本文旨在研究臺北市樟新社區與一壽重殘照顧中心之互動，關於一個都市社區與精神障礙照顧機構之互動情形。分析主要分為兩部分，第一部份回溯一壽重殘照顧中心進入樟新社區之過程與情形，第二部分則分析樟新社區與一壽重殘照顧中心現階段之互動情形與未來建議。此外，本文也特別引用了「鄰避情結」（即「不要在我家後院」，”Not-In-My-Backyard syndrome”，簡稱NIMBY）作為論述基礎，試圖去檢視社區居民對於照顧中心的觀感，找出居民排斥或接納照顧中心之情形與原因等，並以衝突歷程的概念去剖析互動現狀。本研究目的則是希望透過個案研究，探討一個社區如何與精神障礙照顧服務機構互動，以從中找出能使社區居民與照顧服務機構二者共生、互助、融合之社區工作精隨。 本研究採質性研究之個案研究法，運用多重資料來源，並藉由觀察互動及深度訪談法來蒐集資料。其中深度訪談選取參與或了解本研究議題者作為訪談對象，包括規劃或承辦照顧中心進入社區的政府人員、來自照顧中心承辦單位及在照顧中心服務的管理者或工作者、對議題了解或熟悉社區事務的社區居民，藉此先行了解一壽重殘照顧中心進入社區之過程，包括照顧中心設立的過程與決策考量、照顧中心設立時與社區之衝突對立情形，以及政府單位、民間團體、社區居民三方對於衝突對立的認知、處理方式或行動。再者，也深度探究社區與機構過去至今的互動樣貌，包括社區與照顧中心的互動現況、社區居民對照顧中心設立觀感與鄰避情結、社區居民排斥或接納照顧中心之情形與原因，進而找出促進照顧中心融合社區或其他可能作法。 最後，根據本研究，提出相關政策建議如下： 一、檢討我國公有土地政策，以避免社福資源被稀釋； 二、讓障礙者參與決策過程，以落實真正的社區照顧； 三、在各地廣設心理衛生中心，讓障礙者能在原本的社區居住； 四、透過立法保障與教育倡導，以維護障礙者之居住權； 五、組織經營照顧中心志工團，並促進機構與社區的互惠及共生關係； 六、社區或機構相關工作者可採低姿態、柔性、創意方式，長期經營社區關係。 　　 關鍵字：社區、精神障礙、照顧機構、鄰避情結 / This research aims to study the interaction between the Zhangxin Community in Taipei City, an ordinary community in a big city, and the Taipei Yi-Shou Care Center, an institution for the psychiatric disabled. In the first part of the study, the researcher reviews the process of how the Taipei Yi-Shou Care Center moved into the Zhangxin community, whereas the second part analyzes the interaction between them and further provides suggestions for future cooperation. Besides, the researcher specifically adopts the concept of “Not-in-my-backyard syndrome” (NIMBY) as the theoretical background to survey the perceptions of the community residents toward the care center. Moreover, this study identifies the reasoning behind the acceptance or refuse of the move-in of the care center. Finally, this paper analyzes current status of interactions through the lens of conflict process. In summary, the aim of the research is to identify how community residents interact with an institution for the psychiatric disabled; furthermore, this study concludes the essence of community work in helping community residents and health care institution to cohabit, achieve mutual help, and integrate with each other. This research adopts case study method and collects data from multiple sources, such as onsite observation of the interaction and in-depth interview. For the in-depth interview, this study recruited key persons who have participated in and are aware of the issue. Therefore, the interviewees range from the government officials who have planned or taken charge of the move-in, the managers or workers of the care center or higher level of administration, to the Zhangxin community residents who are aware of the issue or general community affair. Accordingly, this paper first strives to investigate the move-in process, from the decision-making processes of the establishment of the Taipei Yi-Shou Care Center and the conflicts between the supporters and critiques during construction, to the perceptions, solutions, and actions toward the problem from the government, non-government organizations, and the residents. Second, the study thoroughly reviews the history of the interaction pattern between the residents and the institution, including the status quo of the interaction, the perception and the NIMBY of the residents toward the care center, and the situation and reasons of acceptance or refuse of the care center. In the end, this paper proposes possible means to help the care center better integrate with the community. This research proposes six suggestions for policy below: 1. Review the policy of public lands to avoid diluting the resources of social welfare. 2. Invite the disabled to participate in policy making to realize essential community care. 3. Set up community mental health centers to render the opportunities for the disabled to live in the original community. 4. Safeguard the right of residence of the disabled through legislation and education. 5. Organize volunteer groups of the care center, and improve the mutual benefit and cohabitation relationship between the institution and the community. 6. Community and institution workers manage long-term relationship with the community through modest attitude and in flexible, creative ways. Key words: community, psychiatric disability, care institution, Not-In-My-Backyard syndrome(NIMBY).

