照顧服務員分級可行性之探討

The practicability of care worker classification

照顧服務員為長照重要人力然招募不易；本研究針對實施照服員分級制度國家瞭解其作法，並探討分級可行性。本研究以文獻探討有實施照服員分級制國家之作法，並辦理五場專家會議，共計42人次參與。日本、韓國、德國依照服員能力設計進階制度，證照考核制度皆須經過高時數的照護訓練；日本將服務時間及時段、服務人數、服務區域以及服務人員等級納入長照保險支付制度。我國照服員採單一級認證，長照十年計劃之每小時補助費用仍屬定額，未將個案失能程度、複雜程度、特殊性納入考量，為使照服員量能提升，未來長照十年計劃補助費用及長照保險居家照顧服務給付宜將勞力負荷、夜間加成、偏遠地區、失能程度、失智照顧、疾病類型、特殊生理狀況、高風險家庭納入加成考量。發展照服員分級制度，並設計工酬相符之補助標準及支付制度，將有助於照服人才留任。

It is difficult to recruit care workers, although care workers are a major part of the workforce within the long-term healthcare system. The aim of the current study was to understand the practices of care worker certification in other countries, and assess the feasibility of the classification system in Taiwan. This study used a literature review to investigate the experience of care worker classification. Five expert meetings were held and 42 experts attended. In Japan, Korea, and Germany, care workers are classified by their personnel working ability, which have to be upgraded by many hours of training. In Japan, the design of the payment system for care workers considers the time, period, volume, area of service, and the level of care workers. Taiwan uses a single-level care worker certification. Therefore, the subsidy per hour is fixed by the payment system, and does not consider the disability, complex, and specific degree of clients. To enhance the quantity and quality of care work, the subsidy and payment of care workers should consider factors, such as labor loading, night bonus, remote areas, degree of disability, dementia care, type of disease, special physical conditions, and families at high risk. Developing multi-level certification and designing equal pay for equal work payment system can promote the retention of care works.