研究目的包括：(一)探討男性家庭照顧者形成的歷程；(二)男性照顧者對照顧工作的經驗感受及其影響；(三)男性家庭照顧者的應付策略及社會支持；(四)提出具性別敏感的政策參考。 本研究採用質性研究方法，深入訪談十二位正在從事家庭照顧工作的男性。重要研究發現為：(一)男性家庭照顧者形成的歷程，依序決定於「勞動就業狀況」、「性別角色規範」以及「親屬關係」。(二)男性家庭照顧者的經驗感受，在情緒認知、表達方式及角色自主性方面，存在男性氣概與照顧者被期待特質之間的矛盾拉扯，同時面臨就業及照顧工作的衝突。(三)男性家庭照顧者的應付策略，傾向以工具性問題解決模式，運用個人經濟資源的優勢，解決照顧工作的困境，其方法包括：創新照顧方法、調整自己的想法、及分攤照顧責任。最後，本研究分別從「保障老人權益減少依賴」、「提供性別適切的照顧者福利支持措施」、「解構照顧工作之性別分化」三個方面提出政策建議。 / As a response to the increasing demand of elder care in the modern aging society, the issue of home care for the elder has attracted more attention in several academic fields. In the literature, there have been some research findings about the experiences and challenges of home caregivers. However, these discussions primarily focused on the impact of caring works on the female caregivers. According to the previous research, there exists significant difference between male and female caregivers in their ways of input and impact from caring work. There is a need to study the topics of male caregivers in order to have a thorough understanding of home caregivers. This thesis studies the relations between gender difference and caregiving by exploring the unique experience of male caregivers, who take 30% to 40% share of total caregivers in Taiwan. The main purposes of this research include: (i) the formation of male caregivers; (ii) the experience and impact of caring work on the male caregivers; (iii) the coping strategy of male caregivers and their social support; (iv) the accordingly policy suggestions with gender-sense. This study adopts qualitative research methods by interviewing twelve male caregivers in Taiwan. The major findings can be summarized as (i) The formation of male caregivers depend on the job market condition, the normative gender role, and kinship relations. (ii) There exist conflicts between socially expected characteristics of care providers and male care provider's masculinity in the caregiving process. Examples include the conflicts between recognized and actual ways of emotion expression, between autonomic and constrained (defined) role playing, and between personal career development and home care works. (iii) The male caregivers develop several innovative problem solving strategies, such as using personal economic resources, adjusting predominate thinking, and sharing care responsibilities with others. Finally, this study provides concrete policy implications in three aspects: reducing elders' dependence, increasing governmental support with gender-sense for caregivers, and de-constructing the division of gender on caregiving systems.

在人類社會中，失能老人大多由家庭來承擔照顧責任，也因此帶給照顧者相當重的負荷。在此脈絡下，家庭照顧者的相關政策與措施逐漸受到大眾的重視，期望藉由各式的措施與服務以減少照顧對生活的不利影響，進而增加照顧者的生活福祉。在心理性的支持服務中，自助團體能夠有效舒緩照顧者的身心壓力，但照顧者自助團體研究甚少，且照顧者自助團體之研究未正視團體成員先前團體參與的經驗，及既有研究忽略照顧者支持團體的延續性效益之探究，是故，本研究目的包括：一、從接觸自助團體的起源—探討照顧者參與支持團體的經驗；二、分析照顧者參與自助團體的經驗；三、以增強權能觀點探究照顧者參與自助團體的經驗；四、從自助團體成員及社工員的角度看自助團體的未來發展；五、依據研究結果，提供建議作為辦理照顧者自助團體的實務工作者及家庭照顧者相關團體之參考。 本研究使用質性取向的研究方法，以「台北縣家庭照顧者關懷協會」作為研究場域，本研究共計訪問八名受訪者，一名社工員及七位照顧者。照顧者皆為女性，年齡介於53-64歲之間。照顧狀況方面，有1位仍持續照顧中，6位已結束照顧工作。照顧者參與自助團體方面，僅有1位非團體幹部。 主要的研究結果如下： 1.照顧者參與支持團體經驗中，透過醫療單位及個人熟識者得知活動訊息。照顧者支持團體前的處境大致可區分心理壓力、生理壓力、缺乏社會支持網絡及不清楚照顧方面的資訊。照顧者實際參與支持團體的條件為能擁有自己可支配的時間，以及有人協助暫代照顧工作。支持團體活動內容包括身心成長類、藝術治療類、活動肢體類、人際學習類，其中團體領導者的角色為教育者、催化者及使能者。領導者與成員的關係會隨著時間而改變，隨著時間的發展，許多不在正式的團體中的互動行為跟關係開始產生，此互動經驗讓成員與領導者在團體之外仍保持密切互動，彼此約定舉辦定期的聚會，逐漸形成自助團體。 2.照顧者參與自助團體之經驗中，北縣家協每個月會安排一次三小時的座談分享會，座談內容偏向靜態主題如舒壓、按摩穴道等。自助團體成員的角色可區分為活動發起者、訊息傳遞者、聯繫者、支持者及追隨者。團體互動歷程包括三個階段：互動初期、關係建立期及關係維持期。成員彼此互動的情形中，共享相似的照顧經驗及用支持的力量陪伴成員走過艱辛路，此外，單身、結束照顧工作的成員與他人互動的頻率較高。 3.以增強權能觀點分析照顧者參與團體的經驗中，在個人面的改變部份，照顧者能夠「減少負面感受」、「改變認知」、「增加知能」、「增加自信」、「支配自己的生活」；在人際面的改變中，照顧者「以同理心與被照顧者互動」、「普同性的照顧經驗」、「利他性的互動」、「知識訊息分享」、「建立同儕友誼關係」及「擴大社會網絡」；在社會面的改變中，照顧者開始從事「志願服務」、「贊助協會」，對「家庭照顧者議題及政策」也有所看法。 4.從自助團體成員與社工員的角度看自助團體的未來發展：從照顧者角度看自助團體，可發現自助團體目前運作狀況為擴大服務據點至偏遠地區，北縣家協與自助團體彼此具有雙向的互動關係。照顧者建議將活動資訊發給每個社區的健康中心，透過增加資訊管道以使訊息更具有可近性。從社工員的角度看自助團體發現，照顧者喜愛輕鬆的聚餐，期待設計自助團體相關教材，並成立自助團體的關懷小組，及補助自助團體的運作經費。 / On an aging society, the disabled elderly usually cared by families that becomes a heavy load of caregivers. In this context, the policies and measures of family caregiver are valued by the general public gradually, and hope to reduce the negative effects, to increase the well-being of caregivers. Self-help groups can effectively reduce the ca-regiver physical and mental pressure, but there are few related studies. In addition, the experience of caregiver involve in previous groups few mentioned in current studies, and caregiver support groups of the continuity of the effectiveness is neglected to explore in existing studies. Accordingly, the purposes of this study are as following: first, examine the expe-rience of caregivers involved in the support group; second, consider the experience of caregivers involved in the self-help group; third, explore the experience of caregivers involved in the self-help group --analyze from the perspective of empowerment; fourth, the expectation of the future development of self-help groups of members from the self-help groups and social workers; fifth, according to research findings, provide suggestions for caregivers’ practitioners and relevant groups. This study employs a qualitative research approach, and data collection is gotten from " Family Caregivers Association in Taipei County", including semi-structured in-depth interviews with a social worker and seven caregivers, aging from 53 to 64. One caregiver who still cares her family members and one caregiver is not the cadre. The study findings are listed below: First, caregivers get information through the medical units and individuals who are familiar to them. Caregivers have psychological stress, physical stress, lack of social support networks, and lack of care information. Caregivers can involve support groups because they have their own time, or someone help to take care temporarily. Support group include physical and mental growth activities, art therapy classes, common activities and interpersonal learning classes. The role of support group leader is a educator, catalyst and enabler. The relationship between leaders and members change over time, as time goes on, members and leaders still remain in close interaction, therefore a self-help group formed gradually. Second, when caregivers involve in the self-help group, the Association arrange a three-hour discussion sharing monthly. The role of self-help group members can be divided into active sponsors, messengers, associates, supporters and followers. Group interaction process consists of three stages: the initial interaction, relationship building and relationship of the maintenance phase. Members interact with each other, sharing similar experiences and support each other .In addition, caregivers who are single, or do not have to care their family members have higher participation rates to involve in self-help group. Third, explore the experience of caregivers involved in the self-help group --analyze from the perspective of empowerment. Changes in the personal aspect include "reduce the negative feelings", "change the perception", "more knowledge", and “more confident”, “control their own life”. Changes in the interpersonal aspect include " empathy the care receivers "," same experiences in taking care "," altruistic interaction "," knowledge and information sharing "," establish peer friendships and relationship "and" expand the social network ". Changes in the social aspect include "engage in voluntary service "," contribute money to Association ", besides caregivers have ability to suggest for family caregiver issues and policy. Fourth, the perspective of self-help group members is self-help groups expand services to remote areas. The Association and self-help groups also have good interaction. Caregivers suggest activities distributed to each community's health information center, make information more accessibility. The perspectives of social workers is design teaching material about self-help group, and set up a support team, and grant funding for self-help.

