台灣長期照顧機構中職能治療服務的現況

背景：從2018年起，台灣成為高齡社會，人口扶養結構轉變為以扶老為主，因此，老年人的照顧問題以及其資源和品質是目前社會中的重要課題，而長期照顧機構便是其中一環。職能治療是一個以個案為中心的衛生健康專業，其可為機構中的老人及住民建立規律的生活作息並提供具有治療性的活動，促進生理、心理與社交活動的表現。然而，近十年來無針對台灣長期照顧機構職能治療的研究，因此本研究將探討長期照顧機構中職能治療的現況。目的：本研究欲了解長期照顧機構中職能治療師的聘用情形、機構中活動的設計與帶領人員以及機構負責人對於職能治療師的態度與期待。方法：以寄送調查表方式收集資料，以SPSS 22版統計軟體進行資料分析，以描述性統計分析機構基本資料、職能治療師聘用狀況、活動設計帶領人員和職能治療師聘用原因；推論性統計部分則是以卡方檢定分析機構基本資料與聘用職能治療師之關係並以獨立樣本t檢定分析機構對於職能治療師符合期待的程度。結果：在機構基本資料中，以護理之家、50-100床、私立財團法人以及醫院附設聘用職能治療師的比例較高且達顯著差異，而其聘用原因以增加復健活動類型、提高住民生活品質、評鑑需求與增加機構服務特色為主，但各機構仍有排序差異。在活動部分，職能治療師在其中佔比低，僅感官刺激活動、被動關節活動、衛教設計、動作肌力感覺訓練在專業人員中佔有前三名比例。結論：長期照顧機構中聘用職能治療師比例略為提升，但仍受評鑑指標、成本考量以及是否有其他專業取代角色而影響，以活動項目觀察，機構仍將職能治療師定位為傳統復健治療之角色，侷限職能治療在其中之發展，而職能治療師應持續發展專業的服務內容，使其成為長照團隊中不可或缺的一員。

關鍵字

職能治療；老人福利機構；護理之家

並列摘要

Background: In 2018, Taiwan has become an ageing society, and its population support structure has been transformed into one of helping the elderly. Therefore, the care of elderly people, and the resources available for and quality of that care, are currently important issues. One key resource is long-term care facilities. In such facilities, occupational therapists, who are client-centered health professionals, can help patients to establish regular lifestyles and provide therapeutic activities for the elderly and residents to promote physical, mental and social performance. In the past decade, however, no research has been conducted to investigate the practice of occupational therapy in long-term care facilities in Taiwan. Therefore, this study explored the current status of occupational therapy in long-term care facilities. Objectives: The aim of this study was to investigate the employment of occupational therapists in long-term care facilities, the designers and directors of activities of the facilities, and the attitude and expectations of the managers of long-term care facilities toward occupational therapists. Methods: Information was collected by questionnaire, and the data were analyzed in SPSS 22 statistical software. Descriptive statistical analysis was conducted on the organization's basic data, occupational therapist hiring status, designers and directors of activities, and reasons for the employment of occupational therapists. Inferential statistics were based on the relationship between the basic information and the chi-square test analysis of the employment of occupational therapists, and on the independent sample t-test analysis of facilities for occupational therapists in line with the degree expected. Results: The proportions of therapists employed in nursing homes of 50–100 beds, private consortiums, and attached hospitals were found to have relatively high and statistically significant differences. The reasons for their employment were to increase the types of rehabilitation activities, improve the quality of life of residents, meet appraisal requirements, and increase institutional features, but sorting differences still existed. In terms of activities, occupational therapists accounted for a low proportion of professionals, and only sensory stimulation activities, passive range of motion activities, health education design, and sensory motor training accounted for the top three proportions. Conclusions: The proportion of long-term care facilities employing occupational therapists has slightly increased, but the magnitude of increase proportion is still influenced by the accreditation index, cost consideration and the availability of other professional replacement roles. In these facilities, occupational therapists still play the role of traditional rehabilitation, which limits the development of occupational therapy. However, occupational therapists should continue the development of professional services so that they can become integral members of long-term care teams.