復能專業服務模式發展：臺灣經驗之省思

Reflection on the Development of Reablement Service Provided by Health Professionals in Taiwan

臺灣復能（reablement）專業服務模式發展自2017年長照2.0政策開始實施至今，縣市政府與專業服務單位對於新制度都在摸索與調整，相關政策及執行面也在短時間內經過許多的修正。本篇從縱貫面探討復能模式的發展與其遇到的瓶頸，包括復能執行現況、2018年起至2021年10月迄之幾次政策重大之修正、個案管理端（照顧管理專員、個案管理人員）與服務執行端之服務輸送情況、以及民眾使用之觀感等，並提出問題包括專業服務轉介率偏低、專業服務使用次數規範之爭議、AA03碼實際執行困難、缺少縱向的繼續教育及個案研討等。我們建議：（1）於照顧管理平台建立轉介專業服務的提醒、（2）調整給付方式及輪派制度以提升專業服務轉介率及穩定度，並（3）重新檢視AA03之目標及效益，依據現況制定鼓勵居家服務與專業服務合作的機制，（4）定期舉辦小規模縱向橫向個案研討，以提升區域共識及。與（5）照專與個管之服務說明標準化協助服務一致性與及增加民眾對於復能成功案例的認知。推動照護典範轉換的復能服務需要更多的討論和溝通，期待復能概念的推行能夠有政策作為助力，在執行上都能更加順暢更有團隊共識，達到提升長者生活品質、減輕照顧者負擔，建立更完善的長期照顧服務體系。

Since the implementation of Long-term Care plan 2.0 in 2017, city governments and professional services have worked hard to navigate the new and complicated delivery and bureaucracy of the Reablement Service, while the implementation regulations went through many revisions in a short period of time. This paper discusses the development and challenges of the Reablement Service, including the implementation of the Reablement, major regulation revisions between 2018-2021, its influences on the service delivery of care managers and health professionals, and the experiences of reablement recipients. We call attention to the issues of low referral rate, the often-contested frequency and number of reablement visits, difficulty with implementing AA03, inadequate case conferences and continuing education that can facilitate interdisciplinary communication.
We suggest to (1) add a reminder for Reablement referral on the online care management platform, (2) modify the payment system and the referral mechanism to improve referral rate and stability of reablement volume, (3) re-examine the purposes and benefits of AA03 for facilitating collaboration between professionals and home health aides, (4) hold regular small-scale interdisciplinary case conferences and workshops to build consensus about Reablement, and (5) provide the case managers standardized introduction manuals on Reablement Service to facilitate service consistency and public awareness of successful Reablement .
The care paradigm shift to Reablement takes work and communication. We call for governmental policies that can help promote Reablement, inter-disciplinary consensus, and smooth service delivery, thus achieve the goals of improving the quality of life for reablement users and reduce the burden on caregivers.