居家失能患者使用長期照顧十年計畫服務之現況

Utilization of the Ten-year, Long-term Care Program by Disabled Home-bound Patients in Taiwan

背景與目的：台灣長期照顧十年計畫推行至今已近四年，但使用情形仍待探究。本文目的在了解居家失能患者與其主要照顧者使用十年計畫之現況，並探索影響服務利用之相關因素。方法：本研究為一橫斷式調查研究，採立意取樣，以南部某地區醫院附設健保特約居家護理機構之個案與其主要照顧者為研究對象，透過家庭訪視及自擬之結構式問卷，自2010年9月1日至2010年12月31日三個月間，由兩位居家護理師蒐集研究對象之背景資料與使用長照十年計畫服務之經驗。結果：共計獲得有效問卷52份。個案平均年齡（±標準差） 為73.8±14.2歲，主要照顧者則為46.7±17.1歲。曾使用過長照十年計畫服務有32人(61.5%)，平均每人使用0.92項服務。八項服務中以輔具的購買與租借利用率為最高(48.1%)，其次為居家服務與居家護理，使用率分別為17.3%與11.5%。雙變項分析後顯著影響是否使用長照十年計畫服務的因素為：主要照顧者年齡、主要照顧者婚姻狀況、照顧關係、居住地區以及有無聘用外籍看護(p<0.05)；經邏輯式迴歸多變項分析後，僅居住地點會顯著影響服務的利用。結論：目前長照十年計畫中多數的服務利用率偏低，並且居住地點可能因城鄉差距而影響服務的利用。政府應該思考如何去推廣服務利用，或作政策的修訂讓更多民眾有能力使用服務，以發揮長期照顧的功能。未來應有大型研究調查不同族群對長期照顧十年計畫服務的使用率以及影響因素，作為增進利用與發展多樣化服務傳遞方式之參考。

Background and purpose: The ten-year, long-term care program of Taiwan was implemented in 2007; however, there is little information about the utilization of the program. The purpose of this study was to investigate utilization of the ten-year, long-term care program by disabled patients. Methods: This was a cross-sectional study. Participants were disabled patients who received home healthcare in southern Taiwan between September 2010 and December 2010. Home healthcare was provided by two skilled home care nurses who were based at a community hospital in the patients' vicinity. Data were collected using structured questionnaires. Caregiver data were also collected and analyzed. Results: Fifty-two valid questionnaires were obtained. The disabled patients had a mean (± SD) age of 73.8 ± 14.2 years, and the caregivers had a mean age of 46.7 ± 17 years. Among the 52 patients, 32(61.5%) had never used the ten-year, long-term care program prior to this study. The most frequently used service was the subsidy for or lease of assistive devices. This was followed by home care services and home nursing care with utilization rates of 17.3% and 11.5%, respectively. On bivariate analysis, the factors associated with long-term care service utilization were caregiver’s age, caregiver’s marital status, relationship between patient and caregiver, residential location, and the employment of a foreign caregiver (p <0.05). On multivariate logistic regression, only residential location was found to be associated with use of the ten-year, longterm care program. Conclusions: We found an under-utilization of the ten-year, long-term care program by disabled, home-bound patients. Data indicated that the location of the patient's residence may have affected service utilization. To ensure reasonable utilization of long-term care services, government agencies should seek to promote accessibility to care. Current policy regarding the criteria used to establish patient eligibility for the program may need to be amended in order to improve service utilization. Research investigating the use of long-term care services by larger populations may also be warranted in order to diversify and improve service delivery in the future.