The Development of an Occupational Therapy Delivery Model for Long-term Care Facilities
羅鈞令(Jin-Ling Lo)；毛慧芬(Hui-Fen Mao)；蔡宜蓉(Yi-Jung Tsai)；黃小玲(Sheau-Ling Huang)；林惠冠( Huei-Guan Lin)；李世代(Shyh-Dye Lee)；張志仲(Jyh-Jong Chang)
長期照護 ； 護理之家 ； 職能治療 ； long-term care ； nursing home ； occupational therapy
|Volume or Term/Year and Month of Publication||
20卷（2002 / 11 / 01）
117 - 128
目前我國長期照護服務多以保護住民安全及滿足住民生理需求為主，長期照護機構之住民普遍缺少活動與刺激。為提昇護理之家的服務品質，本研究以發展長期照護機構職能治療介入模式為目標，針對兩所護理之家以全面介入的方式推展職能治療介入計畫。 介入的方式包括與管理階層的溝通，達成制度面的調整；提供工作人員在職進修，補充其專業知能；評估住民的身心功能並設計個別化治療計畫；指導工作人員個別化治療計畫的實施；以及提供住民個別及團體職能治療等。經過十個月的職能治療介入，工作人員反應位民的身體狀況與心 都比較穩定，生病送醫的情況有減少，活動與刺激增加，生活中支充實。工作人員本身透過觀察住民在團體職能治療中的反應，及每月一次的講習課程或座談討論，亦改變了其服務住民的態度與方式，較能尊重住民的自主性需求。整體而言，不論是對位民或是照護者，職能治療介入促進了長期照護工作正向的改變。 影響長期照護機構改變服務模式的因素主要有三點：（一）專業人力資 源，（主）家屬的要求，以及（三）長期照設機構評鑑指標。因此當務之急是（一）聘請專長日常生活功能訓練與活動設計的職能治療師，來協助長期照 護機構為住民安排有意義的生活內容，（二）教育並協助家屬在長期照護工中扮演積極的角色，（三）盡速訂定以維護住民生活品質為目標的長期照服務標準，並據以擬定長期照護機構評鑑指標，提供機構經營者與主管 人員一個明確的方向去努力，如此我閻長期照護服務品質才可望提昇。
Generally speaking, current long-term care services in Taiwan emphasize safety and survival needs of the residents. There is serious lack of adequate activities and environ- mental stimuli. The purpose of this study was to develop an effective occupational therapy (OT) intervention model for long-term care facilities to improve the service quality of long- term care services. A comprehensive OT intervention program was developed for two nursing homes and its feasibility was investigated. The intervention program included the following:(1)communication with the managing personnel to facilitate organizational reconstruction (2)providing professional education to the facility care-givers, (3)assessing the physical and psycho-social status of the residents, (4)planning individual treatment programs for the residents, (5)instructing the care givers to carry out the individual treatment programs, and (6)providing direct occupational therapy service to the residents. After 10 months of OT intervention, the caregivers reported that both the physical and psychological status of the residents have become more stable. The frequency of hospital visits has decreased and due to enriched content of activities and environmental stimuli, the spiritual aspect of the residents' lives had become more abundant. In addition, through learning some treatment techniques from weekly OT educational sessions and by observing the residents' responses in the OT group therapy, the caregivers reported that they have gained a better understanding of the residents' capabilities. This has enabled them to make modifications in service delivery and pay more respect to the residents' need of autonomy. Overall, the occupational therapy intervention has facilitated positive changes in the long-term care program from both the residents and the caregivers perspectives. Possible factors affecting the changes of service delivery are as follow:(1)availability of professional personnel, (2)demands from the families, and (3)the index of accreditation for long-term care facilities. To improve the service quality of the long-term care facilities, it is suggested that (1)the long-term care facilities recruit occupational therapists to design meaningful activities for the residents to help them maintain greatest independence as possible, (2)it is important to educating families of the residents to become active participants in the arrangement and implementation of long-term care program, (3)The Department of Health should set practice standards for long-term care services that address the residents' life quality as soon as possible. The practice standards would then serve as references for future accreditation as well as provide the facilities concrete guidelines toward service improvement.