外籍看護工在台灣私立小型長期照顧機構之勞動經驗及社會融合

Abstract

照顧人力不足為推展長照服務之主要困境，政府開放外籍看護工進入老人照護體制，帶動社會照護變遷。本文以長照機構與外籍看護工之雇傭關係爲主軸，分析勞動體制下的勞動經驗與社會融合間之互動性，以了解照顧工作是如何受到特定社會制度的影響。研究方法運用焦點團體做為先導研究，以達研究問題澄清之目的。其次，運用觀察法及深度訪談法進行資料蒐集，透過參與和欣賞的行動與反思研究（PAAR）之介入，對外籍看護工的勞動經驗進行討論。研究對象為北部之三家長照機構，共訪談外籍看護工、本籍照服員、機構負責人、護理人員及社工人員。研究結果指出1.外籍看護工扮演獨撐大局的照顧大軍，承擔小型機構失能老人照顧工作；勞動角色在社會連帶牽引下，發展出「照顧性別化、分工階層化、產業同鄉化」之特色。2.外籍看護工之照顧勞動經驗涵蓋身體與情緒之勞動，且「每個人、每一天」都不同，照顧工作為強調「互動性」之工作型態。3.社會融合受機構管理策略與同儕督導影響，外籍看護工勞動角色呈現出階段性之發展，且顯示出「工作與生活」間之高度重疊性，適應融合之程度則受語言溝通能力影響。機構對外籍看護工之高度依賴，發展出共生關係，以「碎步向前」呈現出有範圍、有程度的社會融合，外籍看護工與管理者在政策與社會文化大環境壓迫下，在小型機構內呈現出「主控」與「被控」的拉鋸。研究建議為能發展社會融合機制，小型機構需要「打掉重練」，先打破原本孤立的處境界線被社會所融合，再藉由外勞政策中利害關係人多方合作，重新落實制度性平等。外籍看護工影響照顧品質甚鉅，我國政府面對獨撐大局的外籍照顧大軍必須面對現實，提出清楚的勞動與社會政策。唯有重視勞動力的永續，建構以社會融合為基礎之發展，才能達到增進社會與個人、本籍與外籍所有個體生活福祉之長期目標。

Recently, the shortage of caregivers is a primary obstacle for promoting long term care services in Taiwan. The Taiwanese government therefore opened up the foreign care workers to enter the elderly care system. The aim of this research was to analyze the interaction between foreign care workers’ labor experiences and social inclusion. It was also to understand how long term care was influenced by specific social circumstances. Two focus groups were held as a pilot study to clarify the research problems and research purposes. Secondly, the author used Participatory and Appreciative Action & Reflection Research (PAAR), observation and in-depth interviews to collect data, analyze and assess foreign care workers’ experiences. Three long term care facilities located in the north of Taiwan participated in this research. The in-depth interviews included the foreign and Taiwanese care workers, administrations, nurses and social workers. The research results indicated that (1) Foreign care workers play a key role in the Taiwanese long term care system and provide the main direct care work to the Taiwanese elderly. This labor force has developed the characteristics of “customized care of gender, division of labor and national grouping”. (2) Caring can be quite challenging for a foreign care worker. It requires high level of interaction loaded with both physical and emotional demands, and the need for individualized care. (3) Foreign care workers’ life and work highly overlapped. Their degree of life adaptation was influenced by personal language skills. A clear pattern of phased development of their labor experiences was discovered by this research. Confined by the unfriendly macro social, cultural and policy environment, the small care facilities and foreign care workers have developed a symbiotic relationship, and social inclusion was therefore quite limited. Finally, this research suggests that foreign caregivers have a great influence on the quality of institutions and care. In order to develop a sustanible labor force of foreign care workers, the institutions must break their old employment routines and to collaborate with the many different stakeholders to improve the social inclusion of foreign care workers. This research urges the Taiwan government to face the reality of the crucial importance of foreign care workers, and to change the outdated paths of social and labor policies. Thus, the ultimate goal of personal and social well-being may be enjoyed by all parties involved.