University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

根據戶口普查資料顯示約六成的老人與子女同住，而這樣的比例日益下降，在華人社會中，老人與子女同住隱含著孝道的象徵，但隨著現代化社會的變遷，此現象逐漸轉變。過去老人居住安排的研究多著重於老人狀況之衡量與選擇，而未討論到子女的影響，因此本研究試圖從「兩代」的屬性探討老人居住安排選擇的影響因素。此外，「三代同鄰」的居住安排係兼顧兩代可以互相照顧且各自擁有自由和私密的居住空間，此課題在過去少有討論，本文亦將該居住方式獨立討論，以期能充分了解兩代的互動關係對於老人居住選擇之影響。 本文以多項羅吉特模型實證分析華人家庭動態資料庫（PSFD）2004年的資料，選取主樣本為已婚子女之樣本。研究結果顯示：在老人的屬性中，喪偶、教育程度低以及無工作者會偏好與子女同住，尤其老年女性喪偶的影響效果最大，使其獨居的機率降低50%；在主樣本的屬性中，當住宅為父母所有、有學齡前小孩、主樣本教育程度高會使兩代同住機率增加。因此對於老人而言，同住是身心狀況下降的較佳選擇；然而對於子女而言，同住是基於「交換」勞務所產生的居住安排。最後，本文並發現「同鄰」者多為身心狀況良好的老人且多與已婚兒子相鄰而居的狀況，顯示父系傳統對於華人家庭的深刻影響。 / According to the census report of population and housing of Year 2000 in Taiwan, about sixty percent of the elderly live with their children, but this situation is decreasing. In Chinese society, the elderly living with their children symbolize the culture of filial piety. With the change of modern society, the phenomenon is changing. Previous researches about the elderly living arrangement pay much attention to the characteristics of the elderly, rather than the influences of children. Therefore, this study attempts to explore the influence factors of the living arrangement between the elderly and their children. Moreover, the “neighboring living arrangement” of the elderly and their children makes the two generations not only could take care of each other, but also possess free and private residential spaces by themselves. This issue wasn’t discussed in the past, so this study also discusses this living arrangement of the two generations in order to realize the influence of intergenerational interaction on the choices of the elderly living arrangement. This study uses multi-nominal logistic regression model to analysis the data of Panel Study of Family Dynamics（PSFD）in 2004. The empirical results shows, the widowed , with low education attainment and unemployed elderly prefer to live with their children. The widowed characteristic especially plays stronger marginal effect, which decreases the probability of living alone fifty percents for the elderly. Housing owned by parents, with under school- age grandchildren and highly educated children would increase the probability of co-residence of two generations. For the elderly, when he (she) is unhealthy or being single, co-residence with children is the better choice. However, for the children, co-residence is based on the “exchange” for elderly labor forces to take care of under school- age children. Finally, this study finds that the healthy elderly prefer to choose neighboring living arrangement with their children, and especially neighbor to their married son. It is implied that the influence of patriarchy culture on Chinese family.

