映照彩虹背後的「耆」望：探析住宿式機構長照人員對同志包容性服務之意向

Abstract

臺灣在同志權益議題上已歷經數十年的倡議，然而同志在長期照顧領域上的議題討論仍相對邊緣。隨著身體功能退化及非正式照顧資源的缺乏，老年同志可能面臨對正式照顧服務的高度依賴，例如住宿式長照服務。為了使老年同志能在住宿式長照機構內以真實身份安享晚年，提升他們對機構的信任感是一項重要課題，而第一線機構長照人員在營造友善環境上更扮演著關鍵的角色。 本研究以衍生式計畫行為理論為基礎，旨在探討機構長照人員執行同志包容性（Inclusiveness）服務的行為意向及其影響因素，包含外部因素（住民支持、家屬支持、同事支持、督導/主管支持）以及內部因素（服務信念態度、能力、權力、阻力）。本研究目的包含：（1）了解機構長照人員在執行同志包容性服務上的意向型態；（2）了解外部因素與內部因素對機構長照人員執行同志包容性服務的影響；（3）了解機構長照人員在執行同志包容性服務上的實務經驗。本研究採用量化研究方法，以自填式網路問卷作為測量工具，研究對象為全臺灣老人福利機構內的本國籍社會工作人員、護理人員與照顧服務員，採便利取樣方式，共收集到137份有效問卷。 本研究發現機構長照人員執行同志包容性服務意向可分為三種型態：「和平倡議參與」、「反歧視介入行動」及「制度環境友善設計」。在多元線性迴歸模型中，內部因素「服務信念態度」在各型態意向上皆具顯著影響力，為最重要預測因子；「能力」對「和平倡議參與」及「制度環境友善設計」具顯著影響；「權力」在「反歧視介入行動」中扮演「服務信念態度」的調節角色。外部因素因模型加入內部因素變項後而不再顯著。此外，性別、參與多元性別課程或活動經驗、機構宗教背景及意識住宿式機構存在同志住民對執行意向亦有影響。實務上僅不到10%填答者有實際行動，多執行「和平倡議參與」型態的行動，且多數填答者回應「上級態度」為影響執行包容性服務的關鍵因素。研究建議應持續提升工作者服務信念與專業能力、針對管理層規劃專門工作坊、將「一視同仁」的觀念轉化為「以個案為中心處遇」，並反思同志住民隱沒的結構性問題，以促進長照機構環境更具同志包容性。

Taiwan has advocated for sexual minorities (SMs) for decades, but their long-term care needs often go unnoticed. As physical abilities decline and informal care options de-crease, elderly SMs may rely more on formal services like residential long-term care. Promoting inclusiveness is essential to foster genuine living and build trust. Frontline care staff play a key role in creating a welcoming environment. This study, based on the Derived Theory of Planned Behavior (DTPB), investigates institutional long-term care staff's intentions to provide inclusive services for SMs and the influencing factors, including external support from residents, families, colleagues, and managers, and internal factors like beliefs, attitudes, competence, authority, and barriers. Its three goals are: (1) to identify staff intention patterns; (2) to analyze how external and internal factors affect intentions; and (3) to explore staff experiences and challenges. Us-ing a quantitative approach, data were collected via online questionnaires from 137 Tai-wanese social workers, nurses, and nurse aides in elderly welfare institutions, recruited through convenience sampling. The study found that staff in long-term institutional care aiming to provide SM-inclusive services can be categorized into three patterns: "peaceful advocacy participation," "anti-discrimination intervention actions," and "institutional environment-friendly design." In the multiple linear regression models, the internal factor "belief attitudes" significantly influenced all intention patterns and was the most important predictor. "Competence" sig-nificantly impacted "peaceful advocacy participation" and "institutional environment-friendly design." "Authority" played a moderating role for "belief attitudes" in "anti-discrimination intervention actions." External factors became non-significant after internal factor variables were included in the models. Additionally, gender, experience with gender diversity courses or activities, institutional religious background, and awareness of SMs in residential institutions also affected implementation intentions. In practice, fewer than 10% of respondents took actual action, mostly engaging in "peaceful advocacy participa-tion," and most identified "supervisor attitudes" as a key factor influencing the implemen-tation of inclusive services. The study recommends continuously strengthening workers' belief attitudes and professional competence, designing specialized training for managers, shifting the concept from "treating everyone equally" to "client-centered intervention," and addressing structural issues surrounding SMs' invisibility to foster more inclusive envi-ronments for SMs in long-term care facilities.