長期照護機構之環境、設備與人力資源的探討-以台中市為例

隨著醫療科技的進步，國人平均壽命不斷上揚，加上少子化因素，使得老年人口所占比例逐年攀升，此乃邁向高齡化社會的主因。而現代人因工作繁忙，照顧老年人的時間相對變少，有些人會選擇由長照機構來安頓晚年。因此，我們有必要針對長照機構的環境、設備、人力資源…等面向，進行更深入的了解，期能在研究後，提出具體的建議，供相關單位參考，這也正是本篇研究的動機與目的。本研究的研究方法是採取一般性訪談以及問卷調查的方式進行。護理之家的部分主要是挑選台中市的所有長照機構當中，選取 7 間護理之家，並從這些機構中，以護理人員、護理長及主管作為本研究的研究對象，共計 74 位。並從 4 間機構中，每間挑選 1~3 位與研究者進行一般性訪談。本次的研究時間範圍為 2018 年 1 月~6 月，並使用信效度分析、描述性統計、因素分析、t 檢定及 ANOVA 分析等統計方法進行相關資料的量化分析。本研究之量化資料顯示：在因素分析部份，經歸納後可歸因為：「員工待遇及設備」、「工作環境」、「政策法規」三個因素，同時也發現：員工待遇、軟硬體設備、工作環境及教育訓練會影響員工的滿意度。一例一休之政策也會對長照機構之人力調度及招募產生影響。進一步檢視並發現：不同學歷的工作人員，對長照機構之「工作環境」議題的看法，有顯著差異。經事後比較，發現學歷在「高中職以下畢業」與「大學畢業」的工作人員，對於長照機構之「工作環境」議題的看法，有著明顯的不同。訪談之意見為： (1)考量到住民也需要人際互動與個人隱私之間取得平衡，建議在護理之家之房型法規的部分，下修至 4 人為上限，且每人並有 4 至 7 坪的活動空間。 (2)關於人力配置的部分，依據每一間護理之家的住民生活狀況，做出彈性的人力配置，適時的調整該護理之家的醫護人員與被照顧住民的比例，而不是用單純的數學公式決定相關人力的配額。 (3)長期照護之財源部分，使用「長照保險制」或是「保險制+稅收制的整合方式」與「純稅收制」來比，較為穩定，且能夠在規劃明年長照經費的預算時，將這些經費做最妥善的運用，也比較不必擔心經費不足的問題。 (4)政府想要讓全民知道長期照護的內涵，可以透過社群網路(如：Facebook, Instagram, Line)、高中的公民課本、新聞廣播、電視媒體…等方式，進行長照政策的宣導，讓民眾對於長期照護的認知更加了解，更有助於長照政策的推動。

關鍵字

長照機構；護理之家；長照政策；長照人力資源

並列摘要

Due to the increasing life expectancy, continuous medical advance and the declining birthrate, Taiwan has become an aging society. Besides, other countries also confront this problem. However, the hardworking of modern people, the time could spend on taking care of the elderly significantly decreasing. To make the elderly lead a happy life, some people choose to settle their old age in the long-term care institutions. Therefore, it is necessary for us to have a further understanding of the environment, facilities, and human resources of long-term institutions. The purpose of the research is to provide suggestions for related authorities. The study is conducted by means of general interviews in qualitative research methods and questionnaire. We choose seven nursing homes of all of the long-term care institutions in Taichung City and select 74 people to be our research objects, including nursing staff, nursing chiefs and supervisor. In addition, we pick 4 from 7 long-term care institutions and interview 1~3 people each. Our research time was from January to June 2018. The statistical methods used the reliability analysis, descriptive statistics, factor analysis, t-test and ANOVA analysis. The followings are conclusions in this study. 1. In factor analysis section, I generalize three important factors---“salary and equipment”, “working environment” and “policies and regulations”. According to that, “staff salary”, “software and hardware equipment”, “working environment” and “training programs” will affect employees’ satisfaction. “One fixed day off and one flexible rest day” could cause effect on human resource planning and recruitment of institutions. Finally, the staff whose education is different have significant differences in the environment issue of long-term care institutions. It is found that the staff who graduated from senior high and college are significant differences in the environment issue of long-term care institutions after types of Post Hoc Multiple Comparison procedures. 2. The opinion of this interview: (1)Considering the balance between social relationship and personal privacy, we suggest that nursing home’s room type should be changed from 6 to 4 per room, and everyone should have 13 to 23 square meters in private activity space at least. (2)The allocations of resources should be based on the conditions of the residents in each nursing home. Flexible resources allocations should be made. The ratio of healthcare workers and care-receivers in the nursing home is adjusted at the appropriate time, instead of deciding quota for related long-term care human resources by using a simple mathematical formula. (3) Which financial resources is the better way? We think “long-term care insurance” or “integration of the long-term care insurance and long-term care taxation” is more stable than “long-term care taxation”. It can make the best use of these funds when planning budgets for long-term funding next year, and it should also be less concerned about underfunding. (4)There are some ways to publicize the “long-term care content” for our citizens. For example, using social network (ex: Facebook, Instagram, Line), citizen textbook of senior high, news broadcast and so on. By making use of the tips mentioned above citizens can acquaint themselves with the long-term care content, which will surely improve the policy implement.

並列關鍵字

long-term care institution ； nursing home ； long-term care policy ； long-term care human resources.

參考文獻

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長期照護機構之環境、設備與人力資源的探討-以台中市為例

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