長照2.0 照顧服務資源對主要照顧者負荷之成效-以臺中市某長照機構為例

Effectiveness of long-term care 2.0 home services on the loading of primary caregivers : retrospective cohort study of a community-based service center in Taichung

吳虹諭(Hung-Yu Wu)

指導教授 ： 李淑杏

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2021年)

https://doi.org/10.6834/csmu202100271

摘要

背景：台灣人口快速老化，長期照護需求增加也形成照顧者之負荷。政府自2017年06月開始實施長照2.0政策，提供相關之照顧服務資源。居家照顧服務與喘息服務是否能改善主要照顧者負荷，值得進一步探討。
目的：本研究旨在瞭解長照2.0政策之照顧服務資源含居家照顧服務與喘息服務對於主要照顧者負荷之成效。
方法：本研究採回溯性世代研究設計（Retrospective Cohort study），以臺中市某長照機構之衛生福利部照顧服務管理資訊平臺之資料進行分析。收案時間為2019年01月01日至2020年12月31日之系統資料，符合長期照顧服務申請對象，連續使用長期照顧服務達1年者，共有211位主要照顧者資料進行分析。以描述性統計含個數、百分比、平均值±標準差；推論性統計含配對t檢定、GEE廣義估計方程式資料進行整理，再以統計軟體進行分析。
結果：主要照顧者以女性66.35%居多，照顧平均4.5年，49.76%有工作，自覺生活品質不好者佔75.83%。主要照顧者負荷評估為5項，初期負荷分別為91%無法承受照顧壓力、72.04%體力負荷、46.45%睡眠受到干擾、36.97%對被照顧者的行為感到困擾及29.38%需分配時間照顧其他家人。經照顧服務資源使用後，於後期上述之負荷均顯著降低(p<.001)。GEE分析結果發現影響主要照顧者負荷為照顧初期、女性、自覺生活品質不好者及被照顧者之ADL與IADL較差者，而使用長期照顧服務則能顯著降低主要照顧者負荷(p<.001)。
結論：研究結果顯示長期照顧服務之主要照顧者多有負荷，而居家照顧服務之長期照顧服務資源使用可有效減輕照顧者負荷。本研究結果初步瞭解長照2.0政策具有成效。

關鍵字

長照2.0 ； 居家照顧服務 ； 喘息服務 ； 主要照顧者 ； 照顧負荷

並列摘要

Background：
Taiwan's population is rapidly aging, and the increasing demand for long-term care has created a caregiver burden. The government implemented the Long-Term Care 2.0 policy in June 2017 to provide related care service resources. Whether home care services and respite services reduce the loading of primary caregivers is worthy of investigation.
Objective：
This study aimed to explore the effectiveness of the care service resources provided by the Long-Term Care 2.0 policy, including home care services and respite services, on primary caregivers’ loading.
Methods：
This retrospective cohort study analyzed data from the care service management information platform of the Ministry of Health and Welfare for a long-term care institution in Taichung City. Data was retrieved on 211 cases meeting the long-term care service application objectives who had continuously used long-term care for at least 1 year between January 1, 2019 and December 31, 2020. Data was analyzed using descriptive statistics (numbers, percentages, and mean±standard deviation) and inferential statistics, including paired t-tests and generalized estimation equation (GEE) analysis.
Results：
The average duration of care was 4.5 years. Primary caregivers were mostly female (66.35%); 49.76% had jobs; 75.83% reported their quality of life was not good. Initially, 91% of carers were unable to bear the care-giving pressure and 72.04%, the physical load; 46.45% had sleep disturbances; 36.97% were troubled by the patient’s behavior; and 29.38% needed to allocate time to care for other family members. Use of the long-term care service resources significantly reduced all of the above-mentioned loads (p<.001). GEE analysis found primary caregiver burden was associated with early-stage care, female carers, poor carer quality of life, and poor carer ADL and IADL, while long-term care resources significantly reduced these loads (p<.001).
Conclusion：
Primary caregivers are often heavily burdened; the long-term home care service resources effectively reduced the caregivers’ burden. This study provides a preliminary understanding of the effectiveness of the Long-Term Care 2.0 policy.

並列關鍵字

Long-Term Care 2.0 policy ； home care service ； primary caregiver ； burden

參考文獻

內政部(2020)。內政統計通報。「109年第10週_老化與扶養」，(7,Mar,2020)，https://www.moi.gov.tw/stat/news_detail.aspx?sn=17589

方圓媛、洪佳黛、詹瑞君、 李芸湘(2017)。 談癌症病人家屬照顧者心理衝擊與介入方案。 榮總護理， 34(3)， 220-226，https://doi.org/10.6142/VGHN.34.3.220

王峻宏(2019)。日本安倍政府高齡少子化下勞動力短缺問題對策之探討--從生產函數的觀點。 淡江大學日本政經研究所碩士班學位論文，1-94。

吳秋燕、張素珠(2014)。 老年人身體活動與生活品質之探討。 臺中科大體育學刊， 10，33-44， https://doi.org/10.6980/NUTCPE.201405_(10).0003

吳聰敏(2004)。 從平均每人所得的變動看台灣長期的經濟發展。 經濟論文叢刊Taiwan Economic Review， 32(3)， 293- 320，https://doi.org/10.6277/ter.2004.323.1