在地老化-社區老人照護資源整合方案研究-以台北市為例

Abstract

人口老化是21世紀以來各國政府面臨的棘手問題，老人照顧成了各國政府亟待解決的課題。 我國老年人口比例將於2018年超過 14％，進入「高齡（aged）社會」國家之列，預估到了2061年我國高齡人口比例預計達38.8%，超過久居世界第一高齡國家的日本，成為世界高齡人口比例最高的國家，這是全人類史上不曾經歷過的挑戰與威脅，無論是政府或國人絕不能忽視老人照護政策的重要與急迫性。 雖然政府已警覺問題嚴重性，也提出相關的政策因應，但從整體需求來看，過去的高齡政策主要聚焦在弱勢失能老人的照顧，試圖用社會福利手段來解決高齡社會的問題，但高齡人口多數是處於健康、亞健康狀況，推動「全人全照顧體系」必須是未來翻轉政策的重要軸心。 本研究係從歐美日等先進國家的長照發展、制度改革，以及檢視國內在長照政策及法規、執行的盲點與缺失兩個面向進行比較、探討，試圖就國內人口老化可能衍伸對國家社會、經濟、勞動力的問題，做全盤性的考量，並建議政府應更宏觀的提出高齡者全人照顧的機制，修改現有的法制，確立永續的長照財源制度，整合政府與民間的資源。 本研究發現目前國內不論政府或民間，仍有相當多的閒置資源可以整合應用在未來在地化-社區老人照護政策的推動，甚至不需要以增稅或徵收保險費方式，就可以擴大服務的層面，更可以讓受照護的老人不必離開原本熟悉的生活圈，透過整合運用社區資源，從健康、參與及安全三大面向，建構完善的高齡者全照顧系統，提升高齡者之生活品質，真正達到世界衛生組織所提倡「活躍老化」 （active ageing）、「在地老化」(aging in place) 的政策架構，也期待有識之士能繼續深入研究，為我國長期照顧機制的完整性貢獻心力，共同努力為國內高齡者營造一個活力、健康、友善、參與的「全人照護」環境，早日達成「在地老化」、「社區式照護服務」、「活力老化」的終極目標。

Aging population is a worldwide phenomenon since 21th century. Elder- care has be-come one of the crucial issues to be tackled by governments. Taiwan elderly population is going to exceed 14% in 2018 and enter into an aged socie-ty. It is expected to be accounted for 38.8% of total Taiwan population in 2061, mean-while Taiwan surpass Japan to be the country that has the highest elderly portion of total population in the world. Such a high elderly population is a threat and challenge which human being have never experienced before. Neither Taiwan government nor citizens should ignore the importance and urgency of the elder-care policy movement. Though the Taiwan government has noticed the seriousness of this issue and proposed relevant responsive policies. Those policies focused on underprivileged and disabled el-derly taking-care of through social welfare means. However, from a broad need-fulfillment perspective, actuating an “Omni humanity care system for the elderly popula-tion' must be the core of elder-care policies for Taiwan as majority Taiwan elderly popu-lation are and will be in a healthy or at least sub-healthy condition. This survey is leading us to build a sustainable financial mechanism to back up long term care system, as well as to establish an “Omni humanity care system for the elderly popu-lation”. Three steps to come out those suggestions on the matter to Taiwan government to think macro. First of all, to explore ahead the possible impacts on Taiwan society, economy and labor force resulted from aging population. Learnt from developed coun-tries like Europe, America and Japan whose long term care development and system evolutions and also make various comparisons. On the other hand, revisit Taiwan exist-ing long term care policies/ regulations and executions, to find out our blind spots and defects. This survey also finds out there are lots of idle resources either owned by Taiwan gov-ernment or by the general public which can be leveraged to roll out Taiwan elder- care policy. By society resource integrations, focus on improving their living quality in as-pects of health, activities participation and security. We can take care of more elderly population w/o extra tax levy or social insurance premium levy. In addition, enable el-derly population to be taken care of w/o leaving their used living environment. As a re-sult, establishing a comprehensive ”Omni humanity care system for the elderly popula-tion” and achieving an “active aging” and “aging in place” level advocated by WHO. Moreover, expect more capable persons who could continue this studying of topic and dedicate to robust Taiwan long term care system. Work together to build and shape an energetic, healthy, friendly, participating “Omni humanity care environment” in order to achieve the final goals of “aging in place” , “Community Care” and “active aging” in early.