人口老化已經是全球性的新議題了，老人學隨著社會變遷也成為重要的新領域。台灣從1993年開始進入高齡化社會。未來不論在食衣住行育樂、醫藥衛生、保健照護等各領域，銀髮族都將成為各行各業服務的重要對象。為了因應台灣高齡社會的到來，行政院院會在2007年3月14日已經通過老人福利十年大溫暖計劃，10年內將投入新台幣817億元，服務對象有四項，其中一項就是65歲以上老人 。 目前安養護機構的床位大約8萬多床，只佔老人人口數的3.5%。老人的安養護市場尚有很大的空間，在人才培育方面目前有十所大專院校已開設老人學相關課程的科系，未來將會持續增加。可預見的未來，老人安養護模式中不論是居家照護、社區照護、機構照護；將在政策法令、機構設立、人才培訓的三大架構整合之下，必定會有很好的發展。 本論文研究目的，就是希望對於獲得評鑑優良的個案-雙連安養護中心進行進一步分析，透過半結構式訪談及問卷調查的方式找出顧客對服務項目的重要度與滿意度差異性，並根據所得結果提供給業者做為經營參考，幫助業者建立更優越的價值定位。 個案研究結果發現對於服務體驗項目中，住民心中最為重視的前五項其重要度均高於滿意度，且均著重於人員服務的項目，顯示人員服務的態度好壞，可能影響著住民對安養護中心的滿意度，及繼續居住的意願。在家屬方面對前五名的體驗項目，其重要度對滿意度有著較大的認知差異，可能是家屬只有在探訪住民時短暫使用這些項目，或是從住民及他人口中得知其使用的感受，其感受程度遠不如住民，故認知差異的程度相對大於住民。 本研究建議中心在制定經營管理策略時，可依體驗項目重要程度的順序作為主要訴求，在策略制定上可強調安養護中心提供了完善的居住環境與無障礙的空間和設備，或是展示實際場景的照片與影片，當消費者打電話或是到安養護中心參訪時，可透過中心人員的實際服務與交談，讓消費者感受到中心人員的服務熱誠，藉此增加對安養護中心的整體滿意度，當消費者評估後對安養護中心的滿意度大於預期的滿意度時，便會將家中長者送至安養護中心接受其服務。 / Aging of population is the latest issue in the world and gerontology also becomes an important new field due to the change of society. Since 1993, Taiwan has become an aging society. In the future, the elderly will be important customers to various walks of life, such as medical treatment, health care, nursing care, entertainment, and so on. In order to cope with the coming of an aging Taiwan, the Executive Yuan had passed a ten-year plan for the welfare of the elderly on March 14th, 2007. Taiwan will spend 81.7 billion dollars in ten years for four categories of citizens, and one of which is the elderly over 65 years old. At present, there are about 80 thousands of beds in the nursing-care institutions, which is only 3.5 percent of the elderly population. There are still a lot of opportunities in the market of elderly nursing care. For the talent development, there are already ten colleges which have added the gerontology-related departments and there will be more colleges to do so. In the near future, with the integration of government policy, set-up of institutions and talent development, home care, community care and institution-based care will definitely be under good development. The purpose of this thesis is to do further analysis of the case, Suan-Lien Elderly Center. Through semi-structured interviews and questionnaires, the gap between the importance and satisfaction of the service items for the customers is discovered and the results are provided to the elderly center as a reference for management to help it establish a better value proposition. In the research results, it is found that in the service experience items, the scores of the importance of the first five items that the habitants value most is higher than those of the satisfaction, and the habitants put more emphasis on the personnel service items. This shows that the attitude of the service personnel may influence the habitants’ satisfaction of the nursing-care centers and their willingness of staying. The family of the habitants found larger gap between the importance and satisfaction of the first five service items. The reason may be that the family of the habitants only use the services for a short time during the visit. Or it may be because the family of the habitants learn the feelings of using the services through the habitants or others. This research suggests that the nursing-care centers can use the order of the importance of the service items as the main appeal while making the strategies of management. The nursing-care centers can stress that they can provide perfect living environment and barrier-free access and equipment or they can display the photos or films of the nursing-care centers. When the consumers call or visit the nursing-care centers, through the actual services and conversations, the consumers can feel the enthusiasm of the staff. In this way, the entire satisfaction of the nursing-care centers will be increased. When the actual satisfaction is higher than the expected one, the consumers will send their elderly to the nursing-care center.

