這樣經營可以嗎？台灣居家式長期照顧服務機構經營模式之研究-以高屏地區為例

Does It Work in Practice? A Study on the Management Model of Home-based Long-term Care Service in Taiwan-Taking Example of Kaohsiung and Pingtung Areas

陳姿妏(Chen Tzu-Wen)

指導教授 ： 趙善如

國立屏東科技大學/人文暨社會科學院/社會工作系所/碩士(2020年)

https://doi.org/10.6346/NPUST202000477

摘要

台灣長期照顧服務朝向福利混合經濟之發展趨勢，運用多元分工、民營化及契約化的整體服務輸送體系下，穩定財源、鞏固人力，以因應我國長期照顧在財源不足及人力短缺之議題困境。因此，為了解我國居家式長期照顧服務不同經營模式於現行長期照顧服務政策之發展及未來運作之可行性，本研究以服務項目需求最高之居家服務為主體，以高屏地區占較高比例之個人設立長期照顧服務機構，及符合混合經濟經營模式之合作社、公司型營利單位經營長期照顧服務機構，作為研究場域；依據文獻探討歸納整理機構組織經營要素與重要指標，含經營管理、人力資源、服務品質及財務管理等四大面向為主體，擬定半結構式訪談大綱，並於2020年01月至2020年03月間，訪談8位機構中熟悉機構經營與管理之幹部等長照機構經營管理人員，其中包含個人設立及合作社設立之經營模式，各3間、以公司型設立之經營模式，共2間。採個案研究方法，針對三種模式在台灣的運作現況與問題困境，作整體性的了解，並進一步分析比較，提出幾點建議：第一，經營管理面，經營管理者背景資格應具備管理專業，以強化外在市場的趨勢及變化之敏感度，設置明確的機構運作目標與方向；第二，人力資源面，個人設立財務來源單一，須有效控管機構運作成本，因此從人力前端招募，到後端的留用，皆應層層把關，以減少人力成本的消耗；第三，品質管理面，為有效提升機構服務量能，應落實人力教育訓練及使用品質監測工具，以修正缺失，提供更貼近人性的服務；第四，財務資源面，個人設立之經營模式應在財務配置及監控上有更多著墨，以利機構了解機構組織的營運現況，而公司型營利單位之經營模式，其母公司掌握財務配置的絕對權力，但組織性豐厚的資源，雖然得以拓展更廣的業務，卻可能壓縮個人設立或合作社的生存空間，因此，中央政府對於長期照顧服務業務的運作與經營權，特別是社區整合型服務中心，應重新檢視，避免造成資源分配不均之現象。最後，針對整體長期照顧服務在政策推動、人力及財務資源等面向提出建議，以積極面對目前長期照顧服務政策所面臨的困境。

關鍵字

長期照顧 ； 居家式長照機構 ； 經營模式 ； 產業化

並列摘要

Taiwan’s long-term care service is moving towards the mixed economy trend of welfare. Using diversified division of labor, privatization and contractualization under the overall service system to stabilize financial resources and consolidate manpower to deal with the dilemma of financial resources and manpower shortage issue in Taiwan’s long term-care service. Therefore, in order to understand the development of the current long-term care service policy and the feasibility of its future operation in different business models of home-based long-term care services in Taiwan, this study takes home care service, which is highly in demand in service items as research subject. Taking long-term care service organization establish by individual which is the largest proportion in Kaohsiung and Pingtung areas, the cooperatives of mixed economy business models, long-term care service organization operated by corporate profit-making units as research fields. Based on Literature Review generalize the element of managing organization and critical index which include management, human resources, service quality and financial management as main subject. Draw up Semi-structure interview outline, 8 supervisors who familiar with the management of long-term care service were interviewed between January to March 2020, including three of each of business models as individual establishment and cooperative establishment, two of business models established as corporate. Using case study method to figure out the current operating condition and problems in Taiwan and further analyze it. There are some suggestions: First, the aspect of management, the organizer should have the qualification of management major in order to strengthen the sensitivity of external market trends and changes and set a precise operating goal and direction of organization. Second, the aspect of Human resources, the organization established by individuals should have single financial source and must effectively control the operating cost, keep an eye on recruitment and retention of manpower in order to reduce the consumption of labor costs. Third, the aspect of quality management, in order to effectively improve service capacity of organization, education training and the tool for monitoring quality should be implemented for correcting deficiencies and towards user-friendly. Forth, the aspect of financial resources, the business model established by individual should pay more attention on financial allocation and monitor to facilitate the organization to understand the operation status. In the business model of corporate profit-making unit, the parent company has absolute power to allocate financial resource, although it has richly organized resources to expand wider business, may reduce the surviving space of individuals or cooperatives. Therefore, the central government should re-examine the operation and management of long-term care service business, especially community-integrated service centers, to avoid the phenomenon of unequal resource distribution. Finally, making suggestion about policy, manpower and financial resources aspects for overall long-term care service to face positively about the difficulties of long-term care service policy.

並列關鍵字

long-term care ； the management of model ； home-based long-term care organization ； industrialization

參考文獻

林金定、嚴嘉楓、陳美花（2005）。質性研究方法：訪談模式與實施步驟分析。身心障礙研究季刊，3（2），122-136。

姚蘊慧（2004）。社會福利民營化的再省思。通識研究集刊，5，39-52。

張和然、邱文志、林晉照、陳文琦（2007）。非營利長期照護機構經營績效之探討以宜蘭地區小型養護機構為例。績效與策略研究，4（1），27-48。

中文文獻

內政部統計處（2019）。第133號國情統計通報。取自https://www.dgbas.gov.tw/public/Data/9717160105LGQ42NT.pdf