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.

精神疾病自發病之初至病程慢性化，不僅對精神康復者的生命歷程造成衝擊，亦帶給其照顧者家庭長期且全面性的影響，產生難以承受之身心負荷並衍生出相對的支持服務需求。本研究將其分為六大向度，包括：資訊支持、精神健康照護支持、照顧者教育支持、社會照顧支持、專業支持及心理支持。本研究旨在瞭解社區精神康復者在康復歷程中，其主要照顧者對於六項支持服務的需求及服務獲得現況，並分析不同背景變項對於主要照顧者支持服務的需求與獲得上的差異情形，及主要照顧者使用支持服務之障礙因素。以期對於提供主要照顧者支持服務時，能有效滿足照顧者之需求。 本研究以自編之「社區精神康復者之主要照顧者的支持服務需求與獲得現況調查問卷」進行資料蒐集，以立意取樣搭配滾雪球方式招募社區精神康復者之主要照顧者進行調查，選取提供精神康復者及家屬服務之社會福利機構及家屬團體作為研究對象來源。本次研究調查資料回收有效問卷共82份。 研究結果發現，主要照顧者對於支持服務在六大向度上皆有中度以上需求程度，並以「資訊支持」、「照顧者教育支持」、「心理支持」及「專業支持」的服務需求高於整體需求平均值。主要照顧者自評對於支持服務在六大向度上皆只有中度以下的服務獲得，僅「資訊支持」及「照顧者教育支持」的服務獲得高於整體獲得平均值。 主要照顧者對於支持服務的需求與服務獲得間沒有一致性的顯著相關，且對於不同支持服務需求程度的主要照顧者在服務獲得上並未有顯著差異。本研究之主要照顧者其資訊獲得來源以「社會福利機構/協會」及「醫護人員」為主，使用支持服務之障礙因素以「不知道該項服務」或「不清楚服務內容」之資訊障礙為首。 根據本次研究調查結果，研究者提出相關建議包括：提升「針對」主要照顧者需求之支持服務的品質及數量、健全資訊管道以改善照顧者使用服務障礙因素、加強精神疾病衛教及相關資源管道之宣傳，及政府應持續給予經費補助並鼓勵專業人員進入社區服務。

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.

本研究之目的：一為探究年輕思覺失調症患者，於荒野臨界中如何形塑其此際體態；二為探討患者主要照顧者面對精神分裂體驗，從何接應患者，如何賦予其心理照顧意義。而後，以對元結構方式，探討患者及其照顧者雙方的心理經驗。研究者將患者「生命經驗」及其主要照顧者「照顧經驗」並置於現象場脈絡中，透過深度訪談，進行現象還原，以接近患者的內在經驗，反思照顧者照顧行動意義。方法上，本研究採取立意抽樣，以年輕思覺失調症患者與其主要照顧者作為研究對象，以配對方式進行資料蒐集，共三對受訪者（6位）接受訪談，患者部分為三位男性，而雙親照顧者部分為一位男性、兩位女性。資料蒐集後，以Henri Ellenberger之現象學分析方法（林耀盛，2002）分析。研究結果發現，年輕思覺失調症患者與其雙親主要照顧者共構之置身結構經驗的定向軌跡為：（1）超常隱匿於日常偽裝之下；（2）超常現身，即特異性經驗被看見，包含病者與雙親照顧者；（3）芻思心緒，反覆思索當前之事件；（4）經驗賦義，理解所發生的事，並給出位置，將其涵容於自我之中；（5）存有的流變：希望與憂懼心思。研究貢獻為在臨床心理實務上可能的幫助：可協助狀態逐漸穩定之個案進行經驗之整理，使其看見自己的狀態，而非僅僅使其擁有病識感、願意配合醫療處遇。而對雙親做為主要照顧者，可協助其釐清對於疾病狀態的未知，及自我照顧技藝的發展。礙於現實收案狀況，難以擴大取樣具異質性的思覺失調症患者，資料豐富度較為不足，為未來研究可改善之處。 / Purpose: This study is exploring (1) how the young schizophrenic patient perceived who he/she is in “the wilderness”; (2) how their caregivers faced with the schizophrenic experiences and constructed the meaning of caring; and (3) disclosing the patients and their caregiver’s mutual situated experiences by the meta-dyadic structure. Methods: Taking a qualitative approach grounded in phenomenological psychology, this study conducted in-depth interviews by which researchers strived to observe, analyze and understand, from their first-person perspective, how they live under such situation. The participants were recruited through purposive sampling. Three patient-caregiver dyads (three male schizophrenic patients with one male and two female caregivers) were interviewed. The analysis step is adopted by Henri Ellenberger’s existential-phenomenological method (Yaw-Sheng Lin, 2002). Results: Five over-arching themes emerged in the analysis on the transformation of experiences of suffering and caring. (1) Camouflaging the “extra-normal” in daily life. (2) “Extra-normal” is understood through the singularity in the daily life, including the patient and caregiver can “encounter” the unique experience. (3) Ruminative reflection about what happening? (4) Make sense of schizophrenic experiences through blurry the boundary between the normal and abnormal to integrate self into life orientation. (5) Existential experience as becoming process through the state of mind of “hope” and “Angst”. Conclusions: The outcome is implicated in clinical practice: (1) Return to young schizophrenic patients’ lifeworld beyond psychopathology comprehension to articulate the intersubjective understanding relationships. (2) Help caregiver to understand their uncanny situation and cultivate the caring ethics for self and the other. Limitation, future research agenda and suggestion are discussed and proposed.

