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標題: | 影響長者居家服務核定到使用比例之相關因素探討—身障和非身障比較 Exploring the Ratio of the Amount of Home Care Services Used and Approved for the Elderly and Related Factors — A Comparison Study of People with and without Disability Licenses |
作者: | 蔡以庭 Yi-Ting Tsai |
指導教授: | 陳雅美 Ya-Mei Chen |
關鍵字: | 居家服務,核定到使用,比例, home care services,approved and used,ratio, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 研究背景與目的:受快速高齡化,慢性疾病,與身心功能障礙等因素增加影響,台灣失能人口迅速增長,將導致對於長照的需求大幅提升,高齡的身心障礙者亦隨著台灣將邁入超高齡社會而持續增加。台灣目前以居家服務為最多人在使用的服務,在服務介入之前,需要先經由專業人員進行核定,這當中可能會產生專業判斷及個人自覺而有最後服務使用落差的問題。因此,本研究將探究核定居家服務後有使用的個案,其核定服務量中使用的比例,以及檢視核定到使用的比例的影響因素,並進一步以身障和非身障進行比較。
研究方法:本研究採用次級資料分析,資料來源為衛生福利部照顧服務管理資訊平台,以台灣某兩縣市2019年1月至2021年12月之資料進行分析。首先檢視居家服務核定到使用比例的樣貌,其次,以安德森健康服務利用模型作為分析架構,藉由傾向因素、使能因素、需要因素,以二部模型由雙變量、羅吉斯迴歸、複迴歸分析先探討長者在核定居家服務後有無使用之相關影響因素,再進一步探究核定後有使用的長者,其核定到使用比例之相關影響因素,最後由分層分析探討身障和非身障用好用滿的影響因素。 研究結果:居家服務核定後約九成有使用。其中,有使用的長者在核定到使用約有四成的落差才會用滿,將居家服務細項分為ADL類和IADL類後則發現皆約有五成的落差才會用滿。在核定後有無使用的影響因素部分,控制其他因素後,長者無身障證明(OR=0.73, p<.0001)、年齡越低(OR=0.99, p<0.05)、教育程度越高(OR=0.9, p<0.01)、非獨居(OR=0.8, p<0.05)、住都市化程度較低的縣市(OR=0.71, p<0.001)、CMS等級越高(OR=0.83, p<.0001),在核定後較不容易有使用。在整體居家服務核定到使用比例部分,控制其他因素後,長者有身障證明(β=1.37, p<0.05)、女性(β=1.19, p<0.05)、低收(β=3.72, p<0.01)、中低收入戶(β=6.69, p<.0001)核定到使用比例較高;住都市化程度較高的縣市(β= -1.68, p<0.05)、CMS等級越高(β= -0.65, p<0.001)核定到使用比例較低。而身障族群中,在核定後都較會使用,影響因子有CMS等級越高在核定後較不容易有使用(OR=0.86, p<0.01)。在核定到使用比例部分,中低收入戶其核定到使用比例較高(β=7.26, p<.0001)。而非身障族群中,在核定後有無使用部分,教育程度越高(OR=0.91, p<0.01)、住都市化程度較低的縣市(OR=0.69, p<0.001)、CMS等級越高(OR=0.83, p<.0001),在核定後較不容易有使用。在核定到使用比例部分,有配偶其核定到使用比例較低(β= -1.58, p<0.05);低收(β=3.86, p<0.05)、中低收入戶(β=6.21, p<.0001)其核定到使用比例較高;CMS等級越高其核定到使用比例較低(β= -0.67, p<0.01)。 結論:居家服務核定到使用之間確實有落差存在,顯示會不會去使用服務與會不會用滿是不同概念。另在ADL類和IADL類較不會用滿的服務細項(協助上下樓梯、陪同就醫)皆屬於非常規性的服務,可能與服務提供單位對於服務及時性方面有關。本研究亦發現傾向、使能、需要因素當中的各個因子,對於ADL類、IADL類服務核定到使用比例的影響有所差別,並且從ADL類服務的核定到使用比例分布以及CMS各級對於ADL類服務使用的現象推論ADL類服務可能易受到服務提供端的影響使得長者較無法用滿,未來可能需再強化此類服務的提供,及未來研究可針對組織面向的因素對於核定到使用比例的影響再進一步探究。此外,儘管有身障證明的長者在核定後越容易有使用也較會用滿,但是能夠預測其在核定到使用比例的因素與解釋變異量皆較少,代表身障與一般長照服務使用長者的影響因子有所不同,有待未來研究釐清身障族群的服務使用情形。整體而言,本研究檢視導致長者居家服務核定到使用比例的影響因素為何,有助於未來針對這些族群再進一步的服務規劃。 Background and Objective: The rapid growth of the disabled population in Taiwan due to rapid aging, chronic diseases, and physical and mental disabilities has led to a significant increase in the demand for long-term care. As Taiwan transitions into a super-aged society, the need for long-term care is expected to continue rising. Currently, home care service is the most commonly used services in Taiwan. The services are evaluated and prescribed by care managers before being provided to those people in need. However, gaps exist between service prescribed and actual usage. Therefore, this study aimed to explore the ratio of the amount of home care services used and approved, as well as the related factors. The study further compared gaps and factors between disabled and non-disabled people. Methods: This study conducted secondary data analysis using information from the Long-Term Care Service Management System of the Ministry of Health and Welfare in two cities in Taiwan from January 2019 to December 2021. Firstly, the study examined the ratio of the amount of home care services used and approved. Secondly, the study used Andersen’s Behavioral Model as the framework to analyze the influence of predisposing factors, enabling factors and need factors on the aforementioned gaps. Logistic regression analyses were employed to examine impact of factors on the gaps resulting from whether services were used after being prescribed, while multiple regression analyses were used to explore the influences of related factors on the ratio of the used and approved amount of services. Lastly, a stratified analysis was conducted to analyze and compare findings between disabled and non-disabled people. Results: About 90% of home care services users have used the services after