照顧服務員的工作狀況與職業安全健康問題

Abstract

照顧服務員在長期照護體系中扮演重要角色，但所處的職場環境不佳，導致這群工作者承受龐大的身心壓力與職業傷病風險；此職業族群雖已適用《勞動基準法》，但實際運作上卻有不少問題，權益規範難以落實。本研究探究照顧服務員在勞動市場上的結構性地位，並探討照顧工作本身的特殊性以及現行組織規範等組織脈絡因素，如何影響工作者的職業傷病風險與傷病發生之後的補償救助。 本研究以深度訪談進行資料收集。訪談對象包括機構式、居家服務之照顧服務員與長期照顧相關機構之管理者。共訪談11位的照顧服務員(機構式8位，居家式3位，其中有2位為男性)，以及8位不同類型的單位管理者。錄音內容經整理歸納形成逐字稿後，進行重點摘錄，並做來回比對與分析。 研究發現分以下兩大主題呈現。首先，研究者從個人層次出發，描繪照顧服務員的工作狀況。研究者發現，照顧工作的特殊性特別對男性工作者帶來限制與挑戰；而照顧工作帶來的龐大情緒勞動、情感關係與工作家庭衝突，乃是此職業重要的社會心理健康危害。研究者也發現，居家服務員的勞動條件較機構式照顧服務員差，而各工作單位的管理制度對工作者工作狀況與職業傷病風險影響甚大。 第二部分則藉由照顧服務員的工作經驗，歸納出此職業族群主要的職業傷病風險。包括：體力負荷造成的肌肉骨骼傷害、社會心理危害造成的身心壓力疾病、生物性危害帶來的感染性疾病風險，通勤與其他事故災害,並進一步探討發生職災之後的補償救助機制，以及上游的職業傷病預防機制。研究發現，職災者是否取得適當的補償救助，與工作單位的管理制度有密切關連；但在預防層次，政策設計所產生的制度性排除，使得照顧服務員全面性缺乏職業安全健康保障。 研究者認為，欲建立良好的長期照護體系，必然不能忽視照顧服務員的勞動條件與職業安全健康。從職業傷病風險的預防，到職災發生後的後續協助，皆有賴相關政策與機構管理制度的建制與改革。

Health care aides play an important role in the long-term care system. However, their work conditions are usually poor and occupational health problems are common. Despite of being covered by the Labor Standards Act, health care aides still face many difficulties. This research was designed to understand the position of health care aides in the labor market and the social context in which occupational health problems occur and are responded by different actors In-depth interviews were conducted with 12 health care aides (including 9 in facilities and 3 home care aides) and 8 managing staffs in long-term care facilities. Voice records were transformed into transcripts and used to analysis. The results are presented in two parts. In part one, the researcher described the working conditions of health care aides. It was found that the nature of care work brings restrictions but also challenges to male workers. Enormous emotional demands, intertwining social relationship and work-family conflict are important psychosocial hazards at work. As compared to health care aides working in institutes, those who worked at clients’ private residences had less favorable working conditions. It was also found that managerial practices had a great impact on working conditions and occupational health risks of these workers. In part two, major occupational health problems were summarized, which included musculoskeletal disorders caused by heavy physical workloads, psychosomatic complaints caused by psychosocial hazards, infectious diseases caused by biological hazards, and traffic-related injuries in commuting. The functions of workers’ compensation mechanisms as well as existing prevention mechanisms were also examined. The results indicated that the ways the injured workers were treated were closely related to the work organizations. Due to the inappropriate design of occupational health policies, health care aides lack of occupational health and safety protection. To establish a well-functioning long-term care system, we should not ignore the importance of working conditions and occupational health risks of health care aides. Prevention and compensation systems should be improved to safeguard the health of health care aides.