近年來國內藉由跨國婚姻形式來台的東南亞籍女性外籍配偶數量不斷增加，相關議題受到各界廣泛討論；另外，台灣在面臨人口老化的趨勢下，所衍生出的老人照顧課題也同樣受到關切。但是關於跨國婚姻家庭中的失能老人照顧問題卻一直被忽略。因此本研究以質性研究方法，訪談了十位居住在台南縣的東南亞籍女性外籍配偶照顧者，以及兩位家人，探討她們成為家庭中失能老人的照顧者之原因與對照顧工作的認知、從事的照顧工作內容與扮演的照顧角色、照顧過程中的正式與非正式社會支持網絡以及照顧工作對其生活各層面所帶來的影響，藉此勾勒出女性外籍配偶家庭的照顧圖像。研究結果顯示，女性外籍配偶成為家庭照顧者的原因有文化規範、性別角色分工、情感上的推拉力以及雙重的生產力身份等等。其扮演的照顧角色為「直接協助者」、「叮嚀與監督者」、「情緒的支持者」、「協同照顧者」以及「家務工作者」。另外，在照顧過程中的社會網絡上，主要由夫妻關係、子女關係、娘家關係、親屬關係、鄰居關係及朋友關係構成的非正式支持體系來提供工具性與情感性的支持；因為其婚姻構成的因素與對資源的掌握能力不足，缺少正式支持體系的協助。而照顧工作對女性外籍配偶照顧者的生活各層面，包括生理/心理層面、家庭關係與社交層面、經濟/財務層面以及工作層面等等都帶來一定程度的影響。總體而言，女性外籍配偶照顧者不但要面對與本國籍女性照顧者相同的照顧情境與問題，因為其特殊的文化及語言背景，還得學習自我調適與生活適應，所承受的生活壓力與照顧負荷可說是加倍的沈重。

本研究試圖探究走過家庭照顧歷程決定成為照顧服務員這群女性勞動者，從這群女性勞動者的生命圖象中，分析這兩種角色之差異性，並進一步探討研究對象對於這兩種角色轉換之轉換歷程與因應策略。 本研究使用質性取向的研究方法，以半結構式的深度訪談進行資料蒐集，有效受訪對象共訪談8位曾有家庭照顧經驗之照顧服務員，年齡介於44歲～63歲之間，教育程度則以高中職為主。婚姻狀況單身3名、單親2名、已婚育有子女3名。照顧關係中女兒照顧者與媳婦照顧者各半。家庭照顧期間從1年到16年皆有，照顧服務員工作年資則從2年到13年不等。 本研究首先歸納整理女性成為主要照顧者的原因，並整理當照顧情境改變時家庭照顧者重返勞動市場之考量因素。研究發現，家庭照顧者在成為照顧服務員的過程當中，受服務經驗扮演相當重要的中介角色，受服務經驗是這群中年婦女在求職過程的一個重要催化劑，轉而投入照顧服務工作。接著耙梳照顧服務員在職場的工作困境，研究發現照顧服務員所面臨到的工作困境相當多元，本研究分從個人面、互動面、實務面及制度面四個層面加以說明。 研究最後統整了兩種照顧經驗之比較，研究發現家庭照顧者成為照顧服務員之後，因照顧對象的不同，隸屬於不同的關係中，佔據不同的位置，扮演不同的角色，並依循此角色之責任義務規範行事。兩種照顧經驗的差異展現在照顧角色轉換的經驗感受、照顧基礎的差異以及照顧過程中照顧者的自主性三個面向上。同樣的照顧工作，一是無酬一是有酬，一是親屬關係一是專業服務關係，一是基於責任一是基於契約提供照顧，一是在家庭成員共識認可下照顧，一是依循科層組織規章在契約的規範下照顧，兩者在不同的面向上呈現相當不同的景象。然而，具有家庭照顧經驗的照顧服務員，對日後的照顧工作是有影響的，其關連性主要包括在下列三個部分：照顧的知識技巧、同理以及情感轉移上。其照顧與互動的技巧是可以透過反覆的實作而熟能生巧，照顧技巧的經驗累積可以視為是一種延續。 私領域的家庭照顧者與公領域的照顧服務員間之兩種照顧經驗，在照顧的任務（care for）上其實大致相同，但在照顧者對他人個感受（care about）上卻大相逕庭。因為照顧關係與照顧基礎的不同，親屬關係的家庭照顧承載著較多的感受狀態，家庭照顧者需時時刻刻、盡己所能地回應失能者所有需求，關注受照顧者的福祉，也因此照顧者會感受到較大的照顧壓力。反觀照顧服務員的照顧本質，對於情感的指涉相對較低，關係建立僅是互動的基礎，互動的時間也多在服務的時數範圍內，對受照顧者而言，更多的關注是在照顧任務是否精確完善的被執行。因此，一樣照顧兩樣情，相似的照顧工作，在不同的照顧場域中，照顧技巧的經驗會延續，但照顧歷程的差異感受卻是呈現相當多元的樣貌。 / This research aims to investigate female laborers who decide to become care workers owing to the experience of being family caregivers. It analyzes the difference between the two roles as well as the transformation and strategies that are taken. With the qualitative approach, the data were collected by semi-structural in-depth interviews.There are 8 valid once-family-caregiver interviewees who are now care workers aged 44 to 66, with the educational background of senior or vocational high schools. Among these interviewees, three are single, 2 are single mothers and 3 are married and have children. Four of whose family roles are daughters, four daughters- in- law. They have 1-16 years of experience