大台北地區公立醫院附設護理養護機構營運策略之研究—以A機構為例

由於經濟的成長、教育知識的普及、社會文化與生活水準發展較高，讓我國由開發中國家漸漸邁入已開發國家行列，進而促成國民平均壽命的延長和近年來生育率下降，台灣社會已出現人口老化的現象。65歲以上老年人口占總人口比率在2018年3月底也到達14.05％，所以臺灣已於2018年邁入「高齡社會」。因此為維護社會老年人口的生活尊嚴與質量，以及因應老人社會日後將帶給年輕壯年們的照顧負擔以及扶養壓力的加重，再者還有生育減少導致少子化的現象，因此扭轉目前老年化的社會，增進生活品質，不僅是政府施政努力的目標，也需我國國民們一起參與與關注。高齡社會的形成造成人口結構的明顯改變，為因應老年社會所帶來的老人陪伴與安養、勞動力減低與生育減少等問題，也為回應失能、失智人口增加所需照護勞力的要求，從家庭生活安養、居家照顧、社區照護到住宿式安養照顧之多元化的服務，得以建立以社區為基本的長照服務系統，刻不容緩。而長照服務機構中的一般長期照護安養機構中為「住宿式」的機構類別，有照顧難易程度來分，計有老人福利機構、榮譽國民之家、身心障礙福利機構及護理之家（護理養護機構）等。由於台北市立聯合醫院附設護理養護機構(護理之家)已營運有多年之久，其入住住民之組成、住民家屬選擇之喜好、住民家屬的地緣性與家庭所得、醫護人員與照服員的異同、還有與鄰近私人獨立護理養護機構之競合關係等，皆因不同因素而有所差別與差異，值得我們進一步加以研究、探討、比較與分析。本研究主要透過文獻的探討、人員議題問卷的訪問結合並目前的政經情況，藉以瞭解目前我國公、私立護理養護機構的經營現況、兩種機構入住住民的異同與醫護人員的現況異同、照服員的人力之調配與本國與外勞組成比例等，進一步探討公立醫院附設護理養護機構與私人獨立護理養護機構服務現況的異同點與經營模式競爭策略差異之研究。

關鍵字

護理養護機構；護理之家；高齡社會；長照2.0 ；營運策略

並列摘要

Due to economic growth and the popularization of education and knowledge, our country has gradually entered the ranks of developed countries from developing countries. Because of the extension of the average life expectancy of the national population and the decline in fertility in recent years, the population has become aging. This has become more apparent in developed countries, but similar phenomena have recently occurred in developing countries. For example, the proportion of the elderly population over the age of 65 in the country has reached 14.05% at the end of March 2018. Therefore, Taiwan has entered the "age society" in 2018. In order to maintain the dignity and quality of life of the elderly in the society, and to cope with the burden of care and support pressures that the elderly society will bring to the young and old, and nowadays, the phenomenon of declining birth due to reduced fertility, thus reversing the current ageing Society and the promotion of quality of life are not only the goals of the government's administrative efforts, but also the participation and attention of the people. The formation of an old society has caused a significant change in the demographic structure. In response to the problems of elderly people’s companionship and maintenance, labor reduction and fertility reduction in response to the elderly society, it also responds to the need to care for labor caused by the increase in disability and dementia. It is imperative to establish a community-based long-serving service system by providing a variety of services from family, home care, community care to residential care. Among the long-term care and maintenance institutions in the long-serving service organizations, there are "stay-type" institutions, including elderly welfare institutions, honorary national homes, mentally handicapped welfare institutions, and nursing homes. Since the attached nursing care institution of the Taipei City United Hospital has been in operation for many years, the composition of its residents, the preference of family members, and the competitive relationship with neighboring private independent care and nursing home are worthy of further discussion and comparison. This study, through the discussion of the literature, the interview of the personnel questionnaire, combined with the current political and economic situation, to understand the current situation of the operation of public and private nursing home institutions in Taiwan, the similarities and differences between the two institutions in the residents and the current situation of the medical staff, the counselor The allocation of manpower and the proportion of domestic and foreign workers, etc. Further explore the research on the status quo of the service and nursing strategy of the attached care and institutions and private independent care and nursing home institutions in public hospitals.