台灣住宿型長照機構之COVID-19防疫經驗

Abstract

研究背景與目的： 本研究旨在探討COVID-19疫情期間，台灣住宿型長照機構在防疫政策執行上的實際經驗與挑戰。隨著全球疫情蔓延，長照機構成為高風險場域，然而相較於國際多數地區出現醫療崩潰或防疫物資短缺的情形，台灣在中央防疫政策與地方資源調度下，整體表現相對穩定。然而，機構第一線在執行政策過程中，仍面臨眾多實務上的困境與制度上的挑戰 研究方法： 本研究採質性研究方法，透過半結構式深度訪談蒐集來自多家住宿式機構第一線工作者的經驗與觀點。研究從防疫物資、人力調度、指引實用性、資訊獲取、空間規劃、住民照顧與心理健康等多面向進行主題分析。 研究結果： 本研究共訪談七間分布於北、中、南、東部的住宿式長照機構，涵蓋老人福利機構、護理之家及住宿式長照機構三種類型，並經由主題分析歸納出三大主題、13項概念與33個次概念。三大主題分別為：一、分倉分流的困難，包括書面指引與實際執行的落差、人力不足、隔離困境、移動風險與硬體環境等困境，在分倉分流執行上，防疫指引多以醫療體系邏輯為基礎，假設機構具備充足空間、人力與可彈性調度之床位配置，然多數機構長期處於滿床與人力不足狀態，致使相關措施難以全面落實；二、持續營運的挑戰，聚焦於防疫物資取得、人力調度、醫療支援、教育訓練與資訊更新困難；甚至在人力短缺、防疫物資取得不穩、資訊頻繁變動與醫療支援不足等營運壓力外，亦須在高度管制要求下承擔防疫責任，卻未能獲得相對應的資源支持三、住民身心功能退化，反映於長期隔離所引發的情緒不穩、認知退化與行動能力下降等現象。但是機構在指引更新頻繁、人力與資源有限的情況下，機構難以兼顧住民的身心功能退化的照顧需求。因應高強度隔離與訪視限制措施使得住民身心功能退化議題在防疫實務中被迫邊緣化。研究亦顯示出台灣現行長照體系在面對大規模傳染病防疫時的制度限制與現場操作落差。 結論： 本研究以「分倉分流的困難」、「持續營運的挑戰」與「住民身心功能退化」三大主題為分析起點，發現這些看似分散的實務困境，實則共同指向政策設計與住宿式長照機構實際運作之間的結構性落差。研究結果反映出我國住宿式長照機構長期存在的角色定位與概念衝突。由於制度發展歷程橫跨社會福利與醫療體系，相關法規與評鑑一方面強調「以人為本」與「居家化」之生活照顧理念，另一方面在 COVID-19 疫情情境下，政策與防疫指引卻傾向將住宿式長照機構視為醫療體系的延伸，要求其比照醫療機構執行高度醫療化的感染管制措施，卻未同步提供相應的人力、物資與醫療支援，未來應該思考機構如何在「生活照顧」與「醫療安全」兩種邏輯取得平衡，是未來超高齡社會重要的挑戰。

Background and Objectives This study aims to explore the practical experiences and challenges encountered by residential long-term care (LTC) institutions in Taiwan during the COVID-19 pandemic . As the global pandemic unfolded, LTC facilities became high-risk settings. Compared with many regions worldwide that experienced medical system collapse or severe shortages of epidemic prevention supplies, Taiwan demonstrated relatively stable performance under centralized pandemic control policies and coordinated local resource allocation. Nevertheless, frontline residential LTC institutions continued to face substantial practical difficulties and systemic constraints in policy implementation.

Methods This study adopted a qualitative research design and collected data through semi-structured in-depth interviews with frontline staff from multiple residential LTC institutions. Content analysis was conducted across multiple dimensions, including epidemic prevention supplies, workforce allocation, practicality of policy guidelines, access to information, spatial planning, resident care, and psychological well-being.

Results A total of seven residential LTC institutions located in northern, central, southern, and eastern Taiwan were interviewed, encompassing elderly welfare institutions, nursing homes, and residential LTC facilities. Through content analysis, three major themes, 13 concepts, and 33 sub-concepts were identified. The three major themes were: (1) difficulties in cohorting and zoning, including discrepancies between written guidelines and real-world implementation, workforce shortages, isolation constraints, movement-related risks, and limitations of the physical environment. Infection control guidelines were largely based on medical system assumptions, presuming adequate space, staffing, and flexible bed allocation, whereas most LTC institutions operated under conditions of full occupancy and chronic workforce shortages, making comprehensive implementation challenging; (2) challenges in sustaining operations, focusing on access to infection prevention supplies, workforce deployment, medical support, staff training, and frequent policy updates. In addition to pressures from workforce shortages, unstable supply chains, rapidly changing information, and insufficient medical support, institutions were required to bear extensive infection control responsibilities under strict regulatory measures without receiving proportional resource support; and (3) physical and psychological deterioration among residents, manifested as emotional instability, cognitive decline, and reduced mobility resulting from prolonged isolation. Under conditions of frequent guideline revisions and limited human and material resources, institutions struggled to address residents’ physical and mental health needs, leading to the marginalization of these concerns in infection control practice. Overall, the findings reveal structural limitations within Taiwan’s long-term care system when responding to large-scale infectious disease outbreaks and highlight the gap between policy design and frontline practice.

Conclusion Using the three themes—difficulties in cohorting and zoning, challenges in sustaining operations, and residents’ physical and psychological deterioration—as analytical entry points, this study demonstrates that seemingly fragmented operational challenges are rooted in a shared structural disconnect between policy design and the realities of residential LTC operations. The findings reflect long-standing tensions in the role and conceptual positioning of residential LTC institutions in Taiwan. Based on the development of LTC institutional policy that spans both social welfare and medical systems, existing regulations and accreditation frameworks emphasize person-centered and home-like care ideals. However, during the COVID-19 pandemic, policies and infection control guidelines tended to position residential LTC institutions as extensions of the medical system, requiring the implementation of highly medicalized infection control measures without providing corresponding workforce, material, or medical support. How residential LTC institutions can balance the dual logics of “everyday living and care” and “medical safety” will remain a critical challenge in an increasingly super-aged society.