為了解失能者家庭親屬結構變化、討論失能家庭照顧關係可能的動態演變，本研究以微觀模擬取向方法試行推計，由描繪樣本家庭在不同時間點的親屬結構圖像，將未失能家庭成員視為潛在資源，觀察家庭親屬照顧可能予受型態。 本研究主要發現： 1.由於樣本家庭平均人數將逐漸減少，平均失能親屬先增後減，家庭照顧失能者壓力將逐年增加。 2.以照顧予受型態分析，關鍵者一生中大致上由毋需被照顧轉變為需要照顧，由給予親屬照顧轉變為接受親屬照顧，轉折關鍵時間平均約在70歲。 3.由於兩性有差別死亡率及失能率，存活之老年關鍵者男性較女性健康且有失能親屬之可能性較高。但未失能女性進入老年期前有失能配偶比例較高。 4.此世代關鍵者老年後若失能，無親代、孫代提供照顧可能性很高。失能老年女性關鍵者無配偶可能性高於男性。 5.以三種失能率模型推算樣本家庭失能者親屬照顧資源，各型每家各代平均人數相當穩定，但降低型失能平均人數較低，升高型親代失能平均人數在2020年前較高。三種模型推算照顧予受型態變化，變動幅度小於失能率變動。 以關鍵者角度，未來其家庭能照顧失能者之親屬資源逐漸枯竭。2005年平均45歲之關鍵者，進入老年期前，將逐漸感受照顧失能親屬之生命經驗。但其進入老年（約2025年）之後，本身失能可能性大增，卻將面臨家中未失能親屬數量較低，照顧壓力增加之風險。 在未來研究方向與政策建議方面，本研究建議： 1.對於長期照顧需求人口之相關研究應持續進行。 2.長期照顧政策規劃應顧慮人口變遷造成之家庭照顧弱化問題。 3.應增加對於家庭動態變化相關研究，以釐清照顧服務需求。 4.長期照顧服務應加速提供，以減輕今後家庭照顧失能者的負擔。 5.考慮我國家庭親屬結構未來變化，長期照顧服務應以廣泛角度思考各種可能（包括搭配行動式照護技術，以及規劃合理引進外籍人士擔任照顧工作相關政策），加以創新。

近年來，隨著人口快速的老化，慢性疾病與功能障礙的盛行，各國對長期照顧需求人口數劇增，為因應不斷增加的長期照顧需求，各國無不積極發展長期照顧相關政策與服務以為因應。長期照顧服務依其服務目的的不同可分為以醫療照顧為主以及以心理社會援助為主的模式，以我國現行提供之長期照顧服務而言，仍以醫療照顧為主要的服務模式。然而，根據研究顯示，心理的健康包括人際關係的建立以及情感性的社會支持，對受照顧者的生理健康有顯著的影響。因此，長期照顧的發展不應只靠醫療照顧的加強，人際及社會關係的維繫也是需著重的部分。 有鑑於此，本研究將網路社群應用於長期照顧領域中，期望透過網路社群在社會關係的建立以及資訊集中的特性，加強長期照顧服務體系(以下稱長照體系)中人際與社會關係的建立。首先本研究將先對長照體系中各利害關係人的需求進行分析，這些需求包括受照顧者對於重建社交生活與人際關係的渴望、家庭照顧者對長照資源之相關資訊以及期望獲得社交網絡關係的需求。此外，照顧服務提供單位與照顧產品廠商，作為提供服務的角色，欠缺與民眾資訊互通的管道，導致民眾不清楚服務單位及廠商的資訊，廠商也難以接觸到終端客戶，致難以掌握其市場。 根據上述各利害關係人的需求以及長期照顧領域的服務特性，本研究進而發展了一長照體系之網路社群(以下簡稱長照網路社群)之架構，架構中包含「資訊整合與分享」、「情感交流」、「連結廠商」以及「社會行銷」四個面向，透過這四個面向的功能，以改善長照體系中各利害關係人的需求以及照顧服務的品質。此外，透過長照網路社群之建立，也能為我國長照體系帶來其他效益，對於照顧服務機構與相關廠商而言，長照網路社群整合了市場的供需雙方，將形成一廣大的長照市場，未來的商機將不可限量；對民眾而言，他們可以對照顧服務機構、廠商，甚至政府的施政進行討論與評鑑，達到全民監督的效果；而對政府而言，也能從而掌握我國長照市場的整體發展，並針對政策措施不足的地方加以改進，以更符合民眾之真正需求。

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.

