臺灣老人日間照顧服務之初探：兩種服務模式之比較分析

A Preliminary Study on Adult Day Services in Taiwan: A Comparison of Two Service Models

近年來失智症日間照顧服務模式在美國、日本興起，而台灣政府對於「失智症老人日間照顧服務」及「失智、失能混合型日間照顧服務」人力配置之規定也於2008年出現，然上述兩種服務模式的運作情形值得探究。本文旨在解析我國社會型日間照顧服務之現況，試圖從結構特性、過程及結果三個面向來比較兩種服務模式之異同。研究方法係採郵寄問卷調查法，針對全國社會型日照中心進行普查，寄出81份問卷，回收61份問卷，回覆率為75.3%；並運用描述性統計分析來呈現研究結果。研究發現可大致歸納為下列二項：（1）每所日照中心平均可服務28.23人，而實際使用人數為20.48人。使用月托的服務對象之身體認知功能情形，在「失智、失能混合型中心」的使用者中七成二為失能者，而僅失智未失能者占二成七；但在「失智症專門型中心」罹患失智者則占六成五，另失能者也占三成五。（2）「失智、失能混合型」及「失智症專門型」兩種服務模式互有異同，其相異之處為：首先，失智症專門型日照中心的專業人力配置比較高（除社工員外，也另聘有專任護理人力）；其次，在活動安排方面，失智症專門型中心體認到「延緩或維持認知功能退化」是方案的主要功能之一，故重視輔療性活動的辦理（特別在「認知輔療活動」和「藝術輔療活動」），也會安排讀報、玩賓果、數字拼盤等休閒活動；此外，中心對家屬提供支持服務也較為普遍。最後在結論部分，本文以美國和日本失智症日間照顧服務發展作為借鏡，研提我國未來建置失智症日間照顧服務模式之政策建議。

With increased focus on adult day services for people with dementia in the United States and Japan, Taiwan had implemented manpower allocation standards for dementia-specific and dementia-disability mixed adult day services in 2008. The operation of these two service models, however, has not been explored yet. This study presented the current status of social model of adult day care centers in Taiwan. A total of 81 questionnaires were sent out to adult day care centers and 61 of them completed the survey. Major findings included: (1) the average number of service users was 20.48. Users who were diagnosed with dementia accounted for 27% of the participants in dementia-disability mixed adult day care centers and 65% in dementia-specific adult day care centers, (2) Compared to dementia-disability mixed day care, dementia-specific day care centers reported a higher prevalence of hiring nurses and social workers. They also expressed a greater emphasis on activities aiming to maintain cognitive functioning, including cognitive stimulation therapy, art therapy and leisure activities such as reading newspaper, bingo or Sudoku. In addition, dementia-specific day care centers also reported a higher percentage of providing services for family caregivers than did dementia-disability mixed day service. Policy and practice implications, based on research findings and the literature on the cases of United States and Japan, were provided. A specialized model for adults with dementia should be developed in the future.