近年我國人口老化趨勢情形，照護人力又長期不足，年輕人從業意願低，已成為沉重問題，而長期照顧工作工作時間長且社會認同度低，使得老人照護人力與服務品質無法提升，長照人力如此之困境，於公部門長期照顧機構首當其衝。臺北市立浩然敬老院為照顧臺北市弱勢族群之公立公費之老人安養機構，並自101年起由安養機構轉型為安養、養護、失智、長照之多層級照顧機構，提供老人多層級連續性照顧，除有上述人力不足難題外，其勞動條件及薪資福利待遇又因不同進用身分而有薪資差別待遇問題，此為我國公部門長期照顧機構急需改善的困境。本研究針對該院照顧服務員工作概況、勞動條件與權益等問題進行訪談，再將訪談結果予以歸納，整理公部門照服員在現行體制中所面臨的問題與保障不足之處，並期提出完善勞動條件、建立專業分級培訓與升遷機制，以充實照顧服務人力，健全當前長期照顧服務施政改進對策。 / In recent years, there has been an increasing demographic shift in Taiwan’s elderly population. However, as there is currently insufficient resource in terms of long-term care, and young people have decreased work aspirations, this issue has become major problem; long-term care work requires long working hours, and these care workers have a low status in society, so elderly care and service quality haven’t improved. The long-term care institutions within the public sector face these elderly care issues. Taipei City has a large number of elderly people that it needs to take care of within its public welfare system and institutions for the elderly. Since 2012, nursing institutions have provided the elderly with multi-level continuous care in terms of nursing, care, dementia, and long-term multi-level care-giving. In addition to the above-mentioned manpower shortage isues, the working conditions and salary packages have been variable due to different status and treatment issues, which is why long-term public care institutions in Taiwan require attention to improve the long-term care situation. In this study, we interviewed the nursing staff to ascertain the general situation of long-term care institutions, as well as the working conditions and staff rights. The results of these interviews were then summarized to determine problems related to public sector care-giving in the existing system, such as when insufficient care is provided, and how to greatly improve the working conditions through the establishment of professional graded training and a promotional system that improves care services. The improvement of current long-term care services needs to be established through policy measures.

在高齡化的潮流下，對於高齡者照顧機構的需求與日俱增，受照顧者在照顧機構內發生事故的案例也隨之增加。然而，我國對於高齡者照顧機構損害賠償責任之討論卻相對稀少。本文以事故類型化我國判決，並透過日本法相同類型之判決內容加以比較，得出以下結論：一、各事故類型之主要爭點及照顧機構之具體義務，亦即事故發生前之照顧義務，以及事故發生後之處理、急救義務內容。二、我國有消費者保護法無過失服務責任可資主張，但僅限於非醫療輔助行為之照顧行為。三、照顧機構對於無責任能力之受照顧者所造成之他人損害，日本有成立監督義務者責任之可能。三、與有過失於照顧事故中適用之前提要件，應僅限於受照顧者有積極不為防範之行為之情形。 　　觀諸我國照顧事故之判決，法院認定照顧機構成立責任者，多為照顧機構實際提供受照顧者之照顧服務行為上有所疏失之情形。因此在涉及受照顧者疾病感染或復發、因其他受照顧者行為所致之事故類型中，法院多以臨床標準為判斷基準，並限縮因果關係之解釋，減輕照顧機構所課與之注意義務，進而否定照顧機構有義務之違反。 　　相較於此，在日本照顧事故之判決中，法院著眼於照顧契約之保護照顧義務，認定設施方負有確保受照顧者生命、身體安全不致發生損害之義務，進而判斷具體個案中受照顧者方所主張違反之義務是否屬於前述設施方之義務範圍內，再加以審酌設施方有無預見及防免之可能，以認定設施方是否成立責任。又法院雖賦予設施方較高之注意義務，卻將所認定之損害賠償額控制在較低之標準，因此課與設施方之責任亦非過重。 　　因受照顧者身處設施方緊密控制之封閉組織內，仰賴設施方提供服務，設施方於契約締結、履行，乃至於終結，均處於較受照顧者更為優勢之地位。因此，我國若同日本，採取以保護照顧義務架構設施方之責任依據，並寬認設施方所負確保受照顧者生命、身體安全不致發生損害之義務範圍，再由設施方舉證證明其不具有預見事故發生及防免之可能，對受照顧者之保護應較為周全。