| 摘要: | 高齡化社會的快速變遷，帶來生活型態與社會結構的改變，同時也會增加家庭照顧的負荷。隨著邁入高齡化社會，慢性病與功能障礙的盛行率將急遽上升，相對的失能人口也將大幅增加，其所導致的長期照顧需求也隨之增加。意味著當老年人口比例逐漸上升時，工作人口的扶養責任與照顧負荷將持續上升。
身為首善之都的臺北市，近年來也有人口老齡化的趨勢。當今，隨著醫藥衛生、生活環境及營養條件的改善，老年人口平均餘命的增長，同時也面臨退休、健康等方面的問題。然而，並非每位老人因為失能而無法活動，老人的自尊可以從參與各項活動而獲得，使得社區照顧服務的推動與發展日趨重要。「在地老化」即是期盼老人在其熟悉的社區中衣食無憂、無住行之慮，在生活上能有人給予照顧和扶助，以滿足老人「老有所養」最基本的生活需求；另外，大多數退休的老人，在退休後也希望回到自己的社區，以含飴弄孫、安享晚年。落葉歸根是國人的文化價值觀，所以，以社區為基礎的照顧服務，在近幾年日益受到重視，而結合社區組織提供各項服務常成為重要的一環。
本研究關注如何以組織的資源整合角度來看待臺北市的社區整合照顧計畫，以凸顯於臺北市其他同樣類型單位所實施的全國性社區整合照顧計畫(如長照2.0)之不同之處於照顧服務的方式。「石頭湯計畫」的政策緣起，源自於2014年年底新上任的柯文哲市長，由於當時就任之後，開始取消實施已久的「不排富」重陽敬老金之政策，改以「排富」的重陽敬老金的發放，以減少預算的浪費。並挪用作為其他福利照顧計畫(如：擴大老人共餐據點等)；於2016年10月試辦的臺北市社區整合照顧計畫，是為2014年年底新上任的柯文哲市長，親自前往日本取經後而發展的在地政策。其「石頭湯」的名稱一詞，源自於繪本故事《石頭湯》的靈感，將居家服務、輔具、無障礙空間規劃、日照機構、醫療與安寧照顧等視作不同食材，加以整合後，把失能長者所需之跨專業服務送到家。其最大的特點，便是設立「整合式服務站」，由具有社工或護理背景的個案管理員，針對長者需要，整合居家服務、輔具、無障礙空間規劃、日間照顧、醫療服務與安寧照顧等，成立跨專業團隊，為長者量身訂做個人照護計畫。
本研究的主要場域為X基金會經營下的松山社區照顧服務中心，即臺北市的社區整合照顧計畫(簡稱石頭湯計畫)於松山區實施的中心點。藉本研究以組織的資源整合角度與觀點，來瞭解石頭湯計畫的照顧服務提供、資源的連結，以及於所在的社區鄰里所扮演的角色等，以及比較實施全國的社區整合照顧計畫之間的不同等研究目的。本研究採取質性研究，並且採取半結構式訪談。
石頭湯計畫的出現，在時間點上確實是個關鍵。由於在當時是長照1.0的末期，而且在2016年的10月試辦與推行，這樣一個新的照顧計畫，很容易就會和長照1.0，以及後來於2017年實施的長照2.0等全國長照政策來比擬，並引發熱烈討論: 石頭湯計畫到底是什麼?會怎麼做?是不是延續長照2.0的台北市版? 石頭湯的初衷與本意，就是希望把照顧服務的資源，盡量集中化，並減少個案所等待的照顧服務資源之時間，以及避免讓個案自己去花費時間與精力來連結資源，所以強調便利性與就近性，是非常重要的。由於石頭湯計畫是在做照顧服務的資源整合，並沿用長照2.0「A個管」(A單位中的個管員)之角色。石頭湯的每年計畫，鎖定的服務族群不太一樣。尤其以110年度來說，石頭湯的個案會分輕重度分離，比較複雜性個案或重度的部分由石頭湯來負責。
然而「石頭湯計畫」將在民國111年12月31日熄燈，這四年的「石頭湯計畫」屬於實驗性質，意即於民國111年年底之後，其正在處遇的臺北市各地的A單位之照顧服務個案，將回歸到長照2.0架構下繼續處遇與服務。同時，X 基金會的松山區A單位，將回歸複雜性個案的處遇。
The rapid changes in an aging-society will bring about changes in life styles and social structures, and will also increase the burden of family care. As we move into an aging-society, the prevalence of chronic diseases and dysfunction will rise sharply, and the relative disabled population will increase significantly, resulting in an increase in the need for long-term care. This means that when the proportion of the elderly population gradually increases, the support responsibility and care load of the working population will continue to rise.
