台灣社區居住服務的發展與挑戰

台灣社區居住服務的發展與挑戰
從 CRPD 檢視台灣身心障礙者居住權與生活品質國際研討會 September 30-October 1, 2015 Supporting Good Life in the Community for People with Disability 支持障礙者在社區過個好生活 Community Living in Taiwan: Development and Challenges 台灣社區居住方案的發展與挑戰 • 臺灣社區居住與獨立生活聯盟 /Taiwan Community Living Consortium (TCLC) • 網站 /website:http://www.communityliving.org.tw • 研究者 / 報告者：周月清 • Presented by Chou, Yueh-Ching (choucyc@ym.edu.tw) 1
聯合國身心障礙者權利公約 (CRPD) 第 19 條獨立生活和融入社區 • 本公約締約各國確認，所有身心障礙者有在社區中生活的平等權利以及與其他人同等的選擇，應當採取有效和適當的措施，以便於身心障礙者充分擁有這項權利，充分融入和參與社區，包括確保：（一）身心障礙者有機會在與其他人平等的基礎上選擇居住地點，選擇在那裡及與那些人一起生活，而不是被迫按特定的居住安排來生活。（二）身心障礙者獲得各種居家、住所和其他社區支持服務，包括必要的個人助理，協助他們在社區生活和融入社區，避免與社區隔絕或隔離。（三）身心障礙者可以在平等基礎上使用為大眾提供的社區服務和設施，且這些服務和設施符合他們的需要。 2
Article 19, CRPD: Living independently and being included in the community • States: recognize the equal right of all persons with disabilities (PWD) to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by PWD of this right and their full inclusion and participation in the community, including by ensuring that: • a) PWD have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement; • b) PWD have access to a range of in-home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community; • c) Community services and facilities for the general population are available on an equal basis to PWD and are responsive to their needs. 3
台灣心智障礙者居住服務類型 Types of residential services for people with ID in Taiwan 機構式 Institutional 全日型住宿照顧機構 24 hrs Institution (7->201 beds) 小型： 7 ～ 29 人中型： 30 ～ 200 人大型： 201 人以上 Small:7-29 beds Medium:30-200 beds Big: >201 beds 方案式 Program 夜間式住宿機構 Evening Hostel (7-200 beds)小型： 7 ～ 29 人中型： 30 ～ 200 人 Small:7-29 beds Medium: 30-200 beds 社區居住 Community living 6 人以下 1-6 beds 4 居住服務 /Residential services
台灣身心障礙福利機構 (# of institutions for PWD in Taiwan) 提供夜間住宿或全日型的服務機構 • 小型 (29 人以下 )=32 家 • 中型 (30~200 人 )=115 家 • 大型 (201 人以上 )=11 家 Hostel for evening and institution for 24 hrs •“small” <29 beds: 32 units •“medium” 30-200 beds: 115 units: •“big” >201 beds: 11 units 5
社區居住與生活的定義 Def. of Community living 社區 (Community) • 和一般人一樣的地點 • 居住房舍是一般住家 • 生活機能都在社區中 • 和一般家戶人口數一樣，少於六人 • Community – Living in the community as others, – Ordinary flat/housing, – Daily life in the community, – flat mates <6 due to household family members <6 persons in Taiwan (usually) 生活 (Living) • 日夜是區隔的 • 自主的日常生活 • 正常的生命節奏 • 包含休閒與社交 • Living – Daily and evening life separated – Self control own daily life, life style, – Involved in recreation and social activities 6
社區居住服務規定 • 服務對象：十八歲以上身心障礙者 • 專業服務團隊：督導、社工及教保員；每位教保員服務之居住單位最多以二個為限身心障礙者個人照顧服務辦法 7
• 合法住宅使用建築物 • 每一居住單位服務不超過六人 • 平均每人使用樓地板面積不得少於 16.5 平方公尺 • 應有獨立出入口 • 建築物應投保公共意外責任險 ( 依機構投保公共意外責任保險規定 ) • 不得兼辦社區式日間照顧服務。身心障礙者個人照顧服務辦法8
Regulations of community living services Based on Personal Care Service Regulation (Disability Rights Act) • Users: >18 years old with disability • Team members providing services: supervisor, social worker, care workers (care workers working for less than 2 units) • Legal housing • Each unit less than 6 residents • Each resident has to have 16.5 m2 • With individual/certain door use for entrance and exit • Housing insurance available • Only for residential service use—cannot also use for daycare (two services provided in the same unit) 9
現況 10
Community Living Services (CLS) Current Development • Launched in end of 2004 • 18 local authorities (county/city) provide such CL service (22 local authorities in Taiwan) • 100 units and 400 users/residents –in Taiwan, the users/residents do not own the flat, they need to pay rent through the providers(NGOs) • Who are the Qualified users? –>18 ys with ID/autism/mental difficulty, or multiple disability in addition ID 11
四種補助型態 • 衛福部方案 • 縣市自方案：辦如台北市、桃園市、新竹市、台中市、台南市、高雄市 • 衛福部方案 + 縣市部分補助：如苗栗縣、台中市、南投縣、台東縣 • 機構自辦 12
