外籍看護與家庭照顧者對接受居家照顧老人住院與死亡風險之差異

Abstract

背景:台灣是全球老化最快的地區之一，為解決老人照顧人力之需求，我國從1992年開始引進外籍看護。之後在政策不斷開放下，人數飛快的增加，目前已經成為長期照顧人力的主要來源。在長照服務法立法的過程中，外籍看護的角色定位面臨了相當大的爭議。此外，外籍看護薪資與訓練規定仍停留在十多年前，使得人力來源、素質與照顧品質無法跟著提升。這些問題也隨著長照需求增加而更加明顯。 目的:有鑑於我國開放引進外籍看護二十多年，對於其照顧品質的相關研究仍然相當缺少。因此本研究希望藉由分析居家照顧老人的住院及死亡資料，探討台灣由外籍看護照顧，相較於家庭照顧者，對於居家照顧品質與老人預後風險之影響，並分析造成照顧品質差異可能的因素。 方法:研究資料取自273位新北市某區域醫院附設居家護理所之居家老人護理紀錄，所涵蓋之資料日期從2003年7月至2015年5月。以收案期間死亡與住院事件進行存活分析，比較外籍看護與不同性別、不同親屬關係之家庭照顧者照顧，對居家老人死亡與住院風險之影響。 結果:由女性(HR= 0.715)、女兒或媳婦(HR= 0.653)所照顧之老人，其住院風險明顯低於由外籍看護照顧。短期由子女照顧同樣優於外籍看護(HR= 0.552)，但子女照顧時間超過1.1年之後兩者則無顯著差異。 討論:本研究顯示家庭照顧者照顧品質優於外籍看護。站在照顧品質觀點，政府應重新考量目前外籍看護的開放政策，並對於願意投入照顧工作的家庭照顧者提供更多的長照資源與協助。

Background: Taiwan is one of the fastest aging countries in the world. In order to solve the problem of manpower needs of care, the government started to introduce foreign care workers since 1992. The number of foreign care workers continued to increase and now they have become the major source of long-term care workforce. One-third of older adults needing long-term care in Taiwan are taken care of by foreign care workers. In the process of Long-term Care Services Act legislation, the role of foreign care workers and their care quality have received increased attention. These problems become more apparent along with the increased demand for long-term care. Objective: Research requiring foreign caregivers’ care quality has been limited in the past two decades. The purpose of this study was to examine the risk of hospitalization and mortality among home care older adults who were taken care of by foreign care workers and family caregivers. Methods: The data from July 2003 to May 2015 was retrieved from the home care records of a home care agency in new Taipei city. A total of 273 older adults were included for analyses. Cox proportional hazards models and recurrent event model are applied to compare the risk of mortality and hospitalization for the elderly between foreign care workers and family caregivers related to different genders and relatives. Results: The older adults who were taken care of by women (HR = 0.715), daughter or daughter in law (HR = 0.653) have significantly lower risk of hospitalization than those who were taken care of by foreign care workers. Being taken care of by children during the early episode of disability also showed better outcome than those being taken care of by foreign care workers (HR = 0.552). However, there was no significant differences between older adults who were taken care by these two groups of caregivers if the duration of care is over 1.1 years. Conclusion: The study findings showed that the quality of care provided by family caregivers is better than foreign care workers. The government should re-evalute the open door policy for foreign care workers and provide more long term care resources and assistance for family caregivers who are willing to take care of the elderly.