長期照顧服務和支持性服務使用類型組合與家庭照顧者生活品質相關性探討

研究背景與目的家庭照顧者，是台灣目前主要提供照顧服務的人力。面對高齡化所造成的龐大照顧需求，照顧壓力與負擔對家庭照顧者自己身心健康產生威脅與耗竭，更會影響照顧品質也可能產生令人惋惜的照顧悲劇。為因應快速增加的長期照顧需求，除了2015年於立法院通過《長期照護服務法》，更於長期照顧十年計畫2.0中提供的家庭照顧者支持服務外，家庭照顧者關懷總會於 2014 年受衛生福利部委託於全台22縣市支持網絡提供家庭照顧者支持性服務，包含心理協談、個案管理服務、紓壓活動、支持團體、電話關懷、居家照顧技巧指導、照顧技巧訓練、喘息服務八大項服務。過去研究指出，正式長期照顧服務的引入不僅能直接對被照顧者產生影響，也會對其家庭照顧者的照顧壓力與生活品質造成影響，而服務的類型亦會欲其健康相關結果相關。然而，國內目前未以「照顧者為中心」探討不同服務使用類型組合的長照服務研究，更少有比較不同服務使用類型組合的長期照顧服務與支持性服務對家庭照顧者生活品質的相關性，故本研究欲將長照2.0與支持性服務進行分組探討家庭照顧者使用不同長照服務與家庭照顧者支持性服務類型組合與其生活品質的相關性。研究方法本研究與中華民國家庭照顧者關懷總會、各縣市家庭照顧者支持據點與縣市衛生局進行聯繫合作，透過家庭照顧者相關社群轉發研究資訊與辦理家庭照顧者支持活動時舉辦說明會進行研究施測。本研究為橫斷性調查研究，針對已使用長期照顧十年計劃2.0服務超過6個月的個案之主要家庭照顧者從110年3月29日到5月30日進行訪員面訪紙本問卷與線上網路問卷調查。本研究使用latent class統計方式找出長照服務2.0與家庭照顧者支持性服務使用的潛在傾向進行類型組合分類，之後透過獨立樣本 t 檢定、卡方檢定、皮爾森積差相關與單因子變異數分析等方法，檢驗家庭照顧者與被照顧者特性與家庭照顧者生活品質間之相關性。最後透過多變量複迴歸分析控制可能影響家庭照顧者生活品質之特性，比較不同長期照顧2.0服務與家庭照顧者支持性服務使用類型組合與家庭照顧者生活品質的相關性。研究結果共收回247位已使用長期照顧十年計劃2.0服務超過6個月的個案之主要家庭照顧者。本研究透過Latent class analysis將13項長照2.0服務與8大項家庭照顧者支持性服務進行分組。將長照2.0服務與家庭照顧者支持性服務分為「居家復能家照個管組」、「日照機構使用組」、「居家據點支持組」；僅以長照2.0服務分類為「居家日照據點組」、「復能交通機構組」、「居家交通喘息組」；最後僅以家庭照顧者支持性服務則分為「家照個管電話關懷組」、「多重支持服務使用組」、「紓壓喘息使用組」。考量家庭照顧者與被照顧者特性並同時以復能交通機構組為參考組的情況下，結果發現長照2.0服務分類中只有「居家交通喘息組」具有顯著較好的生理生活品質（p = 0.018）。由以上研究結果可推論不同服務使用類型組合與家庭照顧者的生活品質具有相關性。結論與建議研究結果顯示使用「居家交通喘息組」的生理生活品質達到最顯著的正向相關，建議若服務使用上能搭配「紓壓與喘息服務」使用，或許能對於家庭照顧者的生理與心理生活品質達到正向益處。本研究為首篇以照顧者為中心初探不同長照2.0服務與家庭照顧者支持性服務使用類型組合與家庭照顧者生活品質的相關性，更發現不同服務使用傾向族群的特性差異。建議未來政策與服務提供者推廣複合式的長照服務與支持性服務彈性搭配模式，並提供彈性的紓壓與喘息支持性服務。此外，建議未來研究可以擴大研究個案數以增加變異性、考量服務使用頻率、改以前後測或準實驗設計方式進一步確立不同服務使用類型組合對於家庭照顧者生活品質的影響。