Four different types of the CLS • Funded by central government: • Funded by the local authority: 6 local authorities (Taipei City,Tauyen City, Hsinchu City, Taichung, Tainan City, Kaushung City) • Both ways: 4 local authorities • NGOs/providers: without funding from government 13
運作經費 • 一個社區居住單位的運作成本約 70 萬到 120 萬 / 年 • 機構每年約須自籌 20 萬到 100 萬 14
Cost of CLS provided • One unit one year: NT$ 700,000- 1,200,000 (20,000- 35,000 Euros) (e.g. YM Institution 1 person 1 year: NT$830,000/23,000 euros) • Gap between the cost and funding from the Governmental:NT$200,000- 1000,000 (7000-30,000 Euros): Providers deal with the shortage of budget themselves 15
服務發展的困境 • 經費補助不足，機構難以永續經營 • 人員召募不易 • 不理解社區居住理念 16
Difficulties of CLS development • Financial: shortage of funding, no future, • Staff recruitment: shortage of service workers working in the evening/overnight, staying with the residents • The philosophy/principles/values of the independent living: misunderstood or cannot be supported by the service workers, managers or providers, even the parents and policy makers 17
租屋面對的困難 • 排斥身障者承租 • 完全合法的住宅難找 • 都會與偏鄉的差異 • 社區管委會的影響 • 房東主要為投資獲利，租屋為過渡期 • 住宅法排除法人承租社會住宅資格 18
Difficulty: Flat/house rent in the community • PWD not welcomed/discriminated • Available housing/flats in the community difficult meet the regulation • Gap between urban and rural area(e.g., attitudes from the owners, neighborhood) • The attitudes from the Community/council: “not in my backyard” ?) • The owner only for benefit, the rent period time for short-term • Housing Act in Taiwan: NGOs not qualified for renting social housing 19
社區居住單位歷年調查統計 Number of units of CLS in Taiwan 20
…但是 • 社區居住服務發展 10 年，服務人數僅 400 多人 • 住宿機構 2008 年 150 家， 2014 年成長至 165 家！ • 2009 年身心障礙者生活狀況及各項需求評估調查報告，總計 7 萬 3,994 人住在機構，占身障人口 6.82% ，意即有 92.84% 是居住在「家宅」。 21
CLS seems growing, BUT • Since 2004, 10 years after, all users are only 400 (0.03% of all population with disability) (movement since 2001) • Number of institutions maintain growing, eg., 150 institutions in 2008, 165 in 2014 • 73,994 PWD living in the institution (6.8% of all population with disability vs 92.8% living with family) (source: 2009 disability survey data) 22
2014 社區居住服務使用者問卷調查 2014 Census survey—users of CLS and their parents • Questionnaires: standardized and open-ended questions • Participants: 421 residents from 89 units provide by 44 providers/NGOs • Completed the interview: – 298 residents with ID (17 out of them with MD) (response rate 71.3%) – 169 parents of the residents 23
分析結果 Results 住民 Chapter 1: Residents 24
入住社區前住哪 ? where did you live before moving in here? 25
入住社區後的改變 ? Comparing with previous, what do you feel after you live here? 26
對目前這種居住安排，還有甚麼心得想跟大家分享？您 What do you feel now you live here? • 住得很開心要再住 • 住這裡很好很快樂 • 可以讓家人更放心，然後讓自己更獨立 • 聽到室友聊天會很開心 • 很快樂 , 有老師有宿友做伴 • 有老師鼓勵 • 有人可以互相幫助 • 像自己的家 • Happy, want to continue to live here • Live here is very good and happy • My family feel relieved, I become more independent • Listen to roommates’ chatting, feel happy • Very happy, have teacher and roommates being companions • Having teacher’s support • have some one to help, help one another • Here like my own home 27
• 學習很多不同生活技能，與外面很多朋友交談 • 住這裡有家的感覺，讓我很自由，很快樂 • 1. 有網路 2. 可以安排報名馬拉松 3. 可以晚睡 • 很自由，很快樂，跟喜歡的室友同住 • 很像一家人 • 可以自由進出 • 感覺很幸福 • 想買手機 • 可以交到好朋友 • 住這裡很好、我很喜歡、要繼續住 • Learn many social skills and make many friends in the community • Feel like home, very free, happy • Have internet, can attend marathon, can go to bed late • Very free, happy, like to live with roommates • We are like a family • Have freedom for going out and in • Feel luckily, happy • Want to buy cell phone • Can have good friends • Live here very good, I like it 28
