老老照顧：老年子女照顧老年父母的困境與復原力

Abstract

本研究的研究目的與重點為描述老年子女輩照顧者對於老年子女輩照顧老年父母輩這樣老老照顧議題的認知，並且描繪其面臨的困境與復原力，並且根據他們服務與照顧政策的經驗，給予現存的照顧政策與服務一些建議。 本研究主要採建構式主義。研究者採半結構式深度訪談法，訪談12位照顧者，並且錄音，爾後將錄音檔轉為逐字稿。研究者採歸納式的主題式分析，反覆閱讀逐字稿後編碼，並產生出主題。 研究結果有以下發現，成為照顧者的起因分為四部分：自然而然、主動承擔、家中排行，以及獨生子女／媳婿。對於老老議題的想像，則分為：自身狀況、世代變遷與差異、別人很辛苦，自己還好，以及應由專業協助。照顧的困境則有十項，包含：時間與社交被束縛、生理負擔、自身疾病困擾、心理負擔、經濟負擔、性別隔閡與差異、角色轉換衝突、照顧意見不合、疫情影響，以及假期影響。而復原力的部分，則包含了老老照顧優勢、所使用的資源、復原力的保護因子，以及最後復原力的展現，還有照顧經驗的回饋。其中，老老照顧的優勢包含了：較有時間專注於照顧、較能同理與溝通、人生經驗充足、被照顧者安全感、相互依賴、更願意承擔照顧責任等。資源使用包含非正式資源的家庭資源、鄰里資源、朋友資源，以及網路資源，以及正式資源的醫院方資源、長期照顧資源、照顧者支持團體、長期照顧、醫療健康相關課程、外籍看護、本國籍看護，以及其他如社會保險、中低收入戶補助等。復原力保護因子，則有紓壓管道、幽默與轉念、宗教幫助、志工經歷等，每一項都有其內涵與不同的面向。復原力的展現則是自助助人，受訪者在接受資源後，再將轉過去幫助其他需要的人。最後在照顧經驗回顧的部分，則分為：照顧正向回饋、訓練出耐心、成就感、準備未來，以及以身作則等五項。對於政策與產業的想法與建議，則有可近性不足（宣傳、服務申請困難）、補助方向、外籍看護政策、專業人員訓練、服務不符合需求與期待，以及其他建議，如普及式衛生教育服務等。 根據上述的研究發現，與文獻回顧對話後發現，老年子女輩照顧老年父母輩的困境與復原力，與過去研究有許多相同、相似之處，是相互呼應的，但亦有一些細微的不同之處，例如：經濟狀況與津貼的政策建議，更反映了老年退休之後收入不穩定性，以及現金給付對於老年照顧者的重要性。政策建議則回應到上述的研究發現，在可近性、資源配給、專業人員服務、服務輸送形式等，都有可以改善的空間。而針對未來研究的建議，則是必須看到其他照顧關係與老年子女輩可能的不同，以及北北基地區以外，不同地區、族裔等交織出來的不同之處。最後，亦可以探討家中其他角色，例如：配偶、孫子女輩等。

Objective: Describe how the aged children caregivers perceive the issue of aged children caring for aged parents, and depict the difficulties aged adult children caregivers encountered and their resilience, and then according to their experiences and perspectives on the services and care policies, give some pieces of advice on the current care policies and industry. Method: This research paragdim is constructivism. The researcher did the semi-structured in-depth interviews with 12 participants, recorded every interview, and then typed down the transcripts. This research used the inductive thematic analysis, the researcher reading the transcripts and coding them to generate themes. Results: There are many research findings. The first is the reasons for becoming a caregiver, including naturally becoming like this, taking the responsibility of their own accord, ordinal position and the only child and their spouses. As for the image of double aging care issue, it includes their own situations, generational change and differences, others being exhausting while I being fine, and that care should be helped by professionals. And there are ten difficulties in care, which are limited free time and social interaction, physical burden, the vexation of their own illness, psychological burden, financial burden, the barrier and differences of different genders, role changing conflict, the conflicts from different caring ways and opinions, and the impact of Covid-19 pandemic and the influence of long-term vacations. Regarding resilience, there are several different aspects, such as the advantages of double aging care, the resources the caregivers used, the protective factors of resilience, the demonstration of the resilience, and the feedback from care experiences. The advantages of double aging care includes more time to focus on care, having more empathy and being able to communicate with the care receipients better, having more life experiences, the sense of safety of the cared ones, interdependency between caregivers and the care receipients, and more willing to take the care responsibility. The resources participants used fall in two categories, informal resources and formal resources. The former comprises family, neighborhood, friends and Internet, and the latter consists of hospital resources, long-term care resources, caregiver support groups, lessons about long-term care and healthcare, foreign care workers, native/Taiwanese care workers and other resources like social insurance and social assistance. The protective factors of resilience are relaxing ways, humor and reframing, the help of religion and the experiences of volunteering. Every single factor has its own content and different aspects. The demonstration of resilience is that the caregivers self-help and then help others. The participants received the help from those resources and after that, they help other people in need. In the end, there are the feedbacks from care experience, including positive care feedback, becoming patient, sense of achievement, preparing for the future, and leading by example. As regards the thoughts and advice on care policies and care industry, there are the lack of accessibility (not enough publicity and hard to apply for services), the grants, policies of foreign care workers, the trainings of professionals, the services not living up to the needs and expectations of the users, and other suggestions, such as universal health education for caregiver families. Conculsion: Matching the research findings with the literature reviews, the researcher found that the difficulties and resilience of aged children caring for aged parents resemble the findings from the previous studies, but there are still trivial differences. For example, the difficulty of financial burden and the suggestion of giving care allowance reflect the inconsistency and instability of the income after retirement and the importance of “in cash” services to the elderly caregivers. According to what has been illustrated in the results, the policy advice comprises accessibility, allocation of resources, services from professionals and the form of service delivery, which all left a lot to be desired. Regarding the suggestions for future research, the researchers can put an eye on the different relationships between caregivers and care recipients, different living areas, different enthnicities of the double aging care issues and so on. Last but not least, the researchers can also discuss different roles in the double aging caregiving family, such as spouses and children of the caregivers.