本研究採質性研究（qualitative research）之深度晤談法（indepth interview）進行資料收集，再以紮根理論方法進行文本分析，共訪12位中年女性，本研究結果如下： 一、照顧家中失能老人中年女性之照顧經驗與感受 個案因「角色認同、婚姻綁樁、反哺回饋及無法承受之罪」承接照顧責任，面臨「專業照護技能學習、人際關係緊張疏離、生活陷入窘迫、家人支援不足」等壓力；透過「修正照顧認知、尋找照顧意義、暫離照護情境」調適壓力；家庭照護政策未見具體效益。 二、照顧家中失能老人中年女性之生命經驗 （一）身心知覺 個案出現身心變化，關心「健康」；對身體變化未積極面對。視更年期為正常發展，對荷爾蒙等醫療處置態度保守；性生活漸入佳境，部分個案偏重心靈契合。 （二）家庭關係 夫妻角色清楚分工，情感依附互補隨時間而質變，婚姻風暴者多已迎刃而解，夫妻做到「獨留心靈空間、相近的價值觀及穩定的經濟基礎」婚姻狀態即非常滿意；先生參與家中特殊兒童的照顧，影響婚姻滿意度。個案親子關係頗佳，隨年齡增加而變化；角色功能多似朋友，成人期親子關係轉為「互惠」。 （三）自我發展 個案自我圖像偏重社會我、心理我的描述，人際互動呈現多元自我，生命經驗中的依序或脫序事件均為中年女性之人生轉捩點，但更年期或停經則非其人生重要里程碑。 三、照顧家中失能老人對中年女性生命經驗之影響 照顧工作影響身心變化；影響夫妻「親密互動」及「依附關係」；對親子關係產生「連累子女、身教典範、矛盾依附」三項結果；對自我發展的「自我實現」及「老年與死亡準備」產生影響。 關鍵字：中年女性照顧者；生命經驗；失能老人；身心知覺；家庭關係；自我發展。 / The main purpose of this study was to explore the life experiences of midlife women who caring disabled elders at home. Twelve midlife women participated in this research. In this study, the semi-structure and in-depth interviews were used to collect data. Their answers were audio-taped as data collection. Ground theory analysis was used to analyze the data. The major findings were divided into three parts according the purposes of this study as follows: （1） The experience and perception of caring disabled elders which we found in this study： The reasons of midlife women caring disabled elders were the sense of responsibility, marriage connection, repay the kindness from disabled elders and didn’t want to be a guilty person. The stressors of caring disabled elders were short of homecare skills, the strain of interpersonal relationship, distress of daily life and deficiency of family support. The coping of the stressors were modifying the cognition of caring responsibility, finding the meanings of caring, and leaving the caring setting for a while. In this study, we didn’t find the efficacy of family care polity. （2）The life experience of mid-age women were divided into three parts： The first part result is psychosomatic perception, we found that women are going through psychosomatic change and more concerned about health. Climacteric is just a nature event for them, most mid-age women never minded that and refuse treatment by medicine. They also expressed the sexual relationship with their husbands are improving in the midlife. The second part is family relationship of the midlife women, we found the marital relations and parent-child relations were dynamic and changeable. The couples had the clear division of gender role, who had the conflicts and were handled finally. Free mind, independent, similar value and stable income were important key points of marriage satisfaction. The midlife women have good parent-child relationships who treat their children as friend. The relationship between midlife women and their adult children turn into mutual benefits. The third part is self development of the midlife women, we ask midlife women to descript themselves focusing on social self and psychological self. We found multiple dimensions of self when women interact with others . All of the twelve mid-age women thought that off time events or on time events are both the turn points in their life-cycle, but climacteric or menopause is not. It is just a nature event. （3）The influence of caring disabled elder for the life experience of midlife women： Caring disabled elder induced some psychosomatic symptoms, disturbing the intimate relations and emotion bond of couples. The influence of caring disabled elder for the parent-child relationships were children of midlife women need to help the caring work, mid-age women were the role model of their children and induced the contradiction between midlife women and their children. In the aspect of self development, caring disabled elder interrupted their plans of the future, reminded mid-age women to prepare their elder life and thinking about death issue. Key words：midlife women; caregiver; life experience; disabled elders; psychosomatic perception; family relationship; self development.