of being family caregivers respectively and 2-13 years of being care workers. The study starts with a generalization of reasons that makes females as main caregivers and factors of their returning to the labor market when care-taking conditions change. It discovers that the experience of having been taken care of plays a crucial role in the transformation—from family caregivers to domestic ones. The experience serves as an important catalyst for these middle-aged women to become care workers. The study, then, scrutinizes the predicament these care workers encounter, followed by an analysis of their mutiple predicament derived from four respectives: personal conditions, interactive relationship with their patients, care-taking practice and public system. The study wraps up with a comparison-- after becoming care workers, these once-family-caregivers make adjustments according to different relationship and roles. The diversity between the two experience presents upon three dimensions: relationship with patients, different care-taking basis and autonomy of patients. Although both family caregivers and domestic ones are responsible for taking care of patients, the formers are unpaid; doing the job out of familial affection and obligations with the consensus of other family members, while the latters are paid workers, looking after their patients on the basis of profession and contracts under relevant regulations. Each unfolds quite disparate views in front of us. As divergent as they are, the experience of family care-taking has impact on the domestic caregiving work in terms of relevant knowledge and skills, compassion and communication abilities. The accumulation of similar experience can be extended and easily applied. The mission of 'caring for' patients is generally identical for both private-domain family cargivers and public-domain care workers, nevertheless, the extent of “caring about” patients varies. Family caregivers carry more affection and emotions; they have to do their best all all times to respond every need and well-being of the disables, which generates much stress. Care workers, however, are less affection-expected; their relationship with the patients is contract-based and they serve their patients in work hours. Instead of emotionally dependent, patients focus more on whether and how the tasks are being done. Two different perspectives are revealed which give us more lights on the care-taking work.

