以案主為中心觀點探討居家服務照顧品質及其相關因素：以南投縣為例

本研究以案主為中心觀點探討影響居家服務照顧品質的相關因素，並探討服務使用者與家庭照顧者、直接服務提供者、間接服務提供者三方對居家服務照顧品質的影響力，以量化研究之問卷調查法瞭解南投縣9間居家服務提供單位之服務使用者與家庭照顧者對居家服務照顧品質看法，共訪查302份問卷，並找出其相對應的照顧服務員發放自填式問卷共167份，且輔以質性訪談方式，訪問服務使用者、照顧服務員、機構督導員各4位，共12位受訪者，以補充量化資料之不足，其研究主要結果如下： 1.居家服務照顧品質會受到服務使用者、家庭照顧者、照顧服務員、居家服務提供單位與督導的影響，在分量表上以「照顧關係」得分最高、「照顧工作技術」次之、「回應案主期待性」最低，顯示照顧關係為影響居家服務照顧品質關鍵要素。 2.從量化資料分析方面發現，對於居家服務照顧品質之階層迴歸分析中，服務使用者之「經濟生活來源」、「先前工作類別」、「使用者主觀感受」、家庭照顧者之「照顧者關係」、居家服務提供單位之「機構成立年數」皆達到顯著相關，均為有效預測居家服務照顧品質的因子，整體居家服務照顧品質量表的解釋力為29.3%。分量表方面，以「照顧工作技術」最高，解釋力為35.3%，其次是「回應案主期待性」，解釋力為29.3%，最低是「照顧關係」，解釋力為25.0%。 3.在質性訪談方面，以「人」的角度來看，影響服務使用者對於居家服務照顧品質的關鍵在於服務使用者與照顧服務員之間照顧關係的優劣，並包含溝通、配合、信任等元素，「準時、不遲到」是使用者最在意的部分；照顧工作技術為基本配備，代表照顧服務員專業展現，然而若照顧關係良好，照顧工作技術差是可以接受的；從制度來看，需求評估是否確實呈現服務使用者的服務需求亦影響居家服務照顧品質，代表能回應案主需求的期待性，即使照顧關係良好，若需求未被滿足或評估不確實，對居家服務照顧品質會有負向感受。最後根據研究結果對實務工作、學術研究、政策與制度上提出具體建議。

關鍵字

居家服務；居家服務照顧品質；照顧關係；以案主為中心

並列摘要

The aim of the study was to investigate the related factors of the quality of care in home services from client-centered perspectives, and to understand the impacts of the users, caregivers, providers, and care workforces on the quality of care in home care services. This study used quantitative method by using face-to-face surveys to collect data to understand the perceptions of the quality of care in home services from users and caregivers of nine agencies in Nantou County. A total of 302 users’ samples used home services completed questionnaires, and from the users’ samples to match that 167 care workforces samples are completed the questionnaires. The researcher also combined qualitative method by using in-depth interview, including 4 users, 4 care workforces, and 4 supervisors of those agencies. The main findings of this research are as following: 1.The quality of care in home services was affected by users, caregivers, care workforces, and agencies. From the Quality of Care Scale, the factors of the relationships between home care clients and their workers had the highest score. In the second place was the factor of the skillfulness of home care, and in the third place was the factor of the homecare in being responsive to client expectations. The result indicates the relationships between home care clients and their workers are the most important factor of quality of care in home services. 2.From the quantitative data, by the hierarchical regression analysis, the significant variables of quality of care in home services are the characteristics of users, caregivers, and agencies, including total income, previous types of jobs, users’ subjective perception of the workforces, relationship, and organization established period. These variables were significant predictive factors of quality of care in home services. In depth analysis, all of the variables accounted for 29.3% of variances. The first sub-scale had the lowest explained variances of 25.0%.The second sub-scale had the highest explained variances of 35.3%, and the third sub-scale accounted for 29.3% variances. 3.In qualitative interviews, from the client perspectives, good care relationships appear to be important determinants of Quality of Care, including communication, appropriateness, and trust. "On time" and "Do not be late" are the most important facors that users are concerned for. The skillfulness of home care is the basic equipment, because the factor shows the professional attitudes of care workforces. However, if the care relationship is positive, the techniques which are poor may be acceptable. From the perspectives of the system, whether the needs assessment actually rendered service users also affect the demands for quality of care, and to respond to the needs of the expectations of the users. Therefore, even care relationship is great, when the needs are unmet or the assessment is incorrect, negative feelings still emerged. Finally, according to the finding and conclusions, this study has suggestions for further research on practice, academic, and policy.