台灣地區老人長期照顧、養護及安養機構收案決策之相關因素探討

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Title:	台灣地區老人長期照顧、養護及安養機構收案決策之相關因素探討
Other Titles:	The study of factors related to residential admissions among elderly long-term care institutions in Taiwan
Authors:	張劭華 CHANG,SAHO-HUA
Contributors:	高廸理 Kao, Ti-Li 社會工作學系
Keywords:	老人長期照顧;養護及安養機構;收案評估;收案決策 Elderly long-term care;nursing home;admission assessment;admission decision
Date:	2018
Issue Date:	2018-11-07T04:39:04Z (UTC)
Abstract:	台灣地區老年人口數呈現逐年增加的趨勢，高齡化社會的來臨，使得老人照顧議題逐漸受到各界的關注。人的身體一旦進入老化階段，且需要被照顧時，尋求的社會福利服務，一般會優先使用社區式與居家式照顧服務，直到社區式與居家式照顧服務無法滿足其需求，進而進入機構式照顧。對於一般家庭來說，家中長輩需要機構式照顧時，會同時考量許多方面，同時機構對於有需求者，也有一套行政管理流程。機構對服務對象的收案評估，使機構能在能量方面有所掌握，使其獲得適切的照顧環境。本研究之對象以台灣地區老人福利機構為母群體，利用分層隨機抽樣抽出423家機構作為由郵寄問卷資料收集對象，最終獲得有效問卷124份。所得資料經統計分析，主要的研究發現如下：一、機構屬性：以私立；位於南部；成立未滿十年；長期照顧機構(養護型)；無特定宗教背景為主；填寫者身分則是以機構主管為多數。二、對入住者評價：對有機構式需求的服務對象進行收案評估；評估進行地點由　　評估人員至案家與服務對象至機構皆有；評估面向以健康狀況為主；主要評　　估者以機構主管為主。三、機構收案決策的考量：以機構式照顧需求程度為主要考量；決策方式由團體　　成員共同決定；團體成員中背景為護理人員者最多；決策上常見困境為機構　　無床位；決策發生問題時，主要處理方式以主管進行最後裁決；大多機構有　　提供轉介服務與建立等候機制。四、機構決策者：以機構主管為主；女性比例較高；年齡介於41至50歲為主；主要專業背景為護理；工作年資1至10年最多；以道教為主要宗教信仰。五、機構屬性與決策方式、決策過程、等候機制有關；機構最高主管專業背景與等候機制有關。六、收案考量家屬的經濟負擔能力與收案決策兩難情境「個案符合機構收案標準，但擔心服務對象及家屬無法負擔費用」有關；收案考量家屬的照顧期待與收案決策兩難情境「個案需要入住，但家屬無法配合」有關。七、機構決策者的專業背景特質與決策方式有關；機構決策者專業背景特質與評\ 估面向社會資源使用狀況有關。分析研究資料後，研究建議如下：一、對服務對象及家屬的建議家屬對機構式照顧期待避免過高或過低，並重視服務對象的意願二、對長期照顧、養護及安養機構的建議（一）建立入住前評估及收案標準（二）收案考量過程提升個案權益（三）以服務對象立場思考，建立服務對象個別化照顧三、對長照政策方面的建議（一）提高長照照顧的價值與人力投入（二）政策納入機構式照顧（三）建立整體機構收案標準制度 The elderly population has increased year over year in Taiwan. The aging society draws attention to the elderly care issue. When people are aging and need care services, they will use community-based and in-home care service until their needs cannot be satisfied. Afterward, the elders will use institutional care services. Families will consider a lot to send an elder to a long-term care facility. On the other hand, the elderly welfare facility has their admissions process to provide the elders suitable care service and nice environment.The population of this study is the elderly welfare facility in Taiwan. This study selected 423 facilities as subjects through Stratified Random sampling, and 124 valid questionnaires were returned. The main findings are as follows:I.The basic information of the facilities: mainly are private, located in Southern Taiwan, established less than 10 years, long-term care facilities (nursing home), and not favor a specific religion. Mainly are the managers of the facility to fill out the questionnaire.II.Assessment to the applicants: the facility has admission process; the location to assess the applicants includes the applicant’s house and the facility; the assessment focuses on the applicant’s health condition; the assessment usually are taken by the manager of the facility.III.The decision making of the admissions: the level of the applicant’s need of institutional care services; team members make the decision together; most of the team members’ background are nursing; the most common difficulty to make decision is the lack of beds in the facility; the manager always makes the final decision when trouble occurs; most of the facilities have the referral service and the waiting system. IV.Decision maker in the facility: mainly are the manager, female, aged between 41-50, nursing background, 1-10 years on job tenure; believing in Taoism.V.The basic information of the facility is correlated to the pattern of decision-making, the process of decision-making, and the waiting system; the background of the chief executive officer is correlated to the waiting system.VI.The family members’ financial ability is correlated to the admission decision dilemma “the applicant is qualified but the facility worries about the applicant’s financial ability;” the family members’ anticipation of the care service is correlated to the admission decision dilemma “the applicant needs institutional service, but the family member cannot cooperate with.”VII.The background of the decision maker in the facility is correlated to the pattern of decision-making; the background of the decision maker in the facility is correlated to the level of using social resources.The research suggestions are:I.Suggestions to the applicant and the family members: Family members should avoid unreasonable anticipation to the institutional care services and respect the applicant’s willing.II.Suggestions to the long-term care facility and nursing home: i.Establish the admission assessment and criterion; ii.Assure the applicant’s right during the decision-making process;iii.Provide individualized and sympathetic care service.III.Suggestions to the long-term care policy: i.Raise the value of the long-term care and input more manpower; ii.Consider the institutional care service into policy;iii.Establish the national long-term care facility admission assessment and criterion.
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