照顧是一種「愛的勞動」， 性的工作，尤其是家庭中的照顧者幾乎都由女性擔任。 我國未來由於人口結構老化及疾病型態的改變， 失能老人照顧勢必逐漸取代女性過去以兒童照顧為主的照顧責任與經驗。 目前女性照顧者在失能老人照顧關係上，因對角色安排及外來協助未有充份的選擇權及自主權， 致使家庭中的女性照顧者與失能老人皆陷入缺乏尊嚴、衝突與無助的家庭照顧關係。 據此，本文之研究目的與研究結果摘要如下： 一、瞭解女性照顧者角色成因。 結果發現受到父權主義、資本主義所影響的家庭、勞動市場及國家等社會結構， 構成了「型塑」及「強化」女性照顧者角色的結構網絡。 而偏好「單系親屬關係體系」、強調「孝道」的文化傳統、及「三代同堂」的居住安排， 使我國女性照顧者有高於西方社會的強制性關係與情感衝突。 二、瞭解女性照顧者的困境與需求。結果發現女性照顧者的責任認知、 從事照顧事務、 外來協助、角色衝突、壓力感受都與男性照顧者有所不同。負荷與壓力主要呈現在身體、心理、社會參與、財務及工作方面， 且女性會面臨較高的貧窮風險， 須借助政府制定經濟性、勞務性、心理性或就業性措施予以協助。 三、探討西 方先進國家女性照顧者福利議題的歷史發展與爭議。 結果發現西方先進國家的失能老人照顧政策， 隨其國家干預政策發展出「傳統模式」、「替代模式」及「支持模式」等三種福利策略。 目前盛行的社區照顧政策可視為支持模式的衍生， 即由國家與家庭「共擔責任」，在失能老人照顧上建立一種「互補性」的合作關係。 四、對我國女性照顧者的福利措施提出策略性建議。

隨著老年人口的增加，首要面對的議題即為慢性病罹病率的劇增，而其中又以近年來大家所最為關注的失智症為最。由於失智症患者的記憶力、語言與自我照顧能力會隨著病程而逐漸退化，使得照顧者在照顧上的負荷更勝一般失能老人的照顧者。因此，本研究欲從失智老人家庭照顧者的觀點，瞭解其選擇使用居家服務之經驗。 據此，本論文之研究目的在於：一、瞭解失智老人家庭使用居家服務之原因。二、探索失智老人家庭照顧者使用居家服務前後的照顧項目變化，並進而探究居家服務對照顧者及老人之功能。三、從失智老人家庭照顧者的觀點出發，探索何謂好的居家服務，以及其他失智症相關的福利需求。四、依據研究結果，作為服務單位改進措施及政策規劃之參考。 本研究使用質性取向的研究方法，由台北市兩間居家服務協助提供適合本研究之研究對象，採用半結構式的深度訪談法進行資料蒐集，共計訪談十位照顧者。主要的研究結果如下： 一、失智老人家庭照顧者普遍都有生理、心理及社會層面的負荷，這些負荷包括照顧壓力太大、自己的時間受到限制及照顧與工作無法兼顧；而當照顧者面臨到老人因素、照顧者因素及照顧人力因素等三個因素的困難時，就會傾向選擇其他的替代方式來照顧老人。 二、對失智老人家庭照顧者而言，居家服務除可分擔自己的照顧責任、增進社會接觸、補充照顧人力不足之問題以及增加可彈性運用之時間外，更能讓自己對老人狀況有所掌握，並能減緩自己與老人間的緊張關係；而居家服務對失智老人亦有所幫助，尤其是在「增加老人社會接觸」與「增進老人生活自理能力」兩方面。但僅對於輕、中度的失智老人有幫助，對於失智重度以上甚至生活自理能力缺損嚴重的老人而言，幫助則有限。 三、對於失智老人家庭照顧者來說，好的服務員應具備：要有服務熱忱、有愛心、能注重細節，並能感受老人的需求；要有好的服務態度；要有專業素養；及要能讓老人信任等特質；而照顧者眼中好的居家服務單位，則應具備：為求服務員穩定提供服務，對於服務員的休假或請假應有相關規定；應要求服務員要定期回報服務狀況；及應定期安排服務員受訓等條件。 / With the increase of elderly population, the rapid growth of the morbidity of chronic diseases has become the most important issue. In recent years, most people pay attention to the elderly with dementia because their memory, language and self-care capacity will be gradually degraded during the course of the disease. The burden of caregivers taking care of the elderly with dementia is much heavier than the general caregivers of the disabled elderly. Therefore, this study aimed to understand the viewpoints of caregivers taking care of the elderly with dementia about their experiences in choosing to use the home-care services. Accordingly, the purposes of this study are the following: first, understanding the reasons of using home-care services of the family with the elderly with dementia; second, exploring the changes of the caregivers taking care of the elderly with dementia before and after using the home-care services; third, exploring what are good home-care services and other dementia-related welfare needs from the viewpoints of caregivers taking care of the elderly with dementia; forth, providing suggestions for policy making and the improvement of the home-care services providers based on the research findings. This study used the qualitative research approach, and collected data from two home-care services providers and included semi-structured in-depth interviews with ten caregivers of the elderly with dementia. The research findings were listed below: First, the caregivers of the elderly with dementia generally had physical, psychological and social dimensions of burden including pressure, limited time and being not able to take charge of caregiving and work simultaneously. When caregivers faced the difficulties of the above three factors such as the elderly with dementia, caregivers and caregiving manpower, they tended to choose other alternatives to provide caregiving for the elderly. Second, for