偏遠地區推動長期照顧經驗之研究

本研究以質性訪談與次級資料分析法等研究方法，來探討高雄市偏遠地區三個長期照顧據點之工作人員，推動長期照顧過程中所面臨的困境與因應之道，以及突破困境之關鍵點。從訪談內容詮釋歸納出抽象的概念，另將三個地區推動長照成果資料分析與訪談資料分析互相驗證。研究結果發現：偏遠地區推動長照必須對當地文化與風俗有相當程度的了解，否則會因此感到焦慮，而透過網路、拜訪關鍵人物、蒐集長照人口相關資料，縮短適應期、順應當地生活習性，進一步了解當地長照需求。另外，推動長照管理專員必須具備良好溝通互動能力，故三區皆為社工人員，運用社區工作專長，以其特有的真摯、同理、澄清等技術去面對困境，以正向心態討論並尋求適當解決方法。因偏遠地區人口老化與乏專業人力，要持續推動長照需中央挹注經費並設置當地據點，方能有就近性、立即性的長期照顧服務，順利做好長照服務輸送過程。至於承接單位對偏遠地區推動長照方向會影響試辦計畫的成功與否，若由醫院端承接初期易以醫療角度切入，但修正執行方向，對偏遠地區個案進行全面性普查，能快速了解當地長期照顧需求。而主管與內部機構的支持能加速長照業務的推動，在行政端的支持與授權讓作業加速，督導的同理與支持，以及個案討論能增強工作人員專業能力。最後，推動新的長期照顧服務項目或規定需考量城鄉差距，如居家藥師與居家護理，因專業人力不足與交通不便以致服務無法至偏遠地區，而居家環境清潔子女同住高雄市就不予核發，但偏遠地區交通耗時或道路易中斷，子女少能返家等，城鄉差距之現實面應被考量在推動長照服務項目或新規定之中。

關鍵字

偏遠地區；長期照顧服務據點；城鄉差距

並列摘要

This is a qualitative research study about experience of long term care promotion in a remote area. The subjects are staffs who work in three remote areas of Kaohsiung city for long term care, focused on the difficulty and the way they deal with it. Materials are collected by interview and secondary data analysis. Abstract conceptions are then inducted from interview, and verified with achievements they had made in those 3 areas. We found that knowledge of social custom and culture are particularly important when promoting long term in a remote area. Collect materials from Internet and interview with local key persons before and during the promotion can help to shorten accommodation period and mix goals together with life of folks. The long- term care manager should have great communication skill. All 3 care managers are social workers and they can use their specific expertise like empathy and clarify to seek for proper solutions with positive attitude. Government should sponsor the promotion. Since relatively high average age of population in remote area, as well as lack of professional personnel, it is hard to make economy scale and thus impossible to promote long term care successfully without subsidy. The prospective of how undertakers think of long term care will determine the outcome. A hospital tends to take it as an extension of medical service because of past experience. Change their prospective and perform a screening of all candidates of long term care user in whole area may of great help. Institution should back their staff by eliminating the bureaucrat process, empathy and support from supervisor and case conference may empower the professions of staff, both make thing much easier. We also current rules are not friendly to remote area long term care. For example: Professional service, like home care nurses or pharmacists are difficult to transport from institution to service area. Rule that can be applied to urban residents, like prohibit aged parents apply for home clean service if they have offspring in the same city, is more than ridiculous going towards if they lived in rural area far away from their sons who live in urban. Urban-rural gap should be carefully taken consideration with a new service or rule.