從偏鄉中老年人需求建構全人長期照顧模式- 以新北市石碇區為例

Abstract

台灣的老化速度已是全球第一，政府及民間都積極在建構無縫接軌的長期照護服務網絡，期望能讓高齡者不只活得久，也能活得好，而且能選擇老年生活的地方。而偏遠地區因年青人口外移嚴重，及交通不便，服務建置不易，長照資源相對不足，為了讓偏鄉地區高齡者及失能者能在自己熟悉的環境及社區中安享晚年，落實「在地老化」，政府積極建置偏鄉長照資源。 新北市石碇區65歲以上老人人口數為1,427人，佔總人口數之18.1%，人口老化相當嚴重，預估有163名失能老人；另外，區內身心障礙人口比亦佔總人口6.7%，達526人，長照資源需求大。本研究為瞭解偏鄉長照服務的現況與困難，以新北市石碇區為例，以深度訪談的方式訪問18位個案及12位專業人員，瞭解區內中老年人之長照需求及未被滿足之需求，並訪談專業人員，瞭解服務提供者困境及建議。 結果發現石碇區內，不論是個案或是專業人員都指出區內長照服務最大的問題是交通不便及人力及醫療資源缺乏。交通不便使得服務輸送不易(申請人少、服務時數少)，服務資源也少，只能先滿足個案的基本需求(身體清潔、營養等)，但健康評估及促進、環境清潔、無障礙、活動、復健、人際互動等需求則較少被滿足。各服務的重疊性高，社福單位之社工及居家服務員與醫療專業人員間溝通少，無溝通機會及整合平台，使得服務成本增加、服務效果減低。 建議對於偏鄉地區，應於區內設立社區服務中心，從完整的需求評估開始，依個案需求，結合居家式、社區式及機構式的服務，從健康促進預防失能出發，到失能個案的完整照顧。增加社區內小規模多機能機構，透過專業授權，整合醫療及社會福利服務、建立社區內的資源網絡，透過專業整合及分工，讓有限資源及人力發揮更大的效果，達到全人照護之最佳成效。

Taiwan has the fastest aging population in the world. The government and community are actively constructing a seamless integration of long-term care service network. Hope not only to make the elderly live longer, but also to live well and they can choose where to live. Since the young population in rural areas move out and transportation is not convenient, the relative resources of long-term care are lack. That makes hard to provide services in rural areas. In order to allow the elderly and those with disability can live in their own environment and community to achieve the goal of 'aging in place', Taiwan Government is actively building long-term care resources in rural areas. Population aging in New Taipei City Shiding District is very serious. 1,427 people are age over 65, which is 18.1% of its total number of population. In addition, 6.7% of the total population are handicapped in this district (526 people). Therefore, it is obvious the long-term care resources are urgently demanded. In this study, in-depth interviews to 18 cases were conducted in order to investigate the needs of long-term care and unmet needs of the elderly and disability. 12 professionals were interviewed to understand the plight and recommendations from the view of service providers. In this study, some results were found either the cases or professionals have pointed out that the biggest long-term care problems are the inconvenience of traffic and the lack of man power and medical resources in Shiding District. The priority is to meet the basic needs of the cases first (body cleansing, nutrition, etc.) because the services cannot be delivered well (less health care service applicants, less service hours) and service resources also reduced. Health assessment, clean environment, accessibility, range of motion exercise (ROM), rehabilitation, social interaction and other needs are less likely to be satisfied. In addition, both overlap each service and few communication between the medical and social work professionals (no communication opportunities and integration platform) increase the cost of services as well as reduce the effect of services. There are several recommendations were made based on the result of the study for the rural areas: to establish the community service center in the area; to conduct long-term care needs assessment; to provide home services, community-based services, and institutions services based on clients’ needs; to provide services from health promotion to total care of disability people; to build small nursing institutions in the area to integrate medical and social welfare services; to establish a network of resources within the community. Through professional integration and delegation of services, the limited resources and manpower can make a greater effect and achieve the goal of holistic care.