the caregivers of the elderly with dementia, they could understand the situation of the elderly and reduce their tensions between themselves and the elderly in addition to sharing their duty of caregiving, improving social contact, supplying manpower, and enhancing the time flexibility by providing home-care services. Home-care services also could help the elderly with dementia particularly in the dimensions of “social contact “and “promotion of daily living”. However, it was only for the elderly with mild to moderate degree of dementia; for the elderly with severe dementia and more severe impairment of daily living, the benefit was limited. Third, from the viewpoints of family caregivers of the elderly with dementia, a good home-care worker should have the enthusiasm for providing services, be compassionate and attentive to details, be able to understand the needs of the elderly, have a good attitude, be professional, and be able to be trusted by the elderly. In addition, a good home-care services provider should provide the stable quality of services, have the relevant regulations, require caregivers to report services status regularly and train the home-care workers periodically.

家庭照顧者的照顧負荷沉重，其多表達有支持性服務的需要，故針對家庭照顧者使用支持性方案之經驗，頗值得研究加以探討。本研究目的為瞭解家庭照顧者使用支持性方案的情形為何，進而探索使用服務期間從事活動的經驗，剖析家庭照顧者在使用支持性服務期間重新回復能量之過程。 本文採質性研究法，以深度訪談法蒐集資料，訪談樣本來自台灣失智症協會，共有4位失智症照顧者接受訪談。主要研究結果如下﹕ 1.家屬使用「各項家庭照顧者支持性方案」的情形，以瑞智學堂、瑞智互助家庭、家屬聯誼會為例，進而比較上述三項服務方案之異同：(1)學堂到互助家庭，家屬「聚在一起」和「舒緩的時間」更多；家屬更懂得「釋放關心」。(2)從學堂到家屬聯誼會：「家屬未經組織的團體聚會」到「成為團體成員後的聚會」。(3)服務對象與受惠對象方面，學堂服務對象以「失智長者為主，長者受惠較多」；互助家庭以「長者和家屬為主，家屬受惠較多」；家屬聯誼會以「家屬為主，家屬受惠較多」；但其實「長者與家屬之間具有相互性」，家屬獲益之後，更能以健康的身心靈來提供長者的照顧，相對的，長者的功能得以維持或減緩退化，亦有益於家屬提供照顧。 2.家屬的需求與動力是推動支持性方案重要的推展，從學堂到互助家庭的歷程，家屬與長者有三個階段的活動經驗，包含麻將班、烹飪班以及樂樂班，其顯示家屬有時間、空間以及活動參與的需求。 3.家屬使用服務期間從事活動獲得「心理喘息」的要素，可就休閒與休息、自我效能感、團體的歸屬感、採取行動的層面進行分析，分別為(1)休閒與休息：「才能展現」、「享受說話」以及提升生活「滿意感」；(2)自我效能感：「學習」、「突破」、「成就感」的過程，增進自我效能感；(3)團體的「歸屬感」，以及(4)社會貢獻的使命和生命的「意義感」，可見家屬由照顧者蛻變成助人者的軌跡。 / The caregivers in families carry a heavy responsibility, and many of them express the need for supportive services. As such, their experience in using supportive programs warrants further study and examination. In this study, we aim to first understand how such programs are being used. Next, we examine the restorative process in which caregivers use such services to gain respite. This study used the qualitative research approach, and collected data from Taiwan Alzheimer's Disease Association and included semi-structured in-depth interviews with four caregivers of the elderly with dementia. The research findings were listed below: 1.We studied the following three supportive programs and analyzed their similarities and differences: the School of Wisdom, the Family of Wisdom, and the Family Club. (1) As the group progresses from the School of Wisdom to the Family of Wisdom, family members have more and more time to spend together and respite time; they also tend to show more care for others. (2) As the group progresses from the School of Wisdom to the Family Club, unorganized group gatherings evolve into organized gatherings for members of the group. (3) The target participants for the School, the Family and the Club are, respectively, senile seniors, seniors and their families, and families; the beneficiaries of the programs are seniors, families, and families. However, there is also an interrelation between seniors and their families: families who benefit from improved mental, physical and spiritual health are better able to care for their seniors. Vice versa, it is easier for families to care for seniors who are able to maintain or mitigate the degeneration of their daily functions. 