they were prescribed. Among them, there was a 40% of discrepancy between the prescribed and used amount of services. A higher rate (50%) was observed when examining the discrepancies based on Activity of daily living (ADL), and Instrumental Activity of Daily Living (IADL). After controlling for covariates, factors associated with a higher risks of not using service after their prescription included being non-disabled people (OR=0.73, p<.0001), younger age (OR=0.99, p<0.05) , higher education level (OR=0.9, p<0.01), not living alone (OR=0.8, p<0.05), residing in less urbanized cities (OR=0.71, p<0.001), having a higher CMS level (OR=0.83, p<.0001). After controlling for the covariates, the ratio of the used and approved amount of home care services were higher for the elderly with disability (β=1.37, p<0.05), females (β=1.19, p<0.05), individuals with low income (β=3.72, p<0.01), and the middle- and low-income households (β=6.69, p<.0001). Living in a more urbanized cities (β= -1.68, p<0.05) and having a higher CMS level (β= -0.65, p<0.001) were associated with a lower ratio of the used and approved amount of services. In the disabled population, the higher the CMS level (OR=0.86, p<0.01), the less likely it was for service to be used after prescription. The ratio of the used and approved amount of services were higher for those with middle- and low-income households (β=7.26, p<.0001). In the non-disabled population, factor associated with less likelihood of using services after prescription included higher education level (OR=0.91, p<0.01), living in the lower urbanized cities (OR=0.69, p<0.001), a higher CMS level (OR=0.83, p<.0001) were less likely to use services after service being prescribed. Those with spouses had a lower ratio of the used and approved amount of services (β= -1.58, p<0.05). People with low income (β=3.86, p< 0.05), and middle- and low-income households (β=6.21, p<. 0001) had a higher ratio of the used and approved amount of services. The higher the CMS level, the lower the ratio between use and approval (β= -0.67, p<0.01). Conclusion: The current study revealed discrepancies between the prescribed and used service, as well as differences in the amount of service prescribed and used. In addition, the study identified non-routine ADL and IADLs service, such as assisting going up and down stairs or accompany to clinics, were less frequently used as prescribed. This may be due to personal care attendants preferring regularly scheduled services, such as bathing, over non-regularly scheduled service. Furthermore, the study found that the predisposing, enable and need factors had different impacts on the prescribed and used amount of ADL and IADL services. Based on distribution between service prescribed and used, and the amount of services prescribed to use in ADL services, and the phenomenon of the ceiling effect in the use of ADL services at all levels of CMS, it seems that ADL services may be vulnerable to the influence of service providers, making the elderly less able to use all service prescribed. Thus, strengthening the provision of non-routine services is recommended in the future. In addition, future studies can further explore the impact of organization-oriented factors on these discrepancies. In addition, although disabled people are more likely to use and have used more prescribed services prescribed, the fewer factors predicting the discrepancies in the disabled people are different from the non-disabled people, and future studies are needed to clarify the service use patterns of the disabled population. In summary, our study findings may contribute to future service development among these groups in the future. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89499 |
DOI: | 10.6342/NTU202302316 |
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顯示於系所單位: | 健康政策與管理研究所 |
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