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
| Identifer | oai:union.ndltd.org:CHENGCHI/G0094921065 |
| Creators | 吳素霞 |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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