2.The needs and motivations of families are pivotal drivers for supportive programs. Throughout the evolution from the "School" to the "Family", families and seniors go through three stages of participation in activities, namely, mahjong classes, cooking classes and hobby classes. The progress reveals the families' need for respite time and space and their levels of participation. 3.Families enjoy a restorative mental break by participating in activities. We analyzed the key elements of this mental break: leisure and rest, self-efficacy, belongingness, and level of participation. (1) Leisure and rest: display of talent, enjoyment of talking, and enhanced satisfaction toward life. (2) Self-efficacy: enhanced self-efficacy through the process of learning, breakthrough and sense of achievement. (3) Belongingness: the sense of belonging to a group. (4) Level of participation: the sense of mission to contribute to the society and meaning of life demonstrated by the families show an evolution from being the caregiver to the one who helps others.

臺灣勞工家庭照顧假自2002年3月8日施行至今已屆滿15年，其間經過2次修正，將適用範圍逐漸擴大到全部事業單位，讓全臺灣勞工在遇有家庭成員需要預防接種、發生嚴重之疾病或其他重大事故時，而必須親自照料該家庭成員時，都能受到保障。在過去15年裡，有部分勞工因為此項政策而得到實際幫助，彰顯家庭照顧假確實有存在的必要。 然而，從勞動部「2016年僱用管理就業平等概況」調查報告結果，雇主會同意員工申請(或有提供)家庭照顧假者，比例僅有77.1%，表示家庭照顧假雖然已經實施15年之久，卻仍然無法全面落實，似乎有其瓶頸在。 本研究是從企業人資主管的立場，探討家庭照顧假未能全面落實的原因、企業進行把關的目的，以及如何增進目前家庭照顧假的政策內容，期以提升未來的施政成效。研究發現，受訪企業都有依法給假，透過員工請假的舉動，可間接瞭解員工目前身心狀況，提出適時且必要的援助。研究建議，短期建議將家庭照顧假與事假的天數分開計算，長期建議在搭配社會保險方式下，將現行無薪家庭照顧假改制為有薪，最終目的在使家庭照顧假得真正全面落實。 / It has been almost 15 years since the policy on Taiwan’s Family Care Leave was enacted in March 8th 2002. After two amendments, the scope of application of the Family Care Leave has covered all business sectors. This policy ensures that when an employee has to take care of a family member who requires a vaccination or who is seriously ill, or when an employee must personally attend to his/her family member for other important reasons, the employee may take Family Care Leave. In the last 15 years, a portion of the work force has benefited from this policy, which has shown forth the necessity of the policy. However, Ministry of Labor’s survey report shows that, only 77.1% of the employers agreed to provide Family Care Leave for their employees. This report has shown that even after 15 years, the policy still cannot be fully implemented. This paper is to examine the extent to which Family Care Leave policy has been implemented, why business corporations maintain checks on the policy, and how can the Family Care Leave policy be enhanced to improve the effectiveness of governance. This study has found, all interviewed companies have complied with the Family Care Leave policy. Through observing the reasons why employees use Family Care Leave, employers can have a better understand of their employees’ family situations and their heath conditions thus provide further assistance. The study suggests that in the short term, Personal Leave and Family Care Leave should be calculated separately. In the long term, accompanied by the social insurance system, a paid Family Care Leave should be implemented. The ultimate goal is to truly implement the Family Care Leave policy.