本篇論文探討在高齡社會下，如何透過創新保險商品設計，提高長期照顧保險以及年金保險的銷售。本篇論文包含兩部分，第一部分討論長期照顧保險以及年金保險可能隱含的逆選擇成本，利用台灣地區中老年身心社會生活狀況長期追蹤調查資料，估算不同的健康轉移速率矩陣，並計算可能存在的逆選擇成本。更也進一步探討不同的商品設計，對逆選擇成本的影響。第二部分則探討這兩種商品結合降低逆選擇成本的效果，過去的文獻指出長期照顧保險結合年金保險可以降低長期照顧保險市場的核保問題，以及年金保險市場逆選擇成本過高等問題。不同於過去文獻，本研究討論當兩種商品結合為一新型產品時，在具備同時吸引具有不同個人健康資訊的長期照顧保險被保險人以及年金保險被保險人之特性下，可降低多少逆選擇成本。若降低逆選擇成本的效果夠大，相信這樣子的商品設計能吸引更多被保險人購買，並有助於商業保險市場之成長，提供更多對老年社會經濟的保障。

本研究旨在瞭解家庭面臨親人罹患阿滋海默症的家庭動力，以及此家庭動力對於家人的影響。研究者採質性訪談的方式，以半結構式訪談大綱，深度訪談一個阿滋海默症患者的家庭，並輔以Olson環繞模式來瞭解家庭各次系統的凝聚力、適應性及溝通。茲將研究結論摘錄如下： 一、家庭面臨親人罹患阿滋海默症的家庭動力 （一）患者與配偶間的夫妻關係受到最大的衝擊：兩人情緒趨向疏離、患者配偶的角色變得領導與控制、夫妻關係轉為母子關係型態、難以雙向溝通、彼此衝突增加且溝通品質下降。 （二）父子關係也受到疾病的影響：父子間難以情緒交流與互動，父親無法提供穩定的領導，反而是孩子變得親職化以照顧父親，角色界限模糊不清。此外，父子關係也受到孩子進入青少年發展階段的影響而更趨向分離。 （三）母子關係因父親罹病而更加親密：母子間彼此相互依賴、情感也更加親密、母親由於外出工作時間增加，提供給孩子更多自主管理的彈性。 （四）未成年子女的手足關係未受父親罹病的影響。 二、阿滋海默症患者家庭動力對於家人的影響 （一）患者原生家庭的動力影響配偶如何面對先生罹病的認知、情緒與行為三個層面。 （二）夫妻關係中無效的溝通加劇配偶照顧者對疾病的適應困擾。 （三）父母子三角關係：夫妻間角色功能不平衡，影響孩子對父親的觀點，也拉攏了母子關係，孩子變得較為親職化。 除上述研究結論外，訪談中還發現當子代面對上一代的奉養責任時，願不願意擔負照顧責任常與原生家庭動力有關。若內心不願照顧卻擔負照顧責任者，會面臨內在衝突與矛盾、呈現較多的抗拒、影響疾病適應。 本研究根據上述的研究結論提出討論，並提出具體建議，以供臨床醫療工作者、心理諮商工作者、衛生福利政策制訂及未來研究的參考。

「長期照顧」係指對具有長期身體功能失常或有重大疾病者，提供一段持續性的協助。臺灣社會的整體人口結構已逐漸朝向高齡化，根據推估，臺灣目前65歲以上的老年人口約208萬人，約占總人口的9.2%，但是因為戰後嬰兒潮即將邁入老年，因此只要再過25年，我國老年人口所占的比率將超過20%。再以身心障礙者為例，2005年底領有身心障礙手冊者達93萬8千人，其中屬於重度與極重度障礙者占29萬人。相對於老人對長期照顧需求的逐漸增加，目前更有大量的身心障礙者需要長期照顧服務的介入協助。臺灣社會對於長期照顧服務的迫切需求不言可喻，因此國家若忽視這類的需求，所造成的不單是個人或個別家庭的困境，更將是整體的社會問題，因此國家身負無可回避的責任。 臺灣社會的長期照顧服務一直高度依賴外籍家庭看護工，為減緩此一情況，國家試圖以投入大量資源扶持機構式照顧服務，與逐步充實社區式與居家式照顧服務等方式改善，但是外籍家庭看護工在台人數卻是不減反增，顯見國家長期照顧政策並未獲得失能者家庭的認同。臺灣外籍家庭看護工現象，其實是一種相當複雜的社會建構過程，是「父權」的家庭文化、「私化」的國家政策與「家庭負擔能力」的鉗制，三者交互影響而建構出失能者由家庭照顧為主的處境。如此過程是值得深入去了解的。 本文以文獻回顧與整合研究法，作為主要的研究方法。本文研究後認為，臺灣現存的整體照顧資源，會與現有文化觀念交互影響，進而強化家庭對「家人照顧」與「照顧行為女性化」的偏好。當女性照顧者面臨愈來愈強的照顧負荷與危害時，終將在國家政策、經濟能力、傳統文化與父權主義的交互影響下選擇具替代性的照顧服務，即便對失能者及其家庭而言並非最佳選擇。很明顯的，臺灣選擇以「外籍家庭看護工」做為傳統長期照顧方式的主要替代照顧方案，即便國家大幅改革長期照顧政策（照顧服務福利及產業發展方案），情況依舊未獲得改善。因此，臺灣如要建構一套完整的長期照顧政策，就必須先理解失能者家庭在選擇照顧服務時，是同時面對「經濟能力」和「文化輿論」等照顧困境。因此，一般的女性照顧者應從「無償照顧者」的社會弱勢角色，轉變為長期照顧政策的思維中心與主導者之一；而外籍家庭看護工的角色與價值更應該被重新定位與肯定，更應尋求將其融入臺灣整體照顧政策的可能性。 / Long-term care service in Taiwan depends on foreign nursing labor for a long time. In order to improve this situation, The government has provided more resources for institutional care services, and community care services and home care services. but foreign nursing labor in Taiwan still increased slowly. It means disabled person’s family can’t relate to The Long-term care service in Taiwan. In fact, foreign nursing labor in Taiwan is a social construction, and was affected by Patriarchy, private policy and home capacity. Finally, disabled person still in their home. This situation need to research. This research is based on document analysis. According to the result of this research, the resource of caring and the traditional culture concept have influenced to each other and emphasized. When female caregivers face heavy pressure of family care, they would choose other caring Long-term care service in Taiwan has been dependant on foreign nursing labor for a long time. In order to improve this situation, The government has provided more resources for institutional care services, community care services and home care services as well. but foreign nursing labor in Taiwan still increased slowly. It means the disabled person’s family can’t relate to The Long-term care service in Taiwan. In