照顧咖啡館採用遠距照護之初探

Abstract

隨著社會變遷與醫療衛生的進步，我國國人平均壽命增加，但生育率與死亡率降低，導致人口快速高齡化，使得長期照顧需求人數增加，而在科技日新月異下，透過資訊通訊科技與電子化醫療器材的應用，使得醫療照護受到地域的限制越來越少，也可以提供更多元化的健康照護服務，因此遠距照護的發展逐漸成為現今老人照護服務的新趨勢。 衛生福利部於2007年起開始試辦遠距照護計畫，主要目標是藉由遠距照護的服務模式建構社區網絡，發展創新科技化的照顧服務，以提升長期照顧相關服務的成本效益，協助民眾於熟悉的社區及居家環境中獲得健康照護與預防保健服務，達到在地且健康老化。然而，目前採用遠距照護服務的單位，主要為社區關懷據點或大型醫療機構，尚未普及在所有的長期照顧單位。未來若能將遠距照護服務推廣到更多長期照顧單位，使服務可以與更多有需求的民眾接觸並且更有效率的提供，勢必更能達到長期照顧資源「找得到、看得到、用得到」的效果。 近幾年興起的民間非營利機構－照顧咖啡館，為長照2.0中的新型計畫，不但提供長者長期照顧相關服務，也同時提供被照護者的服務，並透過咖啡館的餐飲以及其他業外收入等商業模式，來達到自給自足，其設立概念為「社會創新」的實踐，藉由科技或商業模式的創新應用，來創造社會價值。雖然現階段各間照顧咖啡館以不同的形式及特色經營，但是對於遠距照護的利用尚在起步階段；據此，若能援引其他長期照護單位的經驗，融入科技創新之遠距照護服務，不僅可能提高對於高齡者初級照護的可近性，若藉此擴大服務或提高服務人次，也有助於達成永續經營的目的。 本研究採質性研究方法，以立意取樣挑選8家照顧咖啡館，以科技—組織—環境架構為研究架構設計訪綱問題，透過深度訪談，探究其對於遠距健康照護應用在照顧咖啡館上的看法與意見，再利用內容分析法分析訪談內容，分析哪些因素會影響該機構採用遠距照護。 研究結果顯示對於照顧咖啡館來說，主要影響機構採用遠距照護之因素，包括整合成本、感知有用性、人力資源管理、國家法規與規範，而各個因素背後環環相扣。其中感知有用性是照顧咖啡館採用遠距照護時最優先考量的因素，對於照顧咖啡館來說遠距照護之成效及益處是最重要的，目前我國並未有明顯的成效及證據，來顯示這項服務的採用對於機構來利大於弊。而整合成本的支出，亦是考量因素，包括設備的新增及維修、新聘員工或是員工訓練等金錢及時間的支出，再來就是可能需要改變組織內部的人力資源管理，包括工作流程及工作分配需重新調整，最後國家與法規規範是一大關鍵，其涵蓋的內容相當廣泛，除了宣傳及推廣以外，建立相關的法律規範及完整的政策內容，才能使照顧咖啡館有在提供服務時有所依據，同時也可以保障個資安全及隱私權，避免法律糾紛。另外，照顧咖啡館目前的營運狀況仍不穩定，像是經營現況難以達到收支平衡，以及民眾對照顧咖啡館之了解不足導致服務人數不多等等，在面對此情況下，採用新科技服務成為一大阻礙，因此這也是一大關鍵影響因素。 對於照顧咖啡館來說，遠距照護是一種創新的服務，以現況來說，照顧咖啡館要新增此服務較不容易，但未來仍有採用的可能性，除了政府應建立完善的遠距照護法規及流程，並向大眾宣傳其成效及益處，照顧咖啡館本身可以透過調整現有的營運模式，包括切割長照服務及自營模式之區域、提高商品售價並採會員制來改善現有營運狀況，特別是照顧咖啡館經營小規模，大多照著政府政策走，政府的態度會影響其採用意願。本研究之研究結果及建議期望可作為日後相關單位及長照產業，於提供遠距照護時，兼具科技創新與人性化服務之參考依據。

In Taiwan, with social changes and advances in medical and health care, the average life expectancy has increased, but the fertility rate and mortality rate have decreased. This situation has led to a rapid aging of the population, which has increased the number of people who need long-term care. The application of information technology and electronic medical equipment has made medical care less restricted by region, and more diversified health care services can also be provided. Therefore, the development of remote care has gradually become the trend of today's elderly care services. The Ministry of Health and Welfare started the Pilot Telecare Project in 2007. The main goal of this project is to develop innovative and technological care services, and to further improve the cost-effectiveness of long-term care related services. People can also receive health care and preventive services in their familiar communities and home environments. At present, institutions that adopt telecare services for the elderly are mainly Community Care Stations or large medical practices. If other long-term care organizations can gradually adopt telecare and provide telecare services in the future, people will be able to access long-term care services more quickly and directly. With the widely implementation of telecare among long-term care organizations, the goal of 'finding, seeing, and using long-term care resources” is more likely to be achieved. Care Café, the private non-profit organization-, has emerged in recent years. The Care Café is a new type of organization in Long Care 2.0. With its founding concept “the practice of social innovation”, Care Café creates social value through the innovative application of technology or business. Currently, Care Café mainly provides caregivers and long-term care related services, and achieves self-sufficiency through business such as cafe catering and other income. If Care Café can integrate the technological innovation into its practice by providing telecare service, it will not only benefit its own sustainable operation, but also provide people with more accessible and convenient primary care. This research adopts qualitative research methods by selecting 8 Care Cafés’ managers with purposive sampling methods for in-depth interviews. This study aimed to explores managers’ views and opinions on the application of telecare in Care Cafés. The interview outlines were drafted without Technology-Organization-Environment framework. This study used content analysis to analyze factors that influence the Care Cafés’ adoption of telecare. The results of the study show that the main influencing factors for Care Cafés to adopt telecare including integration cost, perceived usefulness, human resource management, national-level regulations and policies. Among them, perceived usefulness is the most important factor. From the perspectives of Care Cafés’ managers, there is no evidenced effect and benefits that would strongly prompt telecare adoption. The cost of integration is also a factor to be considered, including purchasing and setting up new equipment, maintenance services, recruiting new employees or training current staff. Next, it may be necessary to re-organize the Care Café for adopting telecare, including redesigning the workflow and re-assigning work assignment accordingly. Finally, laws and regulations are a major key factor, which covers a wide range of content. In addition to forming policy to promote telecare, the establishment of related regulation can provide Care Cafés with appropriate legal ground for providing such services, and can further protect security of personal information sharing and privacy to avoid legal disputes. Furthermore, the current business operation of Care Cafés is still unstable, with the difficulties to make ends meet and balance financially, and with the lack of understanding of general public on Care Cafés leading to a small number of customers served, etc. Under this situation, the adoption of new technology services has become unlikely. For Care Cafés, telecare is an innovative type of long-term care service. Although under the current situation, it is not easy for Care Cafés to add this service, it is still possible for them to adopt it in the future. Government should establish telecare regulations and procedures for Care Cafés, and also make the evidences available to the public on telecare’s effectiveness and benefits. On the other hand, Care Cafés will need to adjust their existing business operation for future telecare adoption, such as setting up separate areas for long-term care services versus self-operated models, increasing the retail prices of goods, or operating on a member-only model. Care Cafés often operate on a small scale and mostly follow government policies, so the attitude of government will affect their willingness to adopt new services. The research results can inform relevant organizations and the long-term care industry on how to provide both technological innovation and elder-friendly services with telecare in the future.