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E93024
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由供需角度探索社區介入方案中居家服務模式之發展
Exploring the Development of Home Help Model in the Community-based Care from the Supply and Demand Side
1.劉立凡
1.Li-fan Liu
1.立德管理學院醫務健康照護管理學系
1.Department of Health Care Management, Leader College
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1.立德管理學院醫務健康照護管理學系
1.Department of Health Care Management, Leader College
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1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):2004-08-01
A.14 計畫執行期間(訖):2005-07-31
2004-12-012005-02-28
A.16 收到日期:2005-10-31
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抽樣調查全台南市共四家居家服務支援中心,於抽樣當時其總服務病患(家戶)為630人

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327
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C.2 聯絡日期:2005-11-02
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1.立德管理學院醫務健康照護管理學系
1.Department of Health Care Management, Leader College
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C.7 資料公開日期:2006-08-01
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1.供給與需求
2.居家服務
3.社區照護
4.適切性
1.Appropriateness
2.Community Care
3.Home Help
4.Supply and Demand
 本研究基於居家服務模式之重要性,以某城市為例進行有關居家服務模式的探究,研究目的為從供需的角度,探究目前我國居家服務模式之服務內容、適切性及使 用家戶的需求與使用感受。研究過程首先在供給面評估居家服務模式對接受者的服務內容及適切性,另在需求面了解當前此服務模式接受者及家屬對於服務模式內容 的實質需求與感受。

本研究設計為一橫斷面之探索性研究。參與本研究之居家服務支援中心共計四家(供給面),並採分層隨機抽樣法完成接受居家服務樣本數327個個案病患或病患家屬之訪談(需求面)。

本研究結果發現,接受居家服務個案基本上其失能等級均符合內政部收案相關規定,以巴式量表分數而言輕度失能有197人 (60.2%),中重度失能有65人 (19.9%),極重度失能有89人 (27.2%)。以工具性日常生活量表(IADLs)之標準,也有73.5% (輕度及中重度)個案需要協助。經調查各提供居家服務的支援中心服務人次均有增長情形,目前服務案量以非中低收入之一般戶居多,各居家服務支援中心均有此 一趨勢。在使用感受方面,有大於百分之五十的受訪者對居家服務感到滿意。唯居家服務模式的接受者在接受居家服務之初,多半仍以親友介紹(45.6%)或者 是由政府或居服機構推廣(39.7%)之被動方式居多,僅8.9%為自行打聽,因此多數接受者仍不清楚服務宗旨、內涵及服務範圍,也較難進一步要求服務內 容並積極溝通所需服務方式及改善之道。另外,依據服務對象區分亦可發現,中低收入戶老人之服務項目及內容著重於家事服務之環境整理,非中低收入戶則著重在 身體照顧服務之協助個人清潔及肢體復健;其次的服務項目則依屬性之不同而略有差異。 由資源配置角度,居家服務接受者得到的是否為適得其所的長期照護,因目前行政機制僅從其生理需求面加以評估,即所使用的巴氏量表和工具性日常生活量表,然 而實際上,即使功能殘障等級相若之兩位案家其所需服務內容也或有所差異。再者,居家服務性質上僅能協助家庭照顧者提升照護品質或補充不足之人力,並無法取 代,因此真正所需之服務項目應與照顧者充分溝通後方見其效。同時,定期評估機制的建立與落實,建議應由跨專業整合之評估小組客觀為之,將個案整體長期照護 需求納入考量, 而非僅單方面衡量其是否符合居家服務補助之收案條件。

本研究結果在供給面上由資源配置的角度,提供居家服務模式服務現況及接受居家服務個案之失能情形。在需求面藉由病患及家屬其對居家服務的實質需求心聲 和使用感受,可增加對本土化發展居家服務模式特性之瞭解。期藉供需整合資訊平台之搭建,尋求屬於我國的社區化長期照護居家服務模式,能真正深入社區並融入 需求者的家庭和社會。

This study explored the issues regarding home help program in Taiwan based on one sample city. It is aimed to explore from the supply and demand angles, to understand the service contents, its appropriateness, and the real needs and experiences perceived by the users— frail people and their families. There were four home care agencies (supply side) and 327 home service cases/families been interviewed (demand side) in this study by the stratified random sampling method.

This research found that most of the home services users match the criteria of the home services allowances of the government. In terms of the Barthal scale, there were 197 persons belonging to the level of low dependency (60.2%), 65 persons belonging to the middle/severe dependency level (19.9%) and 89人 (27.2%) belonging to the very severe dependent group. It was also found that there were 73.5% need some help in terms of their Instrumental Activities of Daily Living ( IADls ). According to the investigation, the numbers of people who applied for home services have been increased recently in almost every home service agency and the higher percentage are from the non-low income families. Furthermore, it was found that for low-income families, the home service needs are mainly focused on the items of home helps, while for the non-low income families, their main needs are around the items of physical care.

From the view of resources allocation, if the people receiving home services are appropriate is a very important issue. Since the home service regulations and allowances now mainly depends on applicants’ physical and functional disabilities, and home services model is not a proxy to the care function in households, it is not easy to decide who or which family may be more needed. It is suggested that more communication is critical between home service providers and the caregivers in households before any home services are provided to reduce the unnecessary misunderstanding and also enhance the care satisfaction. It is also important to perform the evaluation mechanism regularly by a multi-displinarily team to consider the long-term care need for a person and family as a whole but not only measure their functional status.

In summary, this study explored from the supply and demand angles, to understand the service contents, its appropriateness, and the real needs and experiences perceived by the users— frail people and their families. It is hoped that the voices of both the professionals and the users could be heard and most importantly, policy makers could be based on to develop a needs-led native home help model and also right and suitable for whom under its services.

D.16 完成檢誤日期:2006-06-13
D.17 預定釋出日期:2006-08-01
D.18 初次釋出日期:2006-08-01
D.19_1 最新版釋出日期:2006-08-01
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10.6141/TW-SRDA-E93024-1
https://efenci.srda.sinica.edu.tw/webview/index.jsp?object=https://efenci.srda.sinica.edu.tw:80/obj/fStudy/E93024
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