影響長期照顧十年計畫照管專員核定居家服務時數之因素探討

The Variation of Approved Home Care Service Hours for Disabled Elderly among Care Managers under Ten-Year Long-Term Care Program

目的：探討照管專員核定長期照顧十年計畫居家服務時數之相關因素及差異性。方法：採橫斷性研究，針對2013年該計畫核定居家服務時數之失能老人為對象，探討服務核定時數受哪些因素影響，標準特質含失能者失能程度及認知行為，非標準特質為個案與家庭照顧者特質，另納入照專服務案量及縣市長照資源，以廣義估計方程式進行分析。結果：2013年居家服務核定時數為每月平均29.1小時，輕度16.1小時、中度29.8小時、重度39.1小時。個案失能嚴重、年齡越長、具身心障礙身份、已婚、與家人或親友同住、家庭照顧品質佳、家庭照顧者照顧負荷重、縣市照顧服務員數多者之核定時數顯著高；納入標準特質後迴歸解釋力達20.66％，逐步納入個案與家庭照顧者、照專服務案量、縣市長照資源及縣市別，解釋力提高為24.64％、24.74％、25.88％、31.38％。結論：照管專員核定居家服務時數存在不一致現象，且解釋力偏低；除受標準特質影響，亦受非標準特質如失能者高齡、具身心障礙身份、無配偶、與家人或親友同住、家庭照顧品質佳、家庭照顧者負荷大，及縣市長照資源所影響，肯定長照2.0採用多元評估量表納入更多變項定義標準特質，然照顧服務員人力是關鍵，建議政府須重視照顧服務員投入市場及留任情形。 Objective: To investigate the effect of standard and nonstandard characteristics on the approved home care service hours for disabled elderly among care managers under Ten-Year Long-term Care Program. Method: A cross-sectional design was used to investigate the factors related to the approved home care service hours in disabled elderly in 2013. Disability level and cognitive function were used as standard characteristics, whereas the characteristics of home care cases and their family caregivers, the workload of care managers, and the region resources served as nonstandard variables. Data analyses were conducted using a generalized estimating equation (GEE) because some subjects were repeatedly observed in the ten-year plan of long-term care database. Results: The monthly average approved home care service hours for disabled elderly in 2013 was 29.1 hours. Subjects with mild, moderate, and severe disabilities were 16.1, 29.8, and 39.1 hours, respectively. The approved home care service hours were significantly higher in the subjects with more severe disability, older, disability card, married, living with family members, good care quality, high burden of family caregivers and numbers of nurse aide in different county/city. The explanatory power of initial model included the level of disability and cognitive function was 20.66%. After controlling the characteristics of disabled elderly and their family caregivers, the workload of care managers, the resources of nurse aide in region, and county/city, the explanatory power were 24.64%, 24.74%, 25.88%, and 31.38%, respectively. Conclusion: The approved home care service hours for the disabled elderly was inconsistency, and with low R-squared. Besides of standard characteristics of disabled elderly, nonstandard characteristics such as age, with disability card, without spouse, live with family members, good care quality and high burden of family caregivers, living in different city/county were associated with approved home care service hours. Therefore, multi-dimensional assessment tool were needed in long term care program Version 2.0. However, the manpower of nurse aide was the key variable to influence the home care service hours among county/city. We suggested government should play more attention on the amount and stability of the market of nurse aide.

Objective: To investigate the effect of standard and nonstandard characteristics on the approved home care service hours for disabled elderly among care managers under Ten-Year Long-term Care Program. Method: A cross-sectional design was used to investigate the factors related to the approved home care service hours in disabled elderly in 2013. Disability level and cognitive function were used as standard characteristics, whereas the characteristics of home care cases and their family caregivers, the workload of care managers, and the region resources served as nonstandard variables. Data analyses were conducted using a generalized estimating equation (GEE) because some subjects were repeatedly observed in the ten-year plan of long-term care database. Results: The monthly average approved home care service hours for disabled elderly in 2013 was 29.1 hours. Subjects with mild, moderate, and severe disabilities were 16.1, 29.8, and 39.1 hours, respectively. The approved home care service hours were significantly higher in the subjects with more severe disability, older, disability card, married, living with family members, good care quality, high burden of family caregivers and numbers of nurse aide in different county/city. The explanatory power of initial model included the level of disability and cognitive function was 20.66%. After controlling the characteristics of disabled elderly and their family caregivers, the workload of care managers, the resources of nurse aide in region, and county/city, the explanatory power were 24.64%, 24.74%, 25.88%, and 31.38%, respectively. Conclusion: The approved home care service hours for the disabled elderly was inconsistency, and with low R-squared. Besides of standard characteristics of disabled elderly, nonstandard characteristics such as age, with disability card, without spouse, live with family members, good care quality and high burden of family caregivers, living in different city/county were associated with approved home care service hours. Therefore, multi-dimensional assessment tool were needed in long term care program Version 2.0. However, the manpower of nurse aide was the key variable to influence the home care service hours among county/city. We suggested government should play more attention on the amount and stability of the market of nurse aide.