Taipei City, the capital of kindness, has also seen an aging population in recent years. Nowadays, with the improvement of medical and health, living environment and nutritional conditions, the average remaining life of the elderly population has increased, and they are also facing problems in retirement and health. However, not every elderly person is unable to move because of disability, and the self-esteem of the elderly can be obtained from participating in various activities, making the promotion and development of community care services increasingly important. "Local- aging" means that it is hoped that the elderly will have no worries about food and clothing, no worries about housing and travel in their familiar communities, and that someone can take care and support in their lives to meet the most basic living needs of the elderly "old age and care"; In addition, most retired elderly people also hope to return to their communities after retirement to feed their grandchildren and enjoy their old age. Returning to the roots of Chinese people is a cultural value, so community-based care services have been increasingly valued in recent years, and the provision of services in combination with community
organizations has often become an important part.
This research focuses on how to view the integrated community care program in Taipei City from the perspective of organizational resource integration, so as to highlight the different approaches to care services in the national integrated community care program (such as Long-term Caring 2.0) implemented by other similar units in Taipei City. The policy origin of the "Stone-Soup Program" originated from the newly appointed Mayor at the end of 2014, because after taking office at that time, he began to cancel the long-implemented policy of "not excluding wealth" Chongyang Pension and replaced it with the "Eliminate Wealth" Chongyang Pension to reduce budget waste. and diverted as other welfare care schemes (e.g. expanding the sharing of meals for the elderly, etc.); The Taipei City Community-Integrated Care Program, which was piloted in October 2016, is a local policy developed by the newly appointed mayor at the end of 2014 after personally traveling to Japan to learn from the experience. The name "Stone Soup" is inspired by the picture book story "Stone Soup", which treats home services, assistive devices, barrier-free space planning, daycare institutions, medical and palliative care as different ingredients, and integrates them to deliver the multi-professional services needed by the elderly with disabilities. Its biggest feature is the establishment of an "Integrated Service Station", where a case manager with a social worker or nursing background integrates home services, assistive devices, barrier-free space planning, day care, medical services and palliative care to set up a multi-professional team to tailor personal care plans for the elderly.
The main site of this study is the Songshan Community Care Service Center operated by the X Foundation, which is the central point of the implementation of the Taipei City Community Integrated Care Program (referred to as the Stone-Soup Program) in Songshan District. Through this study, from the perspective and perspective of organizational resource integration, this paper aims to understand the provision of care services, the connection of resources, and the role played by the communities and neighbors of the Stone-Soup Program, and to compare the differences between the implementation of the integrated community-careing program across the country. This study was qualitative and semi-structured interviews.
The emergence of the stone soup plan is indeed a key point in time. Since it was the end of Long-term Caring 1.0 at that time, and it was trialed and implemented in October 2016, such a new care plan could easily be compared with the national long-term care policy such as Long-term Caring 1.0 and later implemented in 2017, and triggered heated discussions: What exactly is the Stone Soup Program? What will be done? Is it a continuation of the Taipei City version of Long-term Caring 2.0? The original intention and intention of Stone Soup is to centralize the resources of care services as much as possible, and reduce the time spent waiting for care service resources in cases, and avoid allowing cases to spend time and energy to connect resources, so it is very important to emphasize convenience and proximity. Since the Stone Soup Program is to integrate resources for care services, it continues to play the role of Long-term Caring 2.0 "Class A Supervisor" (individual steward in Class A). The annual plan of Stone Soup is not the same as the target service group. Especially in a year of semester of 2021, the cases of stone soup will be divided into light and severe, and the more complex cases or the heavy part will be handled by stone-soup program.
However, the "Stone-Soup Program" will turn off the lights on December 31, 2022, and the four-year "Stone-Soup Program" is experimental, which means that after the end of the 2022 of the Republic of China, the care service cases of Unit A in Taipei City that it is handling will return to the Long-term Caring 2.0 framework to continue to deal with and serve. At the same time, Class A of Songshan District operated by the X Foundation will return to the handling of complex cases. |
