以自立支援模式提升居家服務個案自我照顧能力之成效探討

Discussion on the Effectiveness of Improving the Self-care Ability of Home Service Cases by Self-supporting Model

「自立支援」作為提升高齡者自主性、自我照顧能力，可達到延緩失能效果。導入居家照顧服務後，即回應政府推行居家照顧之目的。本研究以長照中心核定派案，護理師指導「自我照顧能力」缺失，提升「自我照顧能力」(即自立支援)的居家服務個案。本研究者承接收案共三位，以回溯性研究分析個案自我照顧能力居家服務之紀錄：包括日常生活功能，如上下樓梯、步行、抬(倒)水瓶等，並以日常生活活動功能量表、功能性體適能以及憂鬱指數進行前後資料成效評值，來了解居家服務個案執行自我照顧之問題、導入自立支援照顧模式後自我照顧能力成效、導入後個案之感受、導入模式後個案家屬之感受。結果顯示，個案經過自立支援模式照顧後，日常生活活動功能以及功能性體適能有部分提升，例如：步行能力、柔軟度、坐到站能力、憂鬱指數有顯著成效。顯示自立支援照顧模式導入居家照顧服務，有賴居服員之個別性活動服務以及家屬支持。尤其個案之日常活動及運動，家屬陪伴比居服員時間長，可提供個案實際生活的觀察與協助。建議可廣泛推廣自立支援模式導入居家照顧服務，實質提升高齡者的自我照顧能力，達到延緩失能的效果。

The concept of self-support is to enhance the independence of the elderly, and to delay disability through the self-care ability of the elderly. The combined with home care services can also respond to the government's purpose of promoting home care. There are three cases accepted in this research, and a retrospective study is used to analyze the records of cases receiving care services: including home care training self-care ability content, such as daily life functions, such as going up and down stairs, walking training, lifting (pouring) water bottles, etc., and using Activities of daily living function scale, functional fitness and depression index were evaluated before and after training. Then understand the problems of home care cases in implementing self-care, the effect of self-care ability after combining the self-supporting model, the feelings of the cases and their family after the combining.
The results showed that after the case had undergone self- support model training, the activities of daily living and functional fitness were partially improved, such as walking ability, flexibility, and ability to sit to stand were significantly improved. The depression index can also be seen to drop significantly in individual cases, which has the effect of reducing anxiety and increasing the desire to learn new things. The effectiveness of combining the self-supporting care model into home care services depends on the individual training of the home workers and the support of family members. Especially for the daily activities and training of the cases, the family members accompany them longer than the home care attendant, which can provide the observation and training of the cases' practical life. It is suggested that the home care services combined with self-supporting model can be widely promoted, which substantially improve the self-care ability of the elderly and achieve the effect of delaying disability.