隨著國內社會變遷，人口結構改變，當失能老人家庭成員無法照顧或根本没有家人可以照顧時，提供可近性之社區型機構式照顧之小型養護機構就應運而生。台北市小型養護機構從未立案時期蓬勃發展，至民國86年「老人福利法」修正，政府開始透過法制化將小型養護機構管理制度化後，機構數從立案初期民國90年之203家降至98年6月之154家。依據內政部社會司民國98年6月統計資料顯示，全國養護機構養護床位平均進住率為73.84%，台北市則為82.37%；98年6月全國老年人口比率為10.52%，而台北市老人人口比率則已達12.43%，顯見台北市老人人口增加比率高於全國比率，且其養護機構占床率亦高於全國平均值。依上述數據合理推估，台北市老人對於養護機構需求應遠大於其他縣市，但統計資料卻顯示台北市養護機構卻逐年遞減。當機構負責人不斷反應，政府政策造成台北市機構經營困境。本研究想瞭解政府對小型養護機構管理政策在不同階段有何變演？進一步探討政策演變過程，對小型養護機構發展產生何種影響？再者探究除政府政策外，尚有那些因素會影響小型養護機構發展？ 本研究在著手進行文獻探討時，發現與台北市小型養護機構政策演變有關時間點，可以依時間序列分為五個階段；第一階段：民國80年以前，完全没有政策規範機構之政策空窗期；第二階段：民國80年至86年，台北市政府頒布「台北市私立老人養護所設置管理辦法」開始規範台北市小型養護機構之政策蘊釀期；第三階段：民國86年至88年，「老人福利法」修正後小型養護機構即將開始法制化規範之政策緩衝期；第四階段：民國88年至96年，小型養護機構邁入正式法制化管理之政策完備期；第五階段：民國96年以後，「老人福利法」再次修正之政策變革期。研究者再依據此五個時間階段，深度訪談機構負責人、地方政府及中央政府政策制訂者、學者專家，瞭解每一階段政府政策演變對小型養護機構發展有何影響。 研究發現，政策空窗期，小型養護機構不需立案、政府無法可管，機構自主性最高可以隨意發展；政策蘊釀期，台北市雖擬以地方法規規範小型養護機構，但因為没有罰則及強制力，機構配合度不高，政府政策對機構缺少制約力；政策緩衝期，老人福利法及子法已經修正通過，小型養護機構面對公權力即將強力規範，仍試圖抗爭以拖延政府管制時間，此階段機構與政府之間關係充滿衝突；政策完備期，政府對於小型養護機構從立案、評鑑、督導等各項法制完備，小型養護機構自主性大幅降低，發展意願也逐漸降低；政策變革期，老人福利法經10 年後再次修正，機構自主性再次限縮，許多理想性修法結果，尤其硬體設備部分對於屬都會型之台北市小型養護機構產生配合困難。本研究同時發現，對小型養護機構之管理政策，中央政府透過法制規範全力主導，地方政府自主性也相對降低，也就是政策完備期開始，影響小型養護機構發展之政策主要在於中央政府之法規。 本研究依據訪談結果，剖析後分別對相關人員提出建議如下，對政策制訂者：應正視台北市小型養護機構減少趨勢規劃因應策略、對於評鑑制度應檢討修正評鑑指標去蕪存菁、規劃小型養護機構專業分級制度、適時修正與小型養護機構發展扞挌之法令規章；對小型養護機構建議：關心政策對小型養護機構發展之影響、運用創新思維營造小型養護機構獨特競爭力、加強小型養護機構組成協會之整合資源能力、加強小型養護機構正面功能宣導；社會大眾則建議利用評鑑指標共同監督機構服務品質。 / With the change of the domestic society as well as the population structure, the small community nursing centers have been established as many family members or even no one can take care of the disabled elderly person. The development of the small nursing center was raised in the unregistered period. Since 1997, the “Senior Citizen Welfare Act” was revised and the government started to systematically manage the small nursing centers by regulations. As a result, the number of the nursing center decreased from 203 in 2001 to 154 in 2009. According to the statistic of the Department of Social Affairs in June 2009, the accommodating rate of the nursing bed of all nursing centers in Taiwan is 73.84% and 82.37% in Taipei City. In June 2009, the ratio of the senior population is 10.52% in Taiwan and 12.43% in Taipei City. It indicates that the proportion of the senior citizens in Taipei is greater than the national proportion. In addition, the accommodating rate of the nursing bed in Taipei is also greater than the average number of the country. Based on the above reasonable estimations, the demand for the nursing centers in Taipei City is greater than other cities and counties. However, the statistic shows that the number of the nursing center in Taipei gradually decreases. When the owners of the nursing centers in Taipei continuously emphasizing the government policy has created barriers to manage