原住民部落長期照護資源使用障礙評估——以花東新村為例

Barriers to Access to Long-term Care Services among Aboriginal Communities: the Example ofHua-Tung Village

本研究目的包括（1）描述原住民部落老人及失能者健康狀況。（2）瞭解原住民部落目前使用長照資源現況。（3）探討原住民部落長照資源使用障礙因素。研究設計採橫斷面訪談調查，母群體為65歲以上和 領有殘障手冊之原住民及其主要照顧者，立意選取汐止花東新村為調查地區，共完訪67位。研究結果顯示原住民老人及失能者教育程度不高，多無工作且自覺經濟狀況僅夠生活；非獨居、意識清醒、 認知功能完整、可完全活動者較多；多數自覺健康狀況尚可，罹病種類以高血壓、糖尿病、骨骼肌肉系統疾病為最多。主要照顧者平均46.75'歲，女性為多，多為國小程度，與個案多為親人關係。被照顧者日常生活照顧除考慮主要照顧者體力，對照護技能應有訓練。幾乎所有研究對象皆未使用長照資源，原因以「不知道有這些 服務」及「不知道去哪裡找該服務j之可用性障礙最多。能顯著影響原住民長照資源使用之障礙因素有個案婚姻狀況與其自覺健康；與五個次面向有顯著相關的因素為：可用性障礙為個案種類、教育、婚姻、工作及與主要照顧者之關係，可近性障礙為個案種類、意識狀態、自覺健康狀況、活動能力和依賴狀況，適度性障礙為個案婚姻、是否癱瘓及自覺健康狀況，可負擔性障礙為個案婚姻、是否癱瘓、自覺健康狀況、活動能力和依賴狀況，可接受性方面則無顯著影響因子。本研究建議：在原住民部落多建置居家式長期照護服務，發展主要照顧 者訓練方案，重視原住民部落慢性病防治宣導及長期照護資源主動性宣導增強。The aim of this study was to explore the long term care needs in aboriginal communities. Research purposes included: 1. to describe their disability profiles; 2. to examine their long term care needs and resources; and 3. to explore certain barriers associated with underutilization. Cross-sectional research design and face to face interviews were utilized. Study samples were 65 years elderly and disabled, purposely selected from an aboriginal community in Shih-Chih. 67 subjects were recruited. Results of this study indicate that most aboriginal elderly and disabled were less educated, without job, under the poverty line and utilizing social welfare. The majority of them felt their income could only cover living expense. Most of them were conscious, cognitive intact, living with families and feel heakhy; however, only 19.4% of subjects were without any chronic diseases. Hypertension, diabetes, and muscular-skeletal diseases were most prevalent. Most caregivers were female relatives, with mean age of 46.75 years old and the educational level of primary school. Those with long term care need who are not using it do so because they “don’t know they are qualified” and “don’t know where to find the service”. Factors associated with utization barriers were marital status and health status. Significant predicting factors for availability were client types, education, marital status, job and relationship with caregiver. Significant factors predicting accessibility were client types, consciousness level, health status, ADL and dependency level. For accommodation, predicting factors were marital status, diability and health status. Significant factors predicting affordability were marital status, diability and health status, ADL & dependency level. Finally, there were no significant factors found to predict acceptability. Considering the caregivers, age, physical ability and low educational level, caregivers training and support groups should be recommended as a top priority for long term care.