臺南教養院中高齡智能障礙者休閒參與內涵及經驗之探討

Abstract

近幾年，臺南教養院意識到安置服務對象平均年齡逐年提高，因而開始思考原有以教育訓練為主要服務型態的適切性，進而嘗試改變過去的服務概念。自2007年起開始規劃一系列中高齡智能障礙者日間休閒活動，期待以休閒安養取代過去的教育訓練。本研究想探討機構中服務對象休閒生活的內涵，及服務提供者執行休閒活動的情形，此議題對於機構未來面對智能障礙者老化的服務轉型極具意義。因此，本研究目的為：(1)了解臺南教養院中高齡智能障礙者休閒活動之內涵；(2)分析臺南教養院服務提供者執行中高齡智能障礙者休閒活動之情形；(3)探討臺南教養院中高齡智能障礙者休閒參與的經驗；(4)依據上述結果提出教養機構規劃中高齡智能障礙者休閒活動之建議。 本研究以深度訪談方式，主要訪談機構內兼具休閒活動帶領者和照顧者雙重身份的服務提供者6人，並輔以訪談機構內口語表達及認知能力較佳的服務對象6人，期望從服務提供者的觀察和服務對象的經驗等多元管道來進行探索。研究發現：(1) 在休閒活動的規劃執行方面：活動安排乃沿用過去技藝陶冶的服務規劃邏輯和用詞，容易忽略服務對象的個別興趣及需求。從工作時間的思維來安排休閒活動，使夜間及假日的休閒活動是較缺乏規劃的，而且受到許多安全考量的限制。雖然體能活動在服務對象的生活及健康方面扮演重要角色，但目前機構安排的體能活動，仍缺乏有目的的整合及規劃。部分休閒活動的安排，仍屬於比較粗淺的活動執行層次。而機構對於服務對象社區融合的努力，也受到人力及安全考量等結構性限制。(2) 在服務對象的休閒參與經驗方面：在休閒參與意願及過程中，服務對象有不同層次的自由選擇及自我決定的經驗。休閒活動可以增加其人際互動的機會，及日常生活的定向感與現實感。而聽收音機是服務對象閒暇之餘很喜歡從事的休閒活動，也是生活中很重要的'伴侶'。(3) 在機構的文化和環境方面：服務對象在日常生活及休閒活動中的安全，是機構很重要的考量。這些安全維護上的要求，可能影響服務提供者執行休閒活動的態度，及服務對象休閒參與的品質。而服務提供者在活動情境營造及空間佈置的努力，有助於服務對象的休閒參與。此外，機構具有適合中高齡者休閒安養的極佳條件，未來機構應善用這些資源及優勢，規劃發展適合在地特色的休閒安養服務模式。 依據研究結果，本研究提出幾個建議：(1) 依據服務對象生心理功能及個別服務需求，分別規劃設計不同難易程度的休閒活動，並配置適當的活動支援人力。(2) 透過作息時間或人力安排的適度調整，規劃活動帶領者間的討論機制，以即時評估服務對象的休閒參與情形，並針對活動執行過程進行檢討與改善。(3) 重視個案及相關服務紀錄的撰寫，並作為服務規劃時之參考。(4) 將服務對象的生活脈絡、當地文化融入休閒及生活。(5) 以科技整合的團隊，提供有關休閒活動規劃設計及執行過程的專業意見，以提升服務對象休閒參與的品質。(6) 透過團隊討論和專業訓練，協助服務提供者發現工作的樂趣和意義；也透過服務對象和服務提供者的間的回饋，使更多專業人員願意投入心力，不斷致力於提供更有品質的服務。

To ensure the highest possible level of care for the aging individuals it shelters, Tainan Education and Nursing Institution (“TENI” hereafter) recently reviewed of the efficacy of its education/training-based services and consequently began to implement appropriate changes. Starting in 2007, TENI established a series of day-time leisure activities for aging people with intellectual disabilities with the aim of replacing past education/training programs. In this study, the content, and the implementation, of the leisure activities provided for the sheltered individuals are examined. The aim of this study is to discuss this important topic and suggest how similar institutions could enhance their programming by changing, or adapting, the services they provide for aging people with intellectual disabilities. The purposes of this study are thus to: (1) understand the content of the leisure activities provided for aging people with intellectual disabilities in TENI, (2) analyze the implementation of these activities, (3) discuss the experiences of the subjects’ participation in the activities, and (4) provide suggestions for similar institutions for providing leisure activities for aging people with intellectual disabilities. Adopting an in-depth interview methodology, six service-providers in TENI who lead leisure activities and provide care were interviewed, along with six individuals who are sheltered by TENI. The service-receivers chosen to be interviewed had a higher cognitive ability and were more capable of verbal expression than the average TENI service-receiver. These interviews served to gather information regarding both the service-providers’ observations and the experiences of the service-receivers. The findings are as follows: (1) In terms of the planning and implementation of leisure activities: The arrangement of activities is still based on the past practice of offering artistic courses, and that this process often neglects the service-receivers’ individual interests and needs. Arranging leisure activities based on the work hours has resulted in a lack of planning leisure activities during evenings and holidays. Restrictions due to safety concerns also limit the range of activities provided. Although the important role fitness activities play in the service-receivers’ lives and well-being is understood, TENI’s fitness activities still lack purposive integration and planning. The arrangement of certain leisure activities is still at a rather superficial level of implementation. The efforts of TENI to help the service-receivers become more involved in their community also face structural restrictions such as manpower and safety.(2) In terms of the service-receivers’ participation and their experience of the leisure activities: In their leisure-related willingness and process, the service-receivers have different levels of freedom-to-choose and enjoy the experience of independent decision. The leisure activities are designed to increase the frequency of interpersonal activities and improve their sense of orientation and connection in the service-receivers’ daily routines. Listening to the radio is a leisure activity popular among the service-receivers and also functions as an important “companion.”(3) In terms of the institution’s culture and environment: The safety of TENI’s service-receivers, while engaged in daily routines and leisure activities, is an overriding concern. Safety-related demands may affect the service-providers’ attitude toward their implementation of leisure activities as well as the quality of the service-receivers’ participation in leisure activities. The efforts of the service-providers to create a conducive atmosphere and an engaging spatial arrangement for an activity improve the quality and level of the service-receivers’ participation. TENI is fortunate to have excellent facilities for meeting the leisure and nursing needs of aging individuals. With a well-designed program that utilizes these resources, TENI can establish a leisure/nursing model, based on local characteristics, that provides advantageous physical, mental and emotional stimulation. A few suggestions were derived from the findings: (1) Design leisure activities of different levels of difficulty based on service-receivers’ individual fitness and needs, and ensure that the requisite staffing is provided to implement the activity. (2) By appropriately adjusting the schedules or staffing, establish a discussion mechanism among activity-leaders in order to instantly review service-receivers’ participation and improve the process and implementation of activities. (3) Establish a standardized recording system for activity and relevant services monitoring and use it as reference for planning services. (4) Incorporate service-receivers’ context of life and local culture in the design of leisure activities. (5) Provide a recognized process by which service-receivers leisure requests are integrated with a dedicated team providers’ professional opinions on how leisure activities should be planned, designed, and implemented in order to improve the quality of service- receivers’ participation.(6) Help service-providers discover the fun, meaning and rewards of their work through team dialogue and professional development seminars, encourage more professionals to get involved, and constantly strive to provide better services through ongoing service-receiver/provider feedback.