推開醫療機構的大門－嘉義市護醫人員居家照護經驗

This paper explores healthcare for the elderly in the context of the reproductive function of the home as well as the impact of healthcare resources going public. While the paper does not feature the elderly and home caregivers as the research subject, it constructs the picture of how healthcare resources circulate around the elderly and how community healthcare is realized in the context of home through presenting the actual work experience of the home healthcare provider.
This qualitative-oriented research adopts methods such as in-depth interview and participant observation. A small group of home healthcare nurses and house call doctors constitutes the research subject. As healthcare is closely related to the geographical context, it is essential to explore the creation and operation of the new healthcare network in order to understand how the transformation of healthcare affects the community and the home. In addition to reviewing existing literature on the supply-demand balance for both professional and amateur caregivers, this paper constructs the picture of the legal, organized caregiver working in the context of home.
The home provides a complete context, allowing the individuality and uniqueness of the patient to unfold. The home healthcare providers are given the convenience of observing the patient up-close, detecting tiny threads of clues such as the patient’s physical health as shown in the appearance, the unique means of self-treatment adopted by elder patients, the feelings of the caregiver, and the senses of weakness, anxiety, and helplessness that come along with the illness. The experience and feelings of the patient are given more consideration than before. The relationship between “the reflective professional” and “the empowered user” is realized through interaction in the context of home.

In presenting the relationship between health and the location factor, two interesting questions emerge: Who gets what? And where? It is important to highlight the absence of the public dimension. Professional home healthcare providers, the elderly, and home caregivers are situated in the bottom layer of the pyramid of policy-making, policy implementation, and the allocation of household resources. Paid home healthcare serves as an interface between the public and private domains, transforming existing arrangement of duties and costs and promoting the recognition of the fact that the home and the nation are inseparable. Through exploring how legal caregivers come to realize their roles and duties, as well as their experience and attitude toward work, the paper develops a better understanding of how policies are implemented. The focus of research shifts from the actual operation of home care, then to the conceptualization of “home health care” and “community care,” and finally to the political context of long-term healthcare.