以裁量權與自主性觀點探討偏遠地區長期照顧管理工作之困境

Discretion and Autonomy in Remote Areas: The Case of Care Managers in Isolated Island and Mountain Area

因應我國高齡化及失能人口增加的長期照護需求，政府核定「我國長期照顧十年計畫」，由當時的衛生署協同內政部與各縣市政府，自2008 年起推動長照計畫，輔導22 縣市設置長期照顧管理中心，作為整合社、衛政長照服務資源，作為受理及連結、輸送長照服務的單一窗口，由該中心的照顧管理專員提供民眾需求評估，並協助連結或轉介所需長照相關資源。由此可知，照顧管理專員除了扮演失能評估的功能外，在服務輸送執行過程扮演關鍵樞紐角色。本研究目的在於從裁量權與自主性觀點分析偏遠地區的照顧管理專員在執行照顧管理工作過程的困境。研究方法除了文獻資料蒐集與量化背景資料分析外，主要透過訪談金門、馬祖與澎湖三個離島與花蓮與臺東山地的照顧管理專員，瞭解其在照管工作執行過程中，在面對資源限制與工作環境下，如何裁量民眾的服務需求，與自主進行資源整合與管理。

In response to the increased long-term care needs of aging and disabled populations, Taiwan’s 10-year long-term care plan was approved by the Department of Health together with county and city governments in 2008. The 10-year plan assists cities and counties with setting up long-term care-management centers and provides service resources, such as the integration of social and health administration and a single-service window for reception. Care managers are involved in evaluating disability, and they also play a key role in implementing the service delivery process.
This study examines the current situation and found that care managers focus on workload, professional initiative, and personality or staffing issues and pay less attention to work discretion and autonomy in long-term care policy and public service. The barriers posed by the geographical environment result in a lack of resources for the outlying islands, which causes care managers to face more difficult working conditions in implementing and promoting public policy. The purpose of this study was to analyze the processes of care managers in these outlying islands regarding policy implementation, discretion, and autonomy. In addition to a literature review and an analysis of quantitative background information, the research method primarily involved interviews with care managers in those remoteareas. The interviews gathered data on the process of policy implementation in the face of resource constraints and difficult working environments, how discretion and autonomy identify public demand for services,