居家照顧服務員的給薪方式與職場身心健康： 訪談研究

Abstract

隨著人口老化，台灣正邁向超高齡社會，長期照顧服務需求急遽增加。在長照體系中，居家照顧服務員扮演至關重要的角色。然而，過去研究指出，照顧服務員的工作環境欠缺保障，常面臨職場危害，可能影響其身心健康。此外，目前居服員的聘僱與給薪方式多元，近年更出現時薪與拆帳制增加的趨勢，對居服員健康的影響尚待探究。 本研究採用質性研究方法，透過深度訪談，分析不同聘僱與給薪方式下，居家照顧服務員的工作經驗、身心健康狀況，以及薪資制度對其健康的影響。研究對象包括16位居服員，蒐集其人口特徵、工作經驗、聘僱與薪資狀況、職場危害經歷及身心健康等資料，並以內容分析法進行歸納整理。此外，亦透過焦點團體訪談4位督導，了解長照單位管理的看法與建議。 研究結果顯示，受訪居服員多為50歲以上女性，教育程度以高中職與專科為主。其投入照服工作的動機包括經濟因素、家庭因素及自我實現。目前居服員的聘僱型態以直接僱用為主，少部分為勞動合作社或個人接案形式；給薪方式則以時薪與拆帳制為主，多數受訪者選擇拆帳制，認為所得較高。 在職場危害方面，受訪者多曾經歷肌肉骨骼傷害、性騷擾及言語暴力，但向公司或督導申訴的情況不多見。整體而言，居服員的工作滿意度尚可，主要來自與服務對象的正向互動。然而，派案、轉場及職場風險等因素為其帶來身心壓力。值得注意的是，無底薪的拆帳制可能引發居服員的焦慮感，但多數受訪者因考量所得而接受此種給薪方式。 透過深入訪談與內容分析，本研究突顯現行給薪制度對居服員健康與勞動尊嚴的挑戰，強調改革薪資結構與提升職場保障的重要性，對我國長照政策發展具實務與學術貢獻。

English Abstract As Taiwan transitions into a super-aged society, the demand for long-term care services is rapidly increasing. Home care workers play a pivotal role in the long-term care system. However, previous studies have highlighted the lack of protection in their working environment, exposing them to occupational hazards that may affect their physical and mental health. Furthermore, the employment and compensation methods for home care workers are diverse, with a growing prevalence of hourly wages and revenue-sharing models in recent years. The impact of these compensation methods on the health of home care workers remains underexplored. This study adopts a qualitative research approach to analyze the work experiences, physical and mental health conditions, and the impact of compensation systems on home care workers under different employment and payment models. In-depth interviews were conducted with 16 home care workers to collect data on their demographic characteristics, work experiences, employment and compensation conditions, occupational hazard experiences, and physical and mental health. The data were analyzed using content analysis. Additionally, focus group interviews were conducted with four supervisors to gather insights into the management of long-term care units. The findings reveal that most interviewed home care workers were women aged over 50, with educational levels primarily at the high school or vocational college level. Their motivations for engaging in care work included economic needs, family responsibilities, and self-fulfillment. The majority were directly employed, while a smaller proportion worked for labor cooperatives or as freelancers. Compensation methods included hourly wages and revenue-sharing models, with many workers opting for the latter due to perceived higher income. Regarding occupational hazards, interviewees frequently reported musculoskeletal injuries, sexual harassment, and verbal abuse, although complaints to supervisors or companies were rare. Overall, job satisfaction was moderate, primarily stemming from positive interactions with care recipients. However, factors such as case assignments, transitions between locations, and workplace risks contributed to physical and mental stress. Notably, the revenue-sharing model without a base salary was found to induce anxiety among workers, yet many accepted it due to income considerations. Through in-depth interviews and content analysis, this study highlights the challenges that current pay arrangements pose to the health and labor dignity of home care workers. It underscores the importance of reforming the compensation structure and enhancing workplace protections, offering both practical and academic contributions to the development of long-term care policies in Taiwan.