老年照護之配適策略與滿意度研究

Study of Satisfaction and Allocation Strategy for Healthcare in Ageing Society

白錫彥(HSI-YEN PAI)

指導教授 ： 鍾任琴

朝陽科技大學/管理學院/企業管理系台灣產業策略發展博士班/博士(2016年)

摘要

本研究主要目的在於探討臺灣地區老年族群照護服務的需求概況及有關照護服務型態「配適策略」（適當性）的因素，並分析「照護服務品質」、「配適策略結果」與「自我效能」對於老年族群「照護滿意度」的影響，歸納適合老年族群照護管理的流程與架構。
研究方法是先就居家照護或非居家照護的老年個案進行質性訪談，經整理本研究主要的分析要素以建立研究架構，再透過到位訪視與問卷方式進行研究。問卷對象係以臺灣地區(本研究含臺中、嘉義、高雄) 可以配合研究訪視的機構式、社區式和居家式之老人照護單位，其中包括護理之家、日間照護、安養中心 ( 或老人住宅 )、日間托老、社區照護、學習單位、居家照護等為主；將問卷記錄經由編碼建檔，進行統計分析與假說驗證。
研究結果如下： 一、分析204位接受照護服務的老人基本資料，年齡以65~74歲(48.5 %)佔最多數，女性比例(74.5 % )較高，喪偶比例 (57.8 % )已超過半數，教育程度多數在小學程度或不識字，分別佔整體樣本之39.2 %及24.5 % (合計63.7 %未接受過中學以上教育)。在受測者中未失能者比例較高且過半數以上（失能者為76位，佔37.3 %，未失能者為128位，佔62.7 %），主要的信仰以傳統之道佛教(合計82.3 % )為主。二、「配適理想與否」的可能影響因素，經由驗證「失能」、「家庭 / 資源」、及「自我效能」三項因素，只有「自我效能 」（p < 0.05）是顯著的相關因素。三、老人「照護滿意度」的顯著因素，包括「照護服務品質」（ p < 0.001 ），「配適適當與否」（ p < 0.05 ）與「自我效能」（ p < 0.01 ）的因素。四、照護滿意度在老年族群因其本身特性而有所差異。
總結：一、老年族群接受照護服務的需求與滿意具有個別的特性與差異；建議規畫老人照護在實務上或政策上都要重視長者的個別需求。二、「自我效能」是影響「配適理想與否」的一項顯著相關因素，但是「失能」因素或「家庭 / 資源」因素則非獨立的影響因素；建議共同考慮以選擇理想照護配適。三、老人「照護滿意度」的因素，主要包括「照護服務品質」、「配適理想與否」與「自我效能」；建議照護提供者應尊重老人自我效能程度而提供配適的照護服務，並積極提昇其照護服務品質。四、在實務現況下照護配適得宜與否仍有個別落差；建議老年族群可參考本研究之「老人照護管理流程架構」，依個人狀況與專業諮商，而選擇其較適當的老人照護模式以提高照護滿意度，尤其老人「自我效能」應更受尊重並提昇「銀髮樂活」的理念。
關鍵詞：老年；照護服務；配適策略；滿意度；銀髮樂活

關鍵字

銀髮樂活 ； 滿意度 ； 配適策略 ； 照護服務 ； 老年

並列摘要

The purpose of this study is to evaluate the needs of healthcare and related factors of ‘healthcare allocation’ (whether well fit or not) for ageing people in Taiwan. The factors including ‘quality of healthcare service’, ‘allocation strategy’ and ‘self-esteem of social function’ are also analysed about ‘the satisfaction of healthcare’ in ageing people, and a framework of healthcare for ageing people is to be constructed.
The study method was quality intervention of home-stay or non-home-stay ageing people at first to set up constructure of study, then underwent case visit with each questionnaire. The 204 questionaires were completed among ageing people in Taiwan area (including Taichung, Chiayi, and Kaohsiung in this study) in which this study is accessible, and included institute-based, community-based and home-based care systems. There were mainly ‘nursing home’, ‘day care’, ‘shelter housing’, ‘day support’, ‘community center’, ‘learning center’, and ‘home (residential) care’. The data were coded systemically and analysed statistically to evaluate related hypothesis.
The Results reveal: 1. The 204 ageing people compose most of 65 to 74 years old (48.5 %), with female predominant (74.5 %), and spouse death rate for 57.8 %. The education level was most below junior middle school (63.7 %). The traditional religions are 82.3 % in percentage. 2. The main factors of ‘allocation strategy’ for ageing people may include ‘disability’,‘family resources’, and ‘self-esteem of social function’ factors. Only ‘self-esteem of social function’ ( p < 0.05 ) is the independent factor significantly. 3. The ‘quality of healthcare service’ ( p < 0.001), ‘allocation strategy’ ( p < 0.05 ) and ‘self-esteem of social function’ ( p < 0.01) are all significant factors and positively relate to ‘satisfaction of healthcare service’ for ageing people. 4. The satisfaction of healthcare is varied among ageing people that differ in their own personal characteristics.
Conclusions of this study: 1.The needs and satisfaction of healthcare service are varied among ageing people with different background. Individual healthcare for them needs be emphasized both in real life and in policy. 2. ‘Self-esteem of social function’ is significantly the factor of ‘allocation strategy’, however, neither ‘disability’nor ‘family resource’ is dependent factor. They might be considered only together when facing allocation strategy. 3. The ‘quality of healthcare service’, ‘allocation strategy’ and ‘self-esteem of social function’ relate positively with ‘satisfaction of healthcare service’ for ageing people significantly. Therefore, we suggest that providers of healthcare service care about self-esteem of social function of ageing people for better fitness in allocation strategy and make more improvements in quality of healcare for which they may provide. 4. In spite that there are really lots of barrier or gap of allocation for ageing people, they can follow the framework of ageing-care model in this study. They need consider their own conditions and had better consult experts for individual allocation to fulfill their needs and satisfy themselves. Finally, more concerns on ‘self-esteem of social function’ of ageing people for ‘active ageing’ are encouraged.

Keywords: Ageing, Healthcare, Strategy of allocation,Satisfaction, Active aging.

並列關鍵字

Active aging ； Satisfaction ； Strategy of allocation ； Healthcare ； Ageing

參考文獻

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