台北市政府去年刪減低收入戶居家服務時數的上限由每週每日四小時減為每週十二小時，刪減服務的政策執行後，弔起受託的民間機構高度反彈，因而引起政策上的爭議。本文嘗試著釐清政策爭議的焦點，並批判政策背後的殘補式思考模式及其建構過程。作者認為決策者狹隘定義居家服務為短時數服務，重蹈西方專業利益糾葛不清的專業情結，不但否定了案主需求的差異情並妨礙了護理專業進入居家服務之體系。台灣的居家服務尚處發展初期，實應避免將服務分割，政府決策者不應為了短期的節省開支而導致長期的資源浪費。歐洲國家居家服務之發展經驗顯示一個有效率又便宜的社區照顧是可能的，綜合文獻，歸納整理分析西方居家服務的發展趨勢後，提出對台北市居家服務政策之建議。本文總結認為，如果我們真的要促成台北市居家服務的突破，民間團體必需要建立足夠的社會共識和民意基礎，才能真正落實普及式褔利的理想。

　　　　　The recent decision to reduce the limit of home care service from 24 hours per week to 12 hours op week for the low-income frail elderly persons in Taipei City had caused conflicts and controversy amony the service recipients, contracted service providers experts and pubilc policy makers, the residual thinking underlying the governmetn policy is critically examined and deconstructed. It is argued that policy makers are reinforcing the unnecessary professional division between social work and nursing. and are short-sighted for short term cost saving without awareness of long term loss, The European experiences, usually based upon a universal model, provide an alternative and demonstrate that an efficient and affordable long term care system is possibly applicable. Besides, the constraints within the current home home care system of Taipei City are completely identified and the measures toward a universal home care system for Taipei City are also presented. This paper concludes with a plead that a shift from residual to unicersal mode of thinking requires efforts of coalition built among voluntary groups to form a solid political base to support a policy as such.