the nursing centers in Taipei City, this study aims to study how the government policy changes in each stage, and discuss how the policy change procedure and the remaining factors affect the development of the nursing centers. This research found that the development period of the small nursing center in Taipei City can be divided into 5 stages according to the time order; the first stage(vacancy period): before 1991, there was no policy to regulate the nursing centers; the second stage(preparation period): from 1991 to 1997, Taipei City Government announced the “Private Elderly Nursing Center Establishment Steps of Taipei City” and started to regulate the small nursing centers in Taipei City; the third stage(initial period): from 1997 to 1999, the small nursing centers started to be regulated after the “Senior Citizen Welfare Act” has been revised; the fourth stage(completion period): from 1999 to 2007,the small nursing centers were officially regulated by the acts; the fifth stage(reform period), after 1997, the “Senior Citizen Welfare Act” was once again amended. The researcher conducts several in-dept interviews of the owners of the nursing centers, local and central government policy makers, scholars and professionals of each stage to understand how the government policy affects the development of the small nursing center in each stage. In the completion period, the government has set up a complete system from registration, evaluation to supervision. As a matter of act, the independence of the small nursing centers significantly decreased which has resulted in a decrease of their willingness for development. During the reform period, the Senior Citizen Welfare Act was revised again after 10 years. The independence of the organizations was once again restricted. Many small nursing centers in Taipei City have had difficulties to cooperate with the ideal revised results such as the hardware facility. This study also found that the central government fully controlled the small nursing centers through the management policies while the local government started to lose the power of control. In the beginning of the completion period, the central government regulation was the key to affect the development of the small nursing centers. It is found that the registration was not required for the small nursing center in the vacancy period. The organizations were highly independent and could develop according to their interests. In the preparation stage, Taipei City has drafted the local regulations to regulate the small nursing center but the centers were not willing to cooperate due to the lack of penalty and government power over the restriction. In the initial period, although the Senior Citizen Welfare Act has been revised, the nursing centers still attempted to