台灣長照體系居家服務利用與結案原因之影響因子探討

Exploring the home services utilization and its influencing factors for case closures in Taiwan long-term care system

目標：居家服務於長期照護中相當普遍，而發展以人為本的社區式服務，必須透過縱向資料的累積來了解高齡者之個人特性、服務使用與留住社區之能力。本研究目的在檢視南部某都市的居家服務利用情形、結案原因以及相關影響因素。方法：以南部某都市照顧管理資訊系統（LTC-CM）資料庫2011年至2015年為止曾核定使用居家服務之身心障礙者及老人現況資料進行分析，第一次需求評估中（T0）共有9,889名個案接受服務。Cox回歸分析應用於檢視服務利用兩年內結案原因分析，來找出潛在影響因子。結果：研究期間結案的比例偏高，其中死亡佔20%，離開服務佔41%（主因為個案之家庭網絡尋求其他照顧資源）。扣除死亡後結案的影響因子為一般戶、照顧者負荷較大、中度智力缺損者較易結案。結論：本研究結果實證居家服務的高結案率，建議除服務提供外，應重視個案的服務利用狀況與結案原因，建議未來進一步探討不續用服務者其產生服務缺口的原因。（台灣衛誌2018；37（5）：539-553）。 In order to develop person-centered service delivery in the community, it is important to understand the causal relationships among older adults’ personal factors, service utilizations, and the ability to reside in the community from a longitudinal perspective. This study aimed to examine the profile of home services utilization and the reasons for case closures in two years, as well as the related influencing factors, among home service recipients in southern Taiwan. Methods: We analyzed the long-term care dataset of one southern metropolitan area from 2011- 2015, and the records of 9,889 persons aged 50 and over who received home services with an initial need assessment (T0). The Cox Regression Analyses were used to examine the potential risk factors for leaving the services. Results: The high rates of case closures included death (20%) and drop-out (41%), mainly due to the need to search for caregiving resources within family networks. In terms of the influencing factors for leaving the services, those who with non-low household incomes, informal caregiving burden and moderate cognitive impairments were more likely to drop out. Conclusions: This study provides empirical evidence of the high dropout rate and the importance of further investigations to explore the service gap in this context, especially the need to give more attention to those service users who then drop out of the system. (Taiwan J Public Health. 2018;37(5):539-553).