以質性研究探討台灣推動復能服務之困境與因應策略──從服務提供者觀點分析

A qualitative study on the difficulties and strategies for promoting reablement services in Taiwan from the perspectives of providers

目標：台灣長期照顧十年計畫2.0自2018年，建立長期照顧新模式，推動復能服務，強調功能性訓練，與長照1.0以身體功能改善為目標的居家復健有所差異。本研究探討專業人員於照護模式的改革中，實務遇到的困難與因應策略。方法：採紮根理論，以南部某縣市所舉辦之復能輔導會議及世界咖啡館討論中，針對復能執行現況與經驗之討論紀錄進行質性分析。參與者包含參與討論之復能團隊人員（如：照顧管理專員、個案管理師、職能治療師、物理治療師及護理師等）。結果：共690人參與活動。實務面臨之困難，共歸納出兩個主題：（1）「對復能無共識」：對復能原則的理解有限或誤解，及建立共識的教育訓練不完善；和（2）「無法有效地團隊合作」：參與人員多與溝通管道不足。因應策略主題有（1）「以個案及其目標為中心」，可行辦法包括個別化目標、關係建立、了解潛能；和（2）「建立新的團隊架構與互動機制」：共同訪視、教育訓練與建立新的溝通管道。結論：推動復能時，從價值觀改變、教育宣導，到服務團隊之配套和整合不足，致使照護模式的改革困難。本研究提出可供參考的策略，未來可納入政策制訂者及服務使用端的觀點更深入探討。

Objectives: Compared with Long-term Care 1.0 in Taiwan that emphasizes improving physical function with home-based rehabilitation, Long-term Care 2.0 adopts a home-based Reablement approach that emphasizes functional training. This study explores the practical obstacles when the providers implemented reablement and proposes corresponding strategies. Methods: Grounded Theory was adopted to qualitatively analyze the records of World Café meetings and advisory meetings collected from the Reablement Improvement Project in a southern city. Participants were the members of reablement teams who participated in the meetings (such as care managers, case managers, occupational therapists, physical therapists, and nurses). Results: 690 people participated. The practical difficulties of implementation included: (1) a limited understanding or misinterpretation of reablement and inadequate staff training to form a consensus on what reablement constitutes, and (2) difficulty in building an inter-disciplinary reablement network. The strategies to overcome these obstacles include (1) a client-centered and goal-centered approach, such as rapport building, individual goal-setting, and potential assessment and (2) exploration of a workable teamwork and communication mechanism, such as joint visits, joint staff training, and new communication platforms. Conclusions: Differing care values about aging and family and inadequate instructions and dissemination of the policy information contributed to the difficulties of implementing reablement. We proposed corresponding strategies for future research and policy making. Perspectives from policy makers and service users can be further explored.