fact, foreign nursing labor in Taiwan is a social construction, and is affected by patriarchy, private policy and home capacity. Finally, disabled person is still in their home. This situation need to research. This research is based on document analysis. According to the result of this research, the resource of caring and traditional culture concept have influenced each other. When female caregivers face heavy pressure of family care, they would choose other caring service, and even it’s not the best one. Obviously, Taiwan chose foreign nursing labor as an alternative route, although the Government have launched a new program of long-term caring (Caring Service welfare & Industry development program). If Taiwan plans to establish a sound caring policy, it must understand the patriarchy, private policy and home capacity. The female caretaker should change from the one who used to be unpaid family caretaker to become the center of the long-term care policy. In addition, we should improve the role and value of foreign nursing labor, and Long-term care service in Taiwan should take foreign nursing labor as its regular as well as essential component. Key Words：long-term care, Foreign Nursing Labor

隨著高齡社會的來臨、85歲以上之「老老人」人數增長，具有長期照護需求者亦隨之增加；在眾多長期照顧資源中，目前以小型養護機構的所提供的服務量最為多，可見此種機構類型在長期照顧領域中的重要性。由於長期照顧機構間競爭激烈及評鑑期待等因素，使得服務品質成為目前小型養護機構發展的目標；社工員專業功能的發揮對於機構服務品質提升多有助益，但社工員的任用或許因為法源不足、成本考量、機構人員認識不足等因素沒有受到同等的重視，亦形成社工員高流動率與聘僱不易等問題。目前對於此研究對象的相關研究甚少，無法對於此種現象進行瞭解，且不能解答筆者過去一年多兼職工作經驗中所產生的疑慮，因而本研究以小型養護機構社工員為研究對象，探討其專業角色的發展歷程。本研究之目的如下：（1）試圖了解小型養護機構社工員在機構內的工作職責；（2）這些角色如何學習、建構與發展之歷程；（3）社工員的角色認知與其它工作人員角色期待磨合的過程；（4）此段過程中的各式影響因素；（5）期待本研究能使政策制定者、社工教育的學者及實務工作者關注社工員在小型養護機構內奮鬥的辛酸，並提出改善社工員所處情境之建議。 本研究因為過去相關研究甚少、據探索性研究特質、以生命經驗作為探索焦點及重視研究參與者觀點等因素採用質性研究典範，使用深度訪談方式蒐集資料，並以樣版式方法進行分析，在研究過程中亦有處裡研究倫理及信、效度等議題。本研究之研究結果為：（1）社工員於小型養護機構內的工作職責為「與個案一起工作」、「與家屬一起工作」及「與機構一起工作」；（2）專業角色發展歷程大致可歸納為兩主軸，其一為「角色不明確->學習」，初入機構時，多數社工員會感到角色不明確，而出現不知所措、挫折感、壓力、沒有成就感與緊張害怕等情緒，其運用正式教育訓練與非正式觀察模範、蒐集資訊、反思學習等方式進行社工員角色扮演、認識角色組成員、病理知識、組織運作資訊等相關學習，但由於機構內正式訓練不足、非正式學習並無相同專業之指導者，所以社工員紛紛表達需求督導支持；（3）專業角色發展歷程的第二主軸為「角色衝突->因應」，社工員對自己專業角色有所認知，進入機構後，部份機構主管因為對社工員專業角色認識不清、人力聘用不足、較不熟悉電腦操作等因素，對社工員有較高的行政角色期待，而引發角色衝突困境，令社工員感到抗拒、排斥、不滿、專業角色不被重視、想要離職、掙扎或對主管的角色期待產生疑惑等負面情緒，若干社工員以工時不足為由與機構主管溝通協調捍衛自己對於專業角色的認知，但多數仍不敵機構主管的期待而妥協接受機構主管角色期待，成為機構內的行政人員或社工兼任行政人員，在同時扮演兩種角色或捨棄原有專業角色轉而扮演自己不熟悉的角色之情況下，社工員會出現角色負荷過度的問題，並對自己專業成長沒有信心、付出收益不等值及引發自責等負面情緒。但仍有些社工員能運用說服的技巧、堅定拒絕的態度、事先避免等策略來堅持自己所認知的專業角色；（4）在上述的兩個主軸的影響因素中，社工員個人的人力資本、社會支持與自我認同會使得社工員較能堅持專業角色，同樣地組織內機構主管的學習經驗、接觸社工員的經驗也會讓機構主管較為清楚了解社工員的工作角色；但社工員重視人際合諧、畏懼權威等個人特質，會讓社工員妥協接受機構主管的角色期待，而機構內學習資源不足、社工員兼職工作身分等因素會阻礙社工員資訊之取得，機構內無行政專責人員、機構專業分工不清之文化，則會令機構主管對於社工員產生角色期待；除了個人與組織層次之助、阻力之外，社會環境層次中，規範小型養護機構的法規及評鑑項目等亦對於社工員專業角色發展有所影響；（5）學習是小型養護機構社工員專業角色發展歷程之核心機制，貫穿了「角色不明確->學習」主軸，也與角色衝突、因應策略息息相關，更是左右此歷程發展之重要因素。最後，研究者亦有針對上述研究結果之相關議題進行深入討論，並提出數點建議期待研究成果有較為實質的貢獻。 / With the approach of aged society and the growing number of senior citizens over 85, people with the needs of long-term care is also on the increase. Currently, among all the long-term care resources, the amount of service provided by small-scale nursing home is the largest. Therefore, we can realize the significance of such type of facilities in the field of long-term care. However, due to factors like the keen competition and the expectations of evaluation among long-term care facilities, the quality of service