長期照顧十年計畫服務對臺北市家庭照顧者負荷與健康相關生活品質的影響

Ten-Year Long-term Care Project: Service Impacts on Caregivers’Burden and Health-Related Quality of Life, Taipei City

目的：本研究旨在探討不同類型及數量的長期照顧服務使用對台北市家庭照顧者短期負荷與健康相關生活品質的影響。方法：本研究使用臺北市政府衛生局臺北市家庭照護者評估計畫之資料進行次級資料分析，分析140位長期照顧十年計劃服務申請個案之主要家庭照顧者，其三個月前後負荷與健康相關生活品質之改變。本研究使用獨立樣本t檢定、皮爾森積差相關與單因子變異數分析等方法，檢驗家庭照顧者與被照顧者特性對於家庭照顧者負荷與健康相關生活品質間之相關性，並透過複迴歸分析控制可能影響照顧者負荷與健康相關生活品質之特性，比較使用服務與否、使用不同類型服務，以及使用不同數量之服務對家庭照顧者負荷與健康相關生活品質的影響。結果：研究結果發現，在控制相關家庭照顧者與被照顧者特性後，不論是否使用長期照顧十年服務，其家庭照顧者三個月後之負荷及健康相關生活品質皆無顯著改變。將服務分成喘息型服務、居家支持型服務與醫療相關服務三種類型後，則可發現醫療相關服務可顯著降低家庭照顧者三個月後的負荷（β= -3.919，p=0.015）。進一步考量使用服務數量與類型，將服務分為七種服務類型組合後，可發現與僅使用醫療相關服務相比，「僅使用喘息型服務」與「僅使用居家支持型服務」之家庭照顧者，其三個月後的負荷顯著較高（β=13.939、p=0.003;β=5.868、p= 0.013）；「僅使用居家支持型服務與醫療相關服務」之家庭照顧者，三個月後的心理相關生活品質則顯著較低（β= -5.352，p=0.040）。結論：對於新申請長照服務個案的家庭照顧者，長期照顧十年服務在短期內對家庭照顧者負荷有改善傾向。其中醫療相關服務則是在短期內可顯著改善照顧者的負荷，其他類型服務效果需要長期觀察成效。建議未來政策優先提供新申請服務者醫療相關服務。

Objectives: This study explored the effects of different types and numbers of long-term care（LTC）services on caregivers’burden and health-related quality of life in Taipei. Methods: The study used data from“A Study of Family Caregiver Appraisal in Taipei City”to analyze effects on 140 family caregivers whose care recipients were first-time applicants for LTC services from the Ten-Year Long-Term Care Project（LTCP）in Taipei City. The study controlled care recipients and family caregivers’characteristics which are related to family caregivers’burden and health related quality of life, using multiple regression to investigate how the number of services used, different types of services used, and combinations of services used might have influenced caregivers’burden and health-related quality of life. Result: When the care recipient and family caregivers’characteristics were controlled, the results suggested whether people used Ten-Year Long-term Care services or not, it didn’t have significant effect of caregivers’burden and health related quality of life after 3 months. Among the users of Ten-Year Long-term Care services, the study found no significant positive association between number of services used and caregivers’burden and health related quality of life. After grouping the services in the Ten-Year Long-term Care programs into three category, including respite services, home support services, and medically related services, caregivers using medically related services have a significantly lower burden after 3 months of service use comparing to caregivers using any of other types of services（β= -3.919, p= 0.015）. When examining the effects of different combination of services, we found that, caregivers using respite services only（β= 13.939, p= 0.003）and home support services only（β= 5.868, p= 0.013）had higher caregivers’burden after 3 months comparing to caregiver using medically related services. Caregivers using the combination home care related services and medically related services had lower caregivers’mentally related quality of life after 3 months comparing to caregiver using medically related services（β= -5.352, p= 0.040）. Conclusion: Receiving LTC services benefitted caregivers of care recipients’who were first-time applicants for LTCP. Medically related services showed significant benefit on caregivers’burden within only 3 months, but effects of other types of LTC services will require longer observation. Medically related services are recommended as a priority for care recipients when they first apply for LTC services.