extend the government’s restriction. There were a lot of conflicts between the government and the nursing centers in this stage. Based on the interview results, this study provides the following recommendations to the related personnel after the analysis. To the policy makers: it is necessary to plan the strategies to cope with the decreasing trend of the small nursing center in Taipei City, review the evaluation system, revise the evaluation index, plan the professional classification of the small nursing centers and appropriately amend the regulations for the development of the small nursing center. To the small nursing centers: they should concern about the impact on the development of the small nursing centers, apply new thinking to create the competitive advantage, and improve the resource integration ability of the small nursing center association and the positive promotion of the small nursing center. It is recommended that the public should monitor the service quality of the organization based on the evaluation index. Keywords: small nursing center, evaluation system, senior citizen welfare

在老人人口數增加、失能老人人口數俱增、及婦女勞動參與率上昇的人口趨勢下，女性花費在照顧老人的時間將逐漸超過照顧子女的時間；在此同時，就業也將占據婦女生命中的絕大部份，未來將有許多中年婦女必須同時擔負就業與老人照顧的責任。為深入瞭解這群婦女的獨特感受，本研究的目的包括：(1)瞭解職業婦女照顧家中老年親屬的情形及其經驗。(2)探討婦女兼顧「就業與老人照顧」之經驗感受。(3)探索職業婦女為兼顧「就業」和「老人照顧」所採取之因應策略。(4)分析職業婦女歷經不同處境及採取相異因應策略之原因。(5)根據研究結果提出政策上的建議。 本研究採用質化研究的深入訪談法，計訪問12位從事全職工作的女性老人照顧者。研究發現：(1)職業婦女為老年親屬所提供的社會支持包括：日常生活活動的協助、提醒和監督老人執行日常生活活動、生病時的照顧、照顧管理、陪伴及情緒支持等項目。(2)老人照顧對職業婦女之意義：以文化規範及情感因素佔關鍵性的地位。(3)就業對職業婦女的意義：包括物質報酬、心理報酬、及生活寄託。(4)婦女兼顧「老人照顧」與「就業」責任時面臨錯綜複雜的感受。(5)職業婦女處理「老人照顧」與「就業」衝突之因應策略：可分為「調整照顧責任」、及「調整就業行為」兩類。(6)職業婦女的角色衝突及所採取之五種因應策略。 根據上述結論，本研究針對政策意識型態、企業界及政府提出建議。 目　錄 第一章 研究動機與目的 1 第二章 文獻探討 5 第一節 就業者照顧老年親屬的情形 5 第二節 婦女兼顧「老人照顧」和「就業」之經驗感受 10 第三節 職業婦女兼顧「老人照顧」和「就業」所採取的工作調整行為 13 第四節 從角色理論來看職業婦女兼顧「老人照顧」和「就業」的處境 15 第五節 從交換理論分析職業婦女採取不同工作調整行為之因素 19 第三章 研究設計 22 第一節 研究方法 22 第二節 資料蒐集與分析 23 第三節 研究對象與研究者的角色 24 第四節 樣本的相關資料 26 第四章 分析結果 32 第一節 職業婦女所提供的社會支持 32 第二節 老人照顧對職業婦女的意義 38 第三節 就業對職業婦女的意義 47 第四節 婦女兼顧「老人照顧」與「就業」責任之經驗感受 54 第五節 職業婦女處理「老人照顧」與「就業」衝突之因應策略 75 第六節 職業婦女的角色衝突及所採取之因應策略 94 第五章 結論與建議 107 第一節 結論 107 第二節 相關議題的探討 110 第三節 建議 115 第四節 研究限制及對未來研究之建議 119 參考書目 121 附錄一 訪談導引 129 附錄二 受訪者資料 132 附錄三 受照顧老人資料 133 表 目 錄 表3-1 樣本基本資料 28 表3-2 老人日常生活活動（ADLs）能力失能情形 29 表3-3 老人工具性日常生活活動（IADLs）能力失能情形 30 表3-4 照顧者提供老人照顧工作的協助項目 31 表3-5 老人的失能情形和照顧者提供的協助項目數 31 表4-1 受訪者的「老人照顧」及「就業」角色 97 圖 目 錄 表4-1 Kopelman et al.的工作--家庭衝突模型 94 表4-2 Higgins et al.的工作--家庭衝突模型 94 / The results of a qualitative study on the lives of 12 women who work full-time and care for the elderly are presented. Respondents provide assistance for the elderly, and they have to remind the elderly to carry out the activities of daily living. Also, women play as a carer, care manager, and emotion supporter. The meaning for women to wok is the material reward, the psychological reward, and life goals. When women care for the elderly and work in the meantime, complex feeling will come to their mind. They have to adjust their work or care responsibility when they feel conflict between work and elder care. Policy and practice implications are also discussed.