本研究探討心理衛生社會工作者與精神病患照顧者工作之中相互期待的角色內涵、影響角色期待之因素或歷程，以及相互期待之認知、行動如何修正與調整。本研究採質性研究深度訪談法，採立意抽樣選取研究對象，對三十九位受訪者（二十六位心理衛生社會工作者、十三位精神病患照顧者）進行半結構式訪談，主要研究發現如下： 1. 精神病患照顧者的照顧內容和與角色立場： （1）照顧內容：症狀因應、社區生活 （2）照顧態度：積極主動、合理期待、自我照顧 （3）與其他家屬互動：聚會交流、自助助人、權益倡導 2. 照顧者樣態與社會工作者對照顧者之角色期待： （1）所見樣態：積極參與、消極參與、不當期待、家庭動力不穩 （2）對照顧者之角色期待：配合服務、適度支持、個別化期待、如個案需要協助 （3）影響因素：社經認知條件、家庭文化因素、疾病照顧經驗、社區環境、社工接觸經驗 3. 社會工作者與照顧者之工作方法，與照顧者對社會工作者的角色期待： （1）工作方法：傾聽陪伴支持、協作釐清期待、衛教家屬團體、家庭動力工作、社區資源連結、權益倡導協調 （2）指導原則：聚焦正向改變、以個案為中心、重視家庭經驗、尊重照顧知識、抱持覺察開放的態度 （3）照顧者對社會工作者之角色期待：教育引導、家庭陪伴、權益倡導 （4）影響社會工作者角色因素：個人因素、專業教育、組織因素、結構因素 4. 照顧者與社會工作者關係：夥伴關係、工作關係、彈性關係 5. 照顧者與社會工作者相互角色期待調整方式： （1）照顧者對社會工作者期待調整：接受現況、調整期待、自立自強 （2）社會工作者對照顧者期待調整：接納現況、調整期待、擇善固執 （3）社會工作者挫折因應方法：經驗回饋、自我照顧、團隊支持 最後，研究者結合上述研究結果，嘗試繪製出心理衛生社會工作者與照顧者相互角色期待內涵與影響因素之概念架構圖，並提出本研究限制與建議，提供照顧者、心理衛生社會工作者和政策制定者、未來研究者參考，期冀本研究有助於減少照顧者可能產生的失望，甚至進而奠定一個基於夥伴關係的服務方式。 / The purpose of the study was to explore the content of mutual role expectation for mental health social workers and caregivers, the factors influencing role expectation, and the adjustment process of role expectation. This study used purposive sampling to select thirty-nine participants (twenty-six mental health social workers and thirteen caregivers), conducting in-depth interviews by using a semi-structured interview outline. The major results of the study include: 1. Care content and role of caregivers: (1) Care content: symptom management, community life promotion. (2) Care attitude: proactive, reasonably expected, self-care. (3) Interaction with other caregivers: family support group and gathering, help others and self-help, advocacy. 2. Caregiver pattern and role expectation of caregivers: (1) Caregiver pattern: actively participated, passively participated, improperly expected, unstable family dynamics. (2) Role expectation of caregivers： service adherence, moderate support, individual expectation, potential client. (3) Factors influencing role expectation: socioeconomic and cognitive conditions, family and cultural factors, caring experience, community environment, the experience of contacting social worker. 3. Working methods and role expectation of social workers: (1) Working methods: listening and accompanying, cooperating to clarify expectation, group psychoeducation, family systems therapy, mobilizing community resources, advocacy and negotiation. (2) Guiding principles: focus on positive changes, case-centered, attention to family experience, respect for caring knowledge, open-mindedness and self-awareness. (3) Role expectation of social workers: educator and guide, family supporter, advocate. (4) Factors influencing role expectation: personal factors, professional education, organizational factors, structural factors. 4. Professional relationship: partnership, working relationship, elastic relationship. 5. Adjustment process of role expectation for caregivers and social workers： (1) Role expectation of caregivers adjusted by social workers: accepting the status quo, adjusting expectation, self-reliance. (2) Role expectation of social workers adjusted by caregivers: accepting the status quo, adjusting expectation, persisting. (3) Frustration coping methods: experience feedback, self-care, team support. Based on above findings, researcher drew out the depiction of mutual role expectation for mental health social workers and caregivers, as well as the factors influencing role expectation, proposing the study restrictions and suggestions on policy making, partnership-based approach for mental health social workers and caregivers, and further research.

