都會區私立小型老人長期照顧機構運營管理與品質提升之研究-以雙北市為例

A Study on Management and Service Quality Improvement of Long Term Care Facilities for Senior Adults in Metropolitan Area --- Taking in Taipei City and New Taipei City for Example

林哲弘(Tse-Hung Lin)

指導教授 ： 施顏祥

中原大學/商學院/企業管理研究所/碩士(2018年)

https://doi.org/10.6840/cycu201800060

摘要

高齡化社會與長照服務已成各國發展的重要課題，人口老化所帶來的問題愈趨嚴重，包括國家沉重的福利、醫療與照顧負擔支出、投入勞動人口減低、經濟發展的阻礙與困難等，因此各國政府無不加緊腳步，致力因應人口高齡化所帶來的衝擊，家庭照顧能力是影響長期照顧發展的重要因素，台灣因面臨少子化、經濟力衰退與婦女就業等因素，嚴重影響甚至改變了傳統家庭的照顧模式；
到底是承歡膝下還是送專業機構？在不同世代的父母或子女心中，總各據天秤兩端，要如何盡孝道才能兩全？有限的選擇讓這些家庭開始陷入掙扎，看起來，讓長輩入住離家近又品質好的機構是比較圓滿的選擇，但是，離家近又品質好機構在哪裡？又是怎樣才是品質好的長照機構？
《康健雜誌》在2014年9月舉辦「百大優質老人照顧機構」發表記者會。其中多數被票選出來的優質機構都是長期處於滿床狀態，等候入住的名單極長，甚至有些還需等待數年，而另一方面是，近幾年來，許多小型的優質長照機構逐漸消失了，但消失的原因卻極少被人關注！
我國政府在2017年6月3日起開始實施長期照顧服務法，推動住宿式機構法人化，但因法令與政策本身卻缺少針對機構的分級管理與彈性，對許多小型的安養護長照機構確實造成經營壓力與困難，亦造成住宿式安養護照顧機構陸續退場，逐漸使台灣的長期照顧產業結構改變，而這樣的改變對有重度照顧需求的家庭而言，其影響與衝擊可想而知。
在政策上標準提高的目的是為了提升照顧品質，以保障受照顧者之權益，而良好的照顧品質亦是長期照顧機構永續經營之基礎，政府目前主推的長照2.0雖未納入小型養護機構為計劃核心，但以現實而言，立於都會區或社區之中，49床以下的小型養護機構，優勢在於社區化，其精神與長照2.0相符，長輩儘管入住機構，但仍未離家太遠，方便親人、子女可經常探望，也避免脫離原本的生活圈。
「好的機構排不進，壞的機構不敢去」是民眾普遍反映的現況，養老機構本身的服務水準、內涵及方式，是影響民眾選擇的最大因素，因此，長照機構若能提升照顧的環境與品質，促使提高民眾使用率，也可使機構收入增加，以達到財務平衡與永續經營之目的。
本研究以採用PZB服務品質模式合併SERVQUAL量表做為工具，並透過訪談9位政府評鑑為優等及甲等之業務負責人，匯整影響長照機構營運與品質之因素，依資料進行態勢分析(SWOT)與競爭力分析，並以個人卅年經營多家長照機構之經驗，歸納出數要點與建議，做為長期照顧機構提升其品質與運營之參考，期盼小型長期照顧機構以永續經營為目標，穩定而長久的結合政府政策與社區能量，架構出完善的長照支持服務系統，使青壯年能安心投入職場，成為台灣經濟發展的動力，並落實在地老化的理想，提供每位老人與其家庭維持一個有品質的生活。

關鍵字

高齡化社會 ； 長期照護 ； 長期照顧機構

並列摘要

The concerns of aging society and long-term elderly care services become one of the important developing policies for a country resulting from the amount of problems caused by the aging of population. These problems of the aging of population include the heavy burden on social welfare and medical care, the deceasing population of national labors and increasing obstacles to the social economic development. To solve the difficulties mentioned earlier, every country tries to take action forward to the long-term care system development. The family care is the one of the essential elements for developing the long-term care system in a country. The decline birth rate and social economy and the increase of women employment make the great change in the mode of traditional family care in Taiwan.
For elderly parent care, whether it should be let the family members or the professional institution to take charge of, it becomes the dilemma for parents and children in different generations. Within the limited options for elderly care services, it seems that to let a localized and qualified institution to take charge of the elderly care is much appropriate and ideal solution for most families. However, how to find a localized and qualified elderly care institution and what a qualified long-term elderly care institution should be are still the problems for those families to solve.
In September. 2014, the Top 100 qualified elderly care institution news conference was held by the CommenHealth magazine. According to the news conference, it shows that most of the high qualified elderly care institutions voted by the citizen reach the full quota of the bed capacity over a long period of time, so that, there are still great amount of the elderly on the waiting list. Moreover, in recently, qualified long-term elderly care institutions in small-scale decline but with little concerns.
Taiwanese government proposes the Long-term Care Act on 3 July, 2017 to promote the legalization of the care home for elderly care. However, many small-scale long-term elderly care institutions and care homes encounter great difficulties in management and gradually decline due to the weak levels of management and flexibility in the policies and laws of operating a elderly care institution. The decline of small-scale elderly care institutions and care homes could restructure the long-term care industry in Taiwan. In addition, this industrial decline makes a great effect on those families who have the serious needs for elderly care.
The purposes of the rise in standard of long-term elderly care policies are to improve the quality of elderly care services and to protect the rights for those care recipients. The good quality of the elderly care services is the foundation of the sustainable development of long-term elderly care institutions. Though the small-scale community-based elderly care institutions are not in core of the long-term care plan 2.0 proposed by the government for performing the long-term elderly care services, in reality these small-scale elderly care institutions which are under the total amount of beds of 49 and are located in the urban or community areas could truly meet the needs and the requirements for both the elderly care families and care recipients. For the other elderly care family members, it is convenient for them to visit their elderly parents. For the care recipients, they could still keep the close connections with their previous lives.
The manners and the quality of the elderly care services in a long-term elderly care institution are the important factors for citizens to choose a suitable long-term elderly care institution. Therefore, in order to achieve the goal of sustainable management and profits growth of a long-term elderly care institution, it should improve the environment of the institution and the quality of the long-term care services. By doing so, it could increase the utility rate of the long-term care system and the funding of the elderly care institution.
This study aims to provide some useful information for improving the quality and operating strategies of a long-term elderly care institution by adopting the PZB Service Quality Model, SERVQUAL Model and in-depth interview with 9 professional accountable people who are appraised by the government to analyze the factors in operating a long-term care institution and providing quailed long-term care services. Moreover, through the SWOT analysis and competence analysis of the data with the 30 year-personal experiences in operating long-term care institutions, this study summarizes some key points and suggestions for operating strategies of a long-term elderly care institution. It is also hope that the small-scale long-term care institutions could integrate the power of government policies and community manpower to construct a steady long-term care service system. Therefore, it could foster the youth turn into the workforce to promote the national economic development. Also, it could accomplish the goal of aging in place and provide the qualified living standard for both the elderly and their family.

並列關鍵字

aging society ； long-term care ； long-term care facilities

參考文獻

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