巷弄長照站之挑戰與對策──兼論健康促進扎根社區之芻議

Challenges and countermeasures of long-term care lane station-proposal of the implementation of community health promotion

2016年12月衛生福利部核定長期照顧十年計畫2.0（106～115年）。本文之研究目的：以文獻回顧探討了解美國、日本、與臺灣對於長期照顧與老人健康促進政策的發展；以質性訪談探討社區關懷據點之轉型為巷弄長照站在經營管理之挑戰，並探討社區關懷據點推動健康促進之挑戰，並展望未來。美國的經驗，在「美國老人法」框架下，聯邦與地方合力推動老人的社會服務項目，其中疾病預防與健康促進、長期照顧監察員計畫、送餐計畫提供營養教育、老人社區服務就業、老人信息與援助、法律諮詢援助等項目。PACE單位統籌運用老人醫療保險、低收入戶醫療救助經費，提供重度失能老人居家、社區及機構照顧。日本推動社區整體照護制度、地方與民間資源積極參與老人照顧服務、推動高齡者志工服務長者、運用介護保險保費推動預防失能措施、推動健康促進課程等推動方式值得我國參考。社區關懷據點轉型為巷弄長照站在經營管理之挑戰包括配合政府政策的困難、家屬無餘力陪同長輩來社區據點參與活動、轉介個案來源有限、服務項目有限等；日托服務的個案來源難尋；臨托服務缺乏個案來源，志工無法發揮，難以順利留才。展望未來，可自政策面、經營管理面與健康促進扎根社區面等三大面向著手落實。 In December 2016, the Ministry of Health and Welfare approved the Long- Term Care Decade Plan 2.0 (2017-2026). The purpose of this paper is to review the development of long-term care and health promotion policies for the elderly in the United States, Japan, and Taiwan through a literature review; Exploring the transformation of community care bases in qualitative interviews to challenge the management of Long-term Care Lane Station, and explore the challenges of community care bases to promote health promotion. In the US experience, under the framework of the “American Old Law,” the federal and local governments work together to promote social services for the elderly, including Disease Prevention and Health Promotion, Long-Term Care Ombudsman Program, Nutrition Service Programs, Senior Community Service Employment Program, Senior Information and Assistance Program, Legal Services. The PACE unit co-ordinates the use of Medicare and Medicaid to provide care for the elderly, community and institutions of the elderly with severe disability. Japan’s promotion of the overall care system for the community, the local and private resources to actively participate in the elderly care services, the promotion of senior citizens’ volunteer service, the use of care insurance premiums to promote prevention of disability measures, and the promotion of health promotion courses are worthy of reference. The challenges of Long-term Care Lane Station include the difficulties of cooperate with government policies, the fact that family members have no spare capacity to accompany their elders to participate in community activities, limited referral sources, limited service projects, .the source of the day care case is difficult to find; the use of volunteers, because of the non-case source of the service, Because of the lack of source of the case, the volunteers are unable to play, and it is difficult to stay smoothly. Looking into the future, we can implement the three aspects of policy, management, health promotion in the community.