• 住的好、買東西方便、爸爸可以常到家園看我 • 朋友互相照顧很好 • 有自己的房間很好 • 我喜歡自己照顧自己，學會煮菜技術回家也煮給阿嬤吃 • 可以做自己、很快樂 • 我要住在 OO 家，不要回教養院 • 很快樂可以自己洗衣煮飯 • 住這裡很自由，可以吃到自己煮的菜 • 可以選擇自己要看的電視 • Convenient for shopping, my father can often come to visit me • Friends care for one another • Have own bed room is good • I like to take care of myself, learn how to cook, I can cook for my grandmother when I go home • Can be myself, very happy • I will live here, I do want to move back to OO institution • Very happy and I can do laundry and cook for myself • Very free, I can eat food that I cook myself • I can choose the TV programs that I like to see 29
你未來是否想買房子 ? In the future do you want to buy a flat for yourself? 2014 年社區居住服務使用者問卷調查 30
是否聽過聯合國身心障礙者權利公約 Have you heard the UNCRPD? 31
您同意智障者有權利選擇住在哪裡？ Do you agree people with ID have rights to choose where she/he likes to live, as other people? 32
您同意智障者有權利選擇和誰同住嗎？ Do you agree that people with ID have rights to chose whom she/he likes to live with, as other people? 33
你對住在現在的居住服務單位，會有甚麼意見或改善之處？要給服務提供者、工作者或政府？ Do you have any suggestions given to the practitioners, managers or government? • 有電腦、液晶電視、 PS4 • 想要游泳、想要裝冷氣 • 想要彈琴 • 喝咖啡 • 想在家唱卡拉 OK • 做烘培粿子 • 獲得更多的自由 • 一人一間 • 給我有隱私權 • Have computer, TV, PS4 • Go swimming, have air conditioner • Play piano • Drink coffee • Karaoke • Make cake • More freedom • Have own bedroom • Have privacy 34
• 自己的錢可以保管 • 空間大一點 • 多睡一點 • 運動多一點 • 跟社工姊、生輔姊跟家人有個良好的溝通 • 好一點的隔音設備 • 住久了想回家一個人住 • 喜歡住在大樓有電梯 • 還是喜歡和家人住 • Manage money by myself • More space • Sleep more • More exercise • Good communication with workers and family • Quiet place • Live alone • Accommodation with elevator • Like to live with family 35
• 希望有結婚的社區居住 • 沒有時間上控制，有自由的空間 • 希望房子新一點 • 希望有工作機會、賺更多錢 • 希望可以獨立生活 • 零用錢自己保管 • 多舉辦活動 • 房租比較高，就沒辦法住 • CLS available for married couple • Having free time • Accommodation can be renovated/new condition • Have paid work and make more money • Rent can be cheaper 36
37 家長 Chapter 2: Parents
您覺得ＯＯ接受社區居住服務後，最明顯的改變是？ After ＯＯ uses CLS, what do you think she/he has changed most obviously? 38
您支持ＯＯ自主決定日常生活怎麼過嗎？ Do you support that ＯＯ is able to make her/his own decision in her/his daily life? 39
建議 • 搭配「負擔得起」的社會住宅等措施，障礙者才有邁向更獨立生活的可能 • 以多元化居住服務模式推動，才能更符合 CRPD 居住權的精神 • 住民 / 服務使用者，所有障礙者包括心智障礙者，以及家長有權利知道聯合國 CRPD 及國內施行法已經通過 • 資訊獲知的權利 , 包括 CRPT • 重視心智障礙者居住權、在社區過好生活的權利 40
Implications • In order to support this group of people having good life (self control, dignity, freedom, higher quality of life, etc.) in the community, and meet the requirement of Article 19 of the CRPD – Affordable housing, e.g., social housing, provided – Government stable funding support – Individual and group advocacy services provided: rights for housing, rights for life, information accessibility including 41
願每位台灣公民都擁有一個家 Everyone has the right to have a home 並成為社區好厝邊 and a full life in the community 臺灣社區居住與獨立生活聯盟 42
相關參考書目 References • 相關中文資料詳見住盟網站： website:http://www.communityliving.org.tw • Chou, Yueh-Ching, Pu, Cheng-yun, Kröger, Teppo, Lee, Wan- ping & Chang, Shu-chuan (2011). Outcomes of a new residential scheme for adults with intellectual disabilities in Taiwan: A two- year follow-up. Journal of Intellectual Disability Research (JIDR), 55, 823-831. • Chou, Yueh-Ching, Kröger, Teppo & Lee, Yue-Chune (2010). Predictors of job satisfaction among staff in residential settings for persons with intellectual disabilities: a comparison between three residential models. Journal of Applied Research in Intellectual Disabilities, 23, 279-289. • Chou, Yueh-Ching, Lin, Li-Chan, Pu, Cheng-yun, Lee, Wan-ping & Chang, Shu-chuan (2008). Outcomes and Costs of Residential Services for Adults with Intellectual Disabilities in Taiwan: a Comparative Evaluation. Journal of Applied Research in Intellectual Disabilities (JARID), 21, 114-125. 43

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