小規模多機能機構服務與經營之探討

為了瞭解在實務場域中小規模多機能機構在服務提供與經營層面上的現況及所面臨到的困境，透過與九位小規模多機能機構主管的個別深入訪談，並藉由主題分析法的方式，呈現出小規模多機能機構在經營及服務提供的歷程及觀點。本研究發現，服務對象及家屬對於長期照顧機構的使用意願及社會大眾對於機構的認知與機構服務輸送的關係皆是影響小規模多機能機構成效的關鍵之一；在人力資源系統方面，機構服務品質與人力調度的關係存在著相互影響的關係，希望提供良好的長期照顧服務給長輩，就必須建構出高品質的人力資源系統；照顧服務輸送方面，長期照顧服務要能夠流暢的輸送服務，必須具備高度的服務彈性，並建構出連續性的長期照顧服務輸送體系，完整且不間斷的提供長期照顧服務；長期照顧政策方面，必須先穩定發展長期照顧政策，使長期照顧服務能夠確實輸送。因此根據上述研究發現，分成兩個層面提出建議：首先，對小規模多機能機構，提升民眾對社區式長期照顧的認知並促進使用意願、建構高品質人力資源系統、主動向政府持續為長期照顧經營困境發聲等；第二，對長期照顧政策發展，重新調整照顧比例以提升機構照顧品質、給予服務提供單位變更照顧計畫的權利、建構穩定的長期照顧政策等。

關鍵字

小規模多機能；長期照顧；機構經營

並列摘要

In order to understand the current situation in the aspects of service provision and operation management of small- and medium-sized multifunctional institutions in practical fields as well as the predicaments confronted by the institutions, the paper makes in-depth interviews with 9 supervisors of a small-sized multifunctional institution and employs thematic analysis method to present the process and viewpoints on the operation management and service provision of the small-sized multifunctional institution. The paper finds that the relationship among the service targets’ and the patient families’ willingness to use the long-term care institution, the public’s understanding of the institution and the service delivery of the institution are factors affecting the small-sized multifunctional institution. In the aspect of human resource system, there exists a mutual influence in the relationship between the institution’s service quality and manpower scheduling. If we hope to provide good long-term care service to the eldery people, we have to construct a high-quality human resource system. In the aspect of delivery of care service, long-term care service must be the service available to be smoothly delivered, and must possess high degree of service flexibility. Continuous delivery system of long-term care service should be established to provide comprehensive and continuous long-term care service. In the aspect of long-term care policies, first of all, there should be stable development of long-term care policies that can make long-term care service to be able to be really delivered. Therefore, according to the above findings of the study, the paper divides the research into two levels. First, towards the small-sized multifunctional institution, there should be strengthening of the general public’s understanding of community-type long-term care, facilitation of people’s willingness of use of such care service, establishment of high-quality human resource system, active and continuous feedback to the government about the predicaments in operating long-term care service. Second, towards the development of long-term care policies, there should be readjustment of the ratio of care providers so as to enhance the care service quality of the institution, offer of the right to change caring plans to the units providing long-term care service, and formulation of stable long-term care policies.