由護理之家供給者的角度探討台灣長期照護的現況、問題與未來發展

Exploring the Situations, Problems and Future Developments of the long－term Care Market by Presenting the Nursing Home Profile in Taiwan

台灣正面臨人口組成的劇烈轉變，六十五歲以上老年人口比例日增，預估在2036年時老年人口會增加為總人口之21.7％，趕上德國、法國、瑞典等歐洲先進工業國家的水準（內政部，89年）。這種老年人口的急速增加導致人口組成移轉的結果，致使有越來越多的老人，尤其是老老人，對某些型式的長期照護需求會與日俱增，諸如居家護理、護理之家等。本文主題是由供給者的角度來探討我國的護理之家照護，當我國的護理之家照護，在原則上仍舊維持由使用者私人付費而非由第三者付費時，護理之家的擁有者或負責人在市場上其實扮演著相當重要的角色。他／她們在長期照護市場上的投資選擇、定價策略、篩選病患的標準以及管理方式等，都會對護理之家機構照護的發展有舉足輕重的影響。本研究針對立案護理之家作抽樣探訪，借以了解護理之家的擁有者或負責人，他／她們的專業背景、投資動機與選擇，對我國長期照護政策的看法、市場發展之預期以及對政府相關政策衝擊的看法等。研究得知，護理之家的經營管理者希望能夠得到專業上的支持及合法立案者之保障，同時，也期望透過輔導與評鑑提高專業品質。然而，護理之家機構的發展也深受外在環境的影響，其中主要的衝擊來自於財務壓力和政府政策，包括對於長期照護系統的意識形態與公共政策；長期照護的財源籌措與保險制度；以及國家經濟等因素，均有舉足輕重的影響。在社區照護中相關照護服務相繼發展的前提下，政府的長期照護政策方向以及未來的財務計畫，對於護理之家的供給都有決定性的影響，可以預期的是，只有在需要的人都能獲得最適當的照護服務情形下，我國的護理之家才能有真正看好的未來。

Taiwan is facing a radical change in the composition of its population. It is expected that the population aged 65 and over will treble between 1994 and 2036. .One result of this shift is that the growing number of old people, especially the very elderly , may need some form of long-term care, such as the home care program and/or the nursing home care. This study aimed to understand the supply side of nursing home care by examining the proprietors of th nursing homes. This comes from a survey of the 12 registered nursing homes and interviews with the proprietors. It looks first at the homes, i.e., size and structure, characteristics of the homes, charges, the medical service and staff. It concludes with the views of the nursing home proprietors. The result showed that the proprietors were keen to get professional supports from peer groups and the legitimate protection from law as well as razing the quality of care through guidance and accreditations. However, the nursing home industry is deeply influenced by the extemal environments in which the major impacts came from the financial policy and government interventions. These also related to the public ideology towards the care of elderly people, the financing system of the long-term care and the economical factors. Under the premises of the alternative care continuingly being developed in the community, the government policy towards long-term care plays a decisive role. It is anticipated that there is a future of the nursing home industry of Taiwan only when the needs-led long-term care services could be delivered.