社區安寧療護的推展以「居家存有」為中心，以身心整體照顧為導向的醫療，與全然「醫療權力」視角不同。本研究嘗試探討家屬照顧者於居家安寧照顧處境下的經驗，嘗試以「倫理關係」思考居家型的照顧內涵。 本研究透過田野參與觀察及深度訪談法，以北部某醫療院所提供之社區安寧療護服務區域為田野，訪談接受社區安寧照護之五位家屬主要照顧者。資料分析依現象學心理學分析方法（李維倫、賴憶嫺，2009）。而後，邀請兩名受訪者，對資料的組織脈絡描述及其所驅動的主題置身結構，予以交叉討論與分享，提昇質性研究可靠度的品質。 研究結果發現，鄉村型態安寧照顧者的置身經驗中，呈現出一種「鄉村型態的寓居」混合狀態，既安居又陌生的處境。一方面，參與者經驗到的棲居地域，並不侷限於家屋建築或特定地域，更是對地方的認同與情感的依附，從而開展自我「寓居於世」的「照顧者棲居」樣態；另一方面，照顧事件的衝擊，為照顧者帶來一種既熟悉又陌生的詭譎「無居家感」（uncanny）狀態。然而，如此看似矛盾處境，反使其於居家照顧處境之倫理凝視中，啟動反身窺探自我生命，以及於居家照顧處境中與他者間關係的梳理，進一步帶出「居家照顧作為一倫理行動」，進而深刻化「照顧自己/關切他人」的倫理意涵。 由此發現，鄉村型態居家照顧經驗之置身結構，可為與其相似處境之居家照顧者提供置身經驗之參考，並據以推動社區安寧方案的規劃。 / The goal of the home-based palliative care model is to facilitate the patients and their family to feel “being at home.” Differ from the perspective of the “power domination in medical regime,” the home-based palliative care model focuses on the ethical relationship besides the bio-psycho-social care aspects. This study aims to understand the caring situatedness of family members as caregivers in home-based palliative care model, and try to disclose the sense of homelikeness through the caring relationship. We applied the participatory observation and depth interview to collect data. Five family caregivers who agreed the informed consent were recruited from home-based palliative care service in northern Taiwan and were interviewed twice. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method. The results revealed that there is ambivalent caring experience towards “dwelling in the community-home”. The experiences they felt seemed both strange and familiar. On the one hand, the caregivers’ dwelling pattern of being-in-the-world was constructed from the perspective of human-environment comfortable relationship (sense of feeling at home); on the other hand, they are bothered and struck by the caring problem, they faced the new challenges and thrown into the situation of “uncanny.” It is an unhomelike being-in-the-world in which Da-sein takes on alien and uncanny qualities. However, the two caring modes manifested the meaning of existentiality. Immersed in this situation, caring is not only the labor work, it is also the ethical act to respond the worrisome emotion and regain the relationships with others during the caring experiences. Ethical caring is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism. By elaborating the situatedness of home-based palliative care model, further planning of the community-based palliative care model in similar situation may base on this study outcome implication.