| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 91 === This study explores the question why home care system in Taipei City is what it is now. The focus is the shifts of knowledge paradigms in the formation of home care policies. The study seeks to generate interpretation by connecting the participant’s micro experiences with macro social context.
The theoretical perspective adopted in this study is informed by Michel Foucault’s genealogy and Nancy Fraser’s politics of need interpretation. Foucauldian genealogy provides ‘the history of the present’ as the starting point, while the politics of need interpretation provides a detailed research framework. In-depth interview and document review methods were used to collect data. Thirteen interviewees located the different positions of the home care system in Taipei City are involved in the study. Discourse analysis method was adopted for data analysis.
The study shows home care discourse in Taipei City has been through three stages. Basically, the needs to care for the elderly were denied under the familial discourse, which defines the responsibility to care for elderly people as that of the family. In the early 80s, a group of public social workers initiated the first home care program by framing the home care program as an advanced one adopted among Western countries. Although the recipients were limited to the poor, family-less and disabled elderly, it is the first community-based program supported by the state, in which women’s caring work was paid. In the late 80s and early 90s, the home care program was reframed by the privatization discourse. The program was contracted out to voluntary groups, in which the government became planner, contractor and monitor while voluntary groups became service providers. Systems of classification were booming to meet the urge to ensure accountability for public funding. Case management was a privileged discourse to provide the rationale for the daily action of professional workers. A series of public incidents threatened the legitimacy of the government, which forced the government to expand the scope of home care recipients. In the early 2000s, home care was reframed by the Central government as a solution to the rising unemployment rate, and put a lots money and resource to expand the home care market. Home care was reframed as an industry, which should be driven by the force of market and profits. Such reframing enables the government to reduce its role of care responsibility to push the disabled need back into the family and the market.
The history of home care in Taipei is a story of struggles over distribution of the caring responsibility between the private and the public. Under the tide of neo-liberalism, the government seeks to reduce its role in redistribution of resources and reinforce the social relations based on class and gender by emphasizing on the importance of competition, efficiency, and efficacy to re-privatize the caring responsibility for aged peoples.
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