在臺灣地區我們發現，自殺率年齡層愈高，自殺率也會愈高，而65歲以上老人的高自殺率，主要是集中於75－84歲此一年齡層的老人。在性別方面，男性老人之自殺率顯然高於女性，男性約為女性的一．五倍。而在自殺者所採用的方法上，我們發現一般人口多採用溫和而致死性較低的方法，老人則多採用劇烈而致死性較高的方法，顯示出老人自殺的意願要較 勢而言，自1985年後不論男性或女性老人自殺率便急速下降，且其下降的速度要快於其他年齡層。另外我們也分析了老人自殺率與婚姻狀況、省籍及居住地區等因素的相關。就不同婚姻型態的老人自殺率比較而言，離婚者的自殺率最高並且也是上升最快速的。由於社會變遷的快速，離婚老人的比例要比過去增加，而離婚老人缺乏來自家庭的照顧與社會支持因此離婚老人的自殺率在這十年間增加了三倍之多。再者我們就省籍的比較來看，在 1980 年時外省籍老人的自殺率高於本省籍老人，但到了1990 年時前者卻低於後者。但我們認為當隨著政府遷台的外省籍軍民（尤其是老榮民），其自殺率會高於其他群體。首先外省籍老人多數為男性，再者其由於經歷戰亂時期，健康狀況較差，且其未婚的比例為台籍老人的十三倍，因而也較少受到家庭及婚姻的保護，缺乏來自配偶及兒女的社會支持。而在加上其獨居的比例亦為台籍老人的四倍之多，顯見外省籍老人要比台籍老人更亦陷入社會孤立的狀態。另外在居住地區方面，不同地域地區之間的自殺率則無明顯一致的差別，以臺南市、澎湖縣與桃園縣之老人自殺率較高。 在本論文中我們也採用了多重累積生命表的分析，經過生命表的計算，我們發現自殺此一死亡因在老人人口中所站的百分比愈來愈低，即自殺之重要性愈來愈低。顯示隨著年齡的增加，其他慢性病死因增加的速度比自殺更為快速，而成為老年人的主要死因。但值得注意的是，意外死亡在老人中有明顯增加的趨勢，而通常意外與自殺兩者之間（尤其是老人）並無法做一清楚的區分，亦即老人自殺被誤判為意外的可能性相當高。此外我們也將自殺率與其他社會指標做一時間序列的分析，發現中等教育程度以上的人口比例愈多，以及平均每人國民生產毛額愈多，則老人自殺率便會愈低；而離婚率愈高，老人自殺率則愈高。

住宅問題隨著經濟發展、社會型態轉變以及都市人口遽增，已成為目前臺灣社會所面臨之重要問題。尤其老人人口比例快速增加，更突顯老人住宅問題的重要性。檢視國內有關老人住宅問題之研究，有客觀指標探討居住品質，有分析居住者之主觀居住滿意度，惟住宅的品質不應僅依靠客觀的標準或是主觀的滿意度而定，更應該考量居住者對其環境之感受，特別是在瞭解老人的生理、心理、及社會需求下，進一步來探討居住者對環境之認知感受。本研究以環境心理學的角度探究老人室內居住環境，包括下列議題：（一）瞭解目前老人的居住環境品質；（二）試圖從老人的立場出發，明白什麼樣的環境才是好的居住環境；（三）探討當老人在評價環境的好壞時，採取什麼樣的標準；（四）分析哪些因素會影響老人對其環境之評價；（五）根據研究結果提出建議。 　　本研究採用質性研究方法，深入訪談十位居住在一般社區的老人。研究發現：（一）老人們對其居住環境之評估有五個範疇：空間、顏色、照明、溫度及噪音等。（二）老人們對室內居住環境的主觀評價有四個面向：對空間的評估、對顏色的喜惡、對購買東西的權利以及對擺設東西的權利。（三）主觀評價會因其所擁有的資源（自主）而有不同，自主指的是自主權、受到尊重以及自由權。（四）老人對室內居家環境之評價是基於客觀實質環境 vs. 心理感受、生理因素 vs. 心理因素及安全vs. 舒適等。（五）影響老人對室內居住環境評價之因素有身體狀況、社會支持及住宅位置等。（六）以自主的角度來看老人對居住環境之評估，可發現老人的個人特質如性別、年齡及家庭支持等，會影響其評估。本研究分別從政策上的目標、實務上的目標、建立社區支援體系、建立無障礙空間、提供多元化的活動及設施、重視女性老人的權利以及建築業者設計住宅時所需之考量等方面提出建議。

由於經濟發展，人民生活改善，醫藥衛生的進步，使台灣地區國民的平均年齡延長，也使人口老化的速度加快。民國82年9月，65歲以上老人佔台灣地區人口數7%，己達聯合國世界衛生組織所訂的高齡化社會指標。據經建會推估，預計民國121年，將達20％，即每5位人口中，就有一位是65歲以上的老人。在對老人的照顧中，政府除了居家服務、社區照顧外，機構照顧負起了最後的一環。 由於看好未來龐大的安養護市場，許多財團或企業紛紛加入，財團法人醫院、署立、市立醫院為增加占床率，開闢護理之家、長期照護部門，使得現有安養護機構面臨更多壓力。老人安養護工作已由救濟、收容演變為銀髮產業，且由福利服務、市場自由競爭進入以企業管理為導向的型態。因此，許多業者面臨體制改革與重整以順應時代，成為機構生存關鍵。 基於上述理由與考量，引發本研究從「關鍵成功因素」的觀點，深入探討老人安養護機構經營者的經營理念與管理方式，期能透過本研究，使機構業者能更清楚本身的競爭地位，進而對未來經營策略的擬定有所助益，及對有意進入者提供一個參考指標。本論文以在台灣營運績優的老人自費安養護中心為研究對象，運用文獻探討、產業分析及深度訪談找出經營老人安養護機構之關鍵成功因素。 研究結果顯示，台灣老人安養護機構關鍵成功因素共有六項 ，分別是：經營理念、工作團隊、資源、專業服務、機構負責人及地點的選擇。 / Population aging in Taiwan has rapidly accelerated as the life expectancy of people in Taiwan is gradually increasing due to economic development, improved quality of life, and advancement of medicine and public health. Taiwanese aged 65 and over have accounted for more than 7% of total population since 1993, thereby making Taiwan an aging society according United Nation’s definition of “Aging Society”. It is estimated by Council of Economic Planning and Development that 20% of population, or one in five, will be aged 65 or over by 2132. Aside from home care and community care, institutional care is also gaining importance in elder care in Taiwan. Foreseeing the immense need of elder care services in the aging society, many private companies and corporations are entering the elder-care market and competing for market share. Privatized hospitals and public-funded provincial hospitals are increasing bed occupancy, building nursing homes, and expanding units for long-term care. The existent elder-care institutions in the health industry are facing market competition more than ever. The elder care is being transited from charity welfare to silver industry, from welfare service and free market competition to business-oriented planning of strategic management. Thus, elder-care institutions are in need of restructuring and structural changes so as to succeed in the competitive market. This study explores factors that contribute the success of elder care institutions by exploring the philosophy and style of management. So that, existent institutions can better evaluate their competitiveness in the market and strategize their management tactics; potential players can use findings from this study as reference points before entering the market. This study is conducted with assistance of literature review, and industry analysis and in-depth interview of best-run private-funded elder care institutions in Taiwan. The findings of the study show that in Taiwan there are six critical factors for the success of elder care institutions. They are management philosophy, characteristics of the team, resourcefulness of the institutions, professionalism of staff characteristics of ownership of the institutions, and location of the institutions.

全球人口已在2011年10月間突破70億大關，人口老化的速度也加快，老人安養問題成為刻不容緩的議題。對於「窮得只剩下房子的老人」因為不符合救助標準，以致生活無著。於是發展出「在地老化，現宅照顧」的概念，高齡者以自有房屋設定抵押，按期取得資金，支應生活費、醫療費及其他支出，這就是本文所要探討的「反式房貸」。國內對於這樣的議題，相關的著作、期刊或論文較為缺乏，本文蒐集其他國家的文獻，並配合各機構推出的業務方案內容，就適用我國現行法時，可能會產生的問題加以研析，並試圖提出解決方案或方向。 關於反式抵押權定性的問題，本文認為反式房貸的性質雖與最高限額抵押權類似，但仍有其相異甚至矛盾之處，針對問題提出看法。在「無追索權」的部分基本問題是恰當與否的問題，主要是從契約自由原則切入，並對流抵契約之清算義務、剩餘財產分配請求權、成年監護制度等議題分別探討。最後，一般反式房貸在現行法下可能的問題，若以其他方式辦理（本文以信託為例）之可行性等，加以分析與討論。本文獲致之結論略述如下： 一、反式房貸抵押權應適用或類推適用最高限額抵押權規定，其他包括最高限額之決定、設定年限等技術性問題，應由主管機關政策考量加以解決。 二、原則上，無追索權條款仍有契約自由原則之適用，不過對於部分約定是否有違誠信原則致不符定型化契約相關規定，仍應個案審查，不宜一概認為無效。 三、反向抵押信託在運作上，確可解決包括流抵之清算義務、強制執行等問題，但實際業務運作模式仍待主管機關與相關業者共同規劃。 反式房貸對我國來說是一項新的金融產品，本文研究結果或所提出的建議或許不能解決全部的問題，其關鍵因素在於學術性的討論，要全面性的檢討有其限制與困難，可能只是一個方向，或集中在某些爭點上，甚至可能因而產生其他的問題，這可能就必須由政府相關部門或其他的研究者再去深入討論。

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