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  • 學位論文

以資源耗用群分析台中市中低收入失能 者居家照顧服務利用之探討

The Survey of Home Care Services for Medium and Low-income Disable People by Resource Utilization Groups (RUGs) in Taichung City

指導教授 : 朱僑麗
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摘要


中文摘要 目的:欲瞭解台中市中低收入失能者居家照顧服務利用及居家服 務員合理費用之探討。 方法:採結構式問卷調查法進行調查,第一階段由研究者親訪居 家服務中心收160 個案(回收率93 . 6 % ) ,以次數、百分比及卡方檢定 分析,探討個案使用情形、失能程度對居家服務;第二階段由研究者 跟隨居家務員到個案家,以碼錶計時的方式計算,居家服務員實際幫 個案服務項目,再依「困難度.及「耗時性.做資源耗用群之分析。 結果:居家服務個案就以女性(65 . 6 % )、74 一84 歲(48 . 1 % )、喪偶 ( 51 . 3 % )、與人同住(57 . 5 % )及中低收入(81 . 3 % )比例為較高;時數之 使用情形以每月8 小時(33 . 1 % )、每週1 次(36 . 3 % )及每次2 小時 ( 82 . 5 % )比例最高;‘家務及日常生活照顧服務.以居家環境改善需 求最多(86 . 2 % ) ;「身體照顧服務.以協助沐浴需求最高(53 . 8 % )。 個案使用居家服務之服務時數與自變項關係,經雙變項結果分析 發現疾病個案數、居住情形、身心障礙與否、失能程度、日常生活功 能障礙(ADL )及工具性日常生活功能障礙(IADL )之變項,皆與使 用居家服務時數有密切之關係;協助沐浴、穿換衣服、進食及陪同散步四項服務與個案失能程度有顯著相關。 依「困難度」及「耗時性」分為九大項目,最復依配對方式將劃 分出二個族群,「族群二(工作困難度高)」經雙變項分析發現,居家 照顧服務的困難度與個之案之失能程度有呈現顯著相關(p < 0 . 001 ) 即必須重新依照個案之失能程來分別計算費用。 結論:依資源耗用群分析顯示,現今居家服務員之給付,對於工作 困難度及所耗用時問不甚合理。未來期許費用的計算標準,其有必要 重新考慮工作項目之困難度及耗時性,不宜使用單一支付標準,應隨 著服務項目困難度增加費用需提高,才可以達到費用的公平。

並列摘要


Purpose: The topic is discussing the home care service and the almoner fee of the medium and low-income disable in Taichung. Methods: The method is used the structural questionnaire research to conduct investigation. The first step is getting at least 160 individual questionnaires from the institutions of home services. (Recovery 93.6%) Then, disable level of home care use frequency, percent and chi-square test to discuss the cases. The second step is visiting the cases of home care with home care attendant. We use the stopwatch to calculate the service items of home care by attendant. Then, basis of difficult and timing consume for analysis of RUGs. Result: The higher proportion of home care is women (65.6%), the age of 74 to 84 (48.1%), widower (5 1.3%), live together (57.5%), and medium and low-income (81.3%). The highest hours of home care is eight hours every month (33.1%), one times a week (36.3%) and two hours for one times (85.2%): the most demand of home care and life care is house clean (86.2%), and the most demand of body care is helping bath (53.8%). After chi-square test analysis, the relationship of service hours and Independent variables for cases of home care found the disease cases from home care, such as live status, disability handbook(Disable level) Action disable level (ADL) , and implement action disable level (IADL) . Above these items have germane for the hours of home care like helping bath, change clothes, eat and take a stroll. These service use reaches reveals the correlation with disable level cases. According to difficult and timing consume to distribute nine items. Finally, we divide items into two groups by match. After Chi-Square Test analysis, we found that reveal the correlation between the difficult of home care and the disable level of cases (p

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