失智老人家庭雇用外籍看護工之經驗

Abstract

背景 家人提供的非正式照顧，一向是長期照顧的主力。隨著家庭結構改變與婦女就業提高等因素影響之下，導致家庭莫大的照顧負荷與壓力。尤其當個案被確診為失智症後，其存活年限仍長。且失智未必失能，對照顧者而言，是個極度耗費心力的工作。雇用外籍看護工以滿足家庭需求成為國內長照體系之趨勢。 目的 說明失智家庭尋求正式資源之動機與其需求；探討失智家庭取得資訊的管道來源，以及各類長照服務的比較與考量；分析失智家庭在決策過程中如何取得共識；了解家庭實際使用後的感受。 方法 本計畫為質性研究，欲理解失智家庭的認知與想法，以及經歷的真實情境。利用滾雪球抽樣，透過介紹以選取符合研究條件之個案。並且使用半結構式訪談為研究者事先建立訪談摘要，於訪談過程中，依照實際情況做彈性調整。 重要結果 失智症發病呈現出的兩大特性「難以判定」與「循序漸進」影響到正式服務介入的時間點。失智家庭雇用外籍看護工背後所引發的需求包含學習處理失智與失能問題技巧、心理支持、24小時且一對一照顧方式的期待，並且讓個案與家屬之間的家庭關係能夠繼續維持。影響失智家庭選擇長照服務的因素包含資訊的取得、機構形象、即時回應性的安全感、價格、人籍不一等。家庭決策身分主要可分為配偶決策、主要子女決策以及家庭共同決策。主要照顧者與家庭對於失智個案的照顧期待為雇用居家外籍看護工。相較於失能家庭，經濟考量並非失智家庭考量的重要因素。共識過程中難免會遭遇一些掙扎，尤其以配偶照顧者呈現出較多的掙扎情緒，缺乏對外籍看護工的信任，但因意識到自己的照顧能力有限，最終並不影響雇用外籍看護工的決定。家庭在雇用過程中遭遇過外籍看護工語言不通、逃跑、偷竊、虐待、無法適應、無照顧老人之經驗、配合度低等種種問題，不過絕大多數的家庭對於外籍看護工照顧工作上的貢獻給予正面評價，其肯定意義已超越負面的經歷，亦不影響家庭繼續雇用外籍看護工的決定。

Background Informal care giving provided by the family has always been the main resources in the long-term care systems. The influence of the changes in family structure and improvement of the women employment, and other factors, lead to a great load and pressure of the family taking care of the elders, especially when the cases were diagnosed with dementia. Dementia may not be physically disabled, it could lead to caregivers' emotional exhaustion. Hiring foreign caregivers become the trend of the long-term care system in Taiwan foreign caregivers into their families. Objectives The purpose of the study is to explore the experiences of Taiwanese family in hiring foreign caregivers and the factors and considerations related to the process. Method This project is a qualitative study aiming to understand the different family roles of the experience of Taiwan hiring foreign caregivers. Using Snowball Sampling, families which had the experience of employing family caregivers for over three months will be interviewed. Semi-structured guides will be used. Findings Familyies' experiences regarding the process of hiring a foreign caregiver for taking care of Demented caregivers showed two major characteristics: 'difficult to determine' and 'subtle changes overtime ' which may delay the time of using formal service. Dementia families employ foreign caregivers on the underlying needs for families with demented older adults included skills for managing dementia and disability related problems , psychological support, expectations of 24 hour availability and one to one care style , and maintain the relationship between the families and the demented elders. Factors affecting dementia families to choose long term care services including information channels, the images of institutional care , the availability of instant response to needs, price, and autonomy of the elderly. The key person of family decision making process can be divided into spouses, one key person among children, and family decision-making. The main caregivers' expectation and the families' expectation toward taking care of their demented older parents are the main factors for the family to decide to hire a foreign caregiver at home. Unlike families taking care of physically disabled older adults, the financial concerns seemed not to be the main factor for families with demented older adults to hire foreign caregivers. The spouse caregivers revealed more emotional struggle during this process for not trusting foreign caregivers. However, knowing that their limited ability to take care of their demented spouse, it does not affect the decision to hire foreign caregivers ultimately, and family may take some risk management strategies, such as adding surveillant camara. Treating the foreign caregivers like family is another common strategy for family with demented caregivers, in the hope that the foreign caregivers will treat their demented older adults like family memebers. Although families have encountered negative experiences during the hiring process of theirs, such as language barrier, escape, theft, abuse, unable to adapt, no experience in caring for the elderly and with low degree of problems, the majority of these families give positive feedback about their contribution to taking care of their demented elders. Having a foreign caregiver at home certainly has its significance and value beyond the negative experiences without influencing the family to keep employing foreign caregivers.