专业的悖论:长护险居家护理服务的建制民族志研究

The Paradox of Professionalization:An Institutional Ethnography of Home-Based Long-Term Care Insurance Services

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摘要随着老龄化程度的加深和家庭照料模式的变迁,长期护理保险制度应运而生。本研究基于建制民族志的方法,揭示了长护险居家护理服务中专业制度与生活情境的持续拉扯。首先,长护险居家护理服务依赖大量“照护零工”,岗前培训与证照制度将家庭照料者转变为专业的护理人员,建立起标准化的操作实践和知识体系。其次,服务表单作为普遍化的制度文本形塑了分散在各个私人家庭中的照护工作,智慧管理平台、现场稽查及相应的奖惩措施则保证了制度文本的严格执行。其中,服务项目的限定成为长护险服务区别于一般家政劳动、确立自身专业管辖权的重要手段,但也造成了护理员的困扰和不满。他们往往通过工时之外的无偿劳动满足服务对象的需求,形成非正式的照护联结。护理员以自身的道德能动性弥补了制度文本与照护现实之间的断裂,也为改善服务、优化政策提供了新的思路。 With the deepening of population aging and the transformation of traditional family caregiving models,the Long-Term Care Insurance(LTCI)system has emerged as a response to increasing care needs.This study,grounded in institutional ethnography,explores the ongoing tension between professional care systems and the lived realities of home-based care under LTCI.Firstly,LTCI home care services rely heavily on a large number of"care gig workers".Pre-service training and certification systems have transformed informal family caregivers into professional care workers,establishing standardized practices and bodies of knowledge.Secondly,service registering forms function as institutional texts that shape caregiving tasks scattered across private households.Smart management plaforms,on-site inspections,and corresponding reward and penalty mechanisms ensure the strict implementation of these texts.The delimitation of service items is key to differentiating LTCI services from general domestic labor and asserting a distinct professional jurisdiction.However,this also leads to frustration among care workers,who often meet clients'needs through unpaid labor beyond their contracted hours,thus forming informal care bonds.Through their moral agency,care workers bridge the gap between institutional texts and the realities of caregiving,offering new perspectives for improving service delivery and optimizing policy.

作者吴心越 WU Xin-yue(School of Humanities,Southeast University,Nanjing 211189,Jiangsu Province,China)

机构地区东南大学人文学院

出处《妇女研究论丛》北大核心 2025年第3期71-83,共13页 Journal of Chinese Women's Studies

基金国家社会科学基金青年项目“失智症长期照护的人类学研究”(项目编号:21CSH027)的阶段性成果。

关键词长期护理保险居家护理服务建制民族志专业主义 long-term care insurance home-based care services institutional ethnography professionalization

分类号 C913.2 [经济管理]

作者简介吴心越(1988-),女,东南大学人文学院博士后。研究方向:老龄化与照料劳动。