has become the goal of small-scale nursing home. The realization of social workers’ professional roles is beneficial to the enhancement of the service quality of facilities. Nevertheless, probably because of reasons such as the insufficient laws, the consideration of cost, and the insufficient knowledge of staff, the employment of social workers is not equally emphasized, and thus causes problems like the high mobility of social workers and the difficulty in hiring social workers. Since there are few related studies on social workers, I could not understand such phenomena and there is no answer to the problems raised from my part-time experience. Hence, studying social workers, this study aims to explore the developing process of the roles. The purposes of this study are as follows: first, understanding the duties of social workers in small-scale nursing home; second, the way social workers learn and construct roles as well as their developmental process; third, the role identification of social workers and the process they conciliate with the role expectations from other staff; fourth, the various influencing variables during the process; fifth, the hope that this study could make policy-makers, scholars in social worker education field and practician concern the hardship and struggle that social workers encounter in small-scale nursing home, and provide suggestions for improving the conditions of social workers in these workplaces. As a result of elements like few related studies, studies with exploratory features focusing on life experience and on the viewpoints of participants, this study adopts the qualitative paradigm, collects data with in-depth interviewing, and explains with the template analysis style. The study also deals with certain issues like ethics, reliability, and validity during the process. There are 5 findings in this study. First, the duties of social workers in small-scale nursing home include “working with the client,” “working with the family,” and “working with the facility.” Second, the developmental process of professional roles can generally be divided into 2 categorizes. One is “from uncertain role to learning.” At the beginning, most social workers feel uncertainty about the role and emotions like loss, frustration pressure, lack of achievement, nervousness and fear occur. With formal educational training, informal observing model, collecting data, and reflective learning, they learn through the role play of the social workers, knowing group members, pathological knowledge, and information about the running of organizations. Nevertheless, owing to insufficient formal training in the facility and no advisor with the same expertise for informal learning, social workers turn to supervisors for help one after another. Third, the other category is “from role conflicts to solutions.” After social workers realize their professional roles and work in facilities, due to facts like insufficient understanding of the professional roles of social workers, insufficient staff, and unfamiliarity of using computers, part of managers in facilities hold higher expectations of administrative roles on social workers, and thus causes social workers the dilemma of role conflicts and negative emotions like resistance, refusal, disaffection, despise of professional