關鍵字

家庭照顧者；長期照顧十年計畫2.0 ；家庭照顧者支持性服務；照顧壓力；生活品質；服務使用類型組合

並列摘要

Research Background and Study Purposes Family caregivers are the primary caregivers for long-term care services (LTC) in Taiwan nowadays. Due to the rapidly aging population and increasing demand for care, the stress and burden of caregiving threatens the physical and mental health of family caregivers. Therefore, family caregiver support services provided by the government in the second 10-year long-term care plan (LTC 2.0), the Taiwan Association of Family Caregivers was commissioned by the Ministry of Health and Welfare in 2014 to provide family caregiver support services in 22 counties and cities throughout Taiwan. Support services included psychological counseling, case management services, stress relief activities, support groups, telephone counseling, home care skills guidance, caregiving skills training, and respite services. However, there were no studies in Taiwan that have examined different combinations of certain services for long-term care plans in a "caregiver-centered" concept, and there are few studies that have compared the correlation between different combinations of certain services for long-term care plan and supportive services on family caregivers' quality of life. Therefore, this study aims to examine the correlation between different combinations of long-term care services and supportive services for family caregivers and their quality of life. Research Methods The study was conducted in collaboration with the Taiwan Association of Family Caregivers and city health bureaus. The study was a cross-sectional survey conducted from March 29th to May 30th, 2021, using both paper-based questionnaire and online questionnaire for primary family caregivers who had been using Long Term Care 2.0 services for more than 6 months. This study used latent class statistics to identify the potential tendencies of LTC 2.0 and supportive services used by family caregivers. Multiple regression was used to investigate the relationships between different combinations of long-term care 2.0 services and family caregiver support services, and the quality of life of family caregivers with covariates adjusted. Research Result A total of 247 primary family caregivers who had used LTC 2.0 services for more than 6 months were recruited. Latent class analysis was used to categorize the 13 services of LTC 2.0 with the 8 major family caregiver support services. The long-term care 2.0 services and family caregiver support services from the 家總were categorized into the "Home Rehabilitation Personal Care Group," "Adult Day Care and Institutions Group," and "Home-based Support Group"; the long-term care 2.0 services were categorized into the "Home- and Community-based Group", "Rehabilitation, Transportation and Institutions Group", and the "Home-based, Transportation, and Respite Group"; lastly, the family caregiver support services were divided into the "Home-based Personal Care and Telephone Counseling Group", " Multi-Support Service Use Group’, and “ Stress Relief Use Group “. When the care recipient and family caregivers’ characteristics were controlled, and using the “Rehabilitation, Transportation and Institutions Group” as the reference group, " Home based and Transportation and Respite group " in the Long Term Care 2.0 service classification had a significantly better physical quality of life (p = 0.018). From the above findings, it can be inferred that there is a correlation between different combinations of certain services and the quality of life of family caregivers. Conclusion The results of the study showed that the physiological quality of life in the group of the " Home-based and Transportation and Respite Group“ showed better than other groups. It is suggested that using the service in combination with the "stress relief and respite service" tended to have positive benefits of physiological and psychological quality of life on family caregivers. It is recommended that policymakers and service providers promote a flexible combination of LTC 2.0 and supportive services, and provide respite support services for caregivers. In addition, exploring the effects of differnt services use frequencies is recommended for future study.

並列關鍵字

Family caregivers ； Ten-Year Long-term Care Plan 2.0 ； Family caregiver support services ； Caregiving stress ； Quality of life ； Multiple services

參考文獻

中文文獻

Google Scholar

中華民國家庭照顧者關懷總會 (2007)。認識家總家庭照顧者處境與支持性服務。家庭照顧者關懷總會。取自 https://www.familycare.org.tw/about

Google Scholar

中華民國家庭照顧者關懷總會 (2007)。家庭照顧者現況調查。家庭照顧者關懷總會。取自https://www.familycare.org.tw/sites/default/files/2007%E5%AE%B6%E5%BA%AD%E7%85%A7%E9%A1%A7%E8%80%85%E7%8F%BE%E6%B3%81%E8%AA%BF%E6%9F%A5.pdf

Google Scholar

中華民國家庭照顧者關懷總會 (2011)。長期照護保險給付制度—家庭照顧者教育訓練課程計畫。行政院衛生署委託業務計畫期末成果報告，臺北。

Google Scholar

中華民國家庭照顧者關懷總會 (2018年7月23日）。照顧不離職，友善職場來幫忙。家總新聞稿。取自https://www.familycare.org.tw/policy/11262

Google Scholar

主題瀏覽