roles, resignation, struggle, or doubts about the role expectations from managers. Several social workers negotiate with the managers for the reason of insufficient working time to defend their recognition on professional roles. However, most of them still compromise and accept such role expectations. They become the administrative staff or social worker and part-time administrative staff. Under the circumstances of playing 2 roles at the same time or giving up the previous professional roles and turning into a less familiar role, social workers suffer from overload, become not confident in their professional development, feel inequality between devotion and reward, and have negative emotions like reproving themselves. Yet, some workers employ strategies like techniques in persuasion, firm refusing attitude, and prevention in advance to insist on the professional role in their mind. Fourth, among the variables in the 2 categories, the personal human capital of social workers, social support, and self-identification enable social workers to persist in their professional roles. By the same token, the learning experience of institute managers and their experience of contacting social workers also make managers understand the role of social workers better. Nonetheless, characteristics like emphasis on interpersonal harmony and fear of authority lead social workers to compromise and accept the role expectations of facility managers, while factors like lack of learning resources in the facility and the part-time role of social workers prevent social workers from access to information. The lack of full-time administrative staff and the culture of vague division of work in the facility cause facility managers to hold role expectations on social workers. In addition to the encouragement and obstruction from the personal and organizational level, in terms of social environmental level, the laws and evaluation items that regulate small-scale nursing home also affect the social workers professional role development. Fifth, learning is the core mechanism of the process of social workers’ professional role development in small-scale nursing home. It not only penetrates the category of “from uncertain role to learning,” but also is closely related to role conflicts and responding strategies. Moreover, it is the important element that affects the development of this process. At last, the researcher also has a deep discussion in terms of related issues about the results and proposes several suggestions in the hope that the results could have practical contributions.

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.

在高齡少子化的浪潮下，家庭照顧機能與國家公共長照服務體系之界限逐漸浮現，不論是採稅收制或是社會保險制的國家，均紛紛發動改革，發展新型的照顧服務體系，更有效率地結合社會中各種資源，並且透過報酬支付制度的設計，回應長期照顧需求的多元性，以達成充實長期照顧服務量能、發展創新並符合在地需求之照顧服務。本文以日本介護保險制度自2000年創設以來，在服務供給體系與支付制度上之轉變作為比較對象，觀察其社會價值理念的變遷如何反應到法制設計層面，同時報酬支付制度是如何回應社會現實的需求與政策方向；擬自日本介護保險經驗中萃取值得我國參考借鑑之處，減少台灣長期照顧體系發展過程中可能產生的試誤成本。 本文首先對我國長期照顧服務提供體系之法制發展進行分析，包括釐清長照服務提供之法律關係、長照服務供給體系之構造，以及在長照十年計畫下，政府與民間服務提供者合作模式之建構等；並具體地以數份國內地方政府公布之服務提供契約範本為例，嘗試勾勒出台灣長照服務體系公私協力法律關係之圖像，同時探討我國長照服務提供體系與報酬支付制度現存之問題。 在日本介護保險制度部分，本文歸整介護保險法之制定和改革歷程及其基本構造、初探日本介護保險制度與其他社會保障制度之連動性，並集中分析其服務提供者指定制度之法制設計與問題。接著本文將對比台灣長照體系之發展軌跡與挑戰，分析台日兩國公共長照服務供給體系的幾個議題，包括：總體面的公共長照體系理念變遷、國家資源的公平分配、服務品質之管理等。最末於結論歸納日本介護保險經驗值得我國借鏡或反思之處，並簡評目前我國長期照顧服務法修正，以及長期照顧十年計畫2.0之內涵，是否足以回應社會中的長期照顧需求，並有助於實現在地老化之理想。