原住民與非原住民失能者長期照護服務使用情形之比較

Abstract

由於人口老化導致長期照護需求隨之增加，然而根據國內研究調查發現，原住民長期照護需求較一般人高，服務使用卻較少，而國外觀察少數族群服務使用情形也顯示，原住民或者少數民族偏好使用社區式（community-based）與居家式（home-based）照護，優勢或主流族群則偏好使用機構式服務（institutional services）。因此本研究以「全國長期照護需要評估」第二階段調查中，50歲以上之原住民失能者作為分析基礎，並配對同樣失能情形之非原住民個案，共計1,100名樣本，包含550位原住民和550位非原住民。 分析兩族群樣本特質發現：原住民較非原住民多女性、較年輕、較高比例沒有配偶、教育程度低、較少具有社會福利身分、擁有較少的長期照護資源、較多子女、相同的失能程度分布、慢性病數少以及護理服務需要數少。服務使用方面，原住民完全未使用過任一類正式服務的比例比非原住民高，且以多變項邏輯斯迴歸分析族群別與服務使用之關係，更顯著看出原住民較偏好使用社區或居家式服務，而非看護和機構式服務。 接著以Andersen Behavioral Model為分析架構，利用雙變項和多變項邏輯斯迴歸分析影響兩族群使用服務的相關因素。分析結果顯示，兩族群在調整相同失能程度後，對原住民而言，無偶、低教育程度、有社會福利身分、失能程度嚴重、護理服務需要數多者，較易使用社區或居家式服務；有偶、高教育程度、有社會福利身分、長期照護資源數多、失能程度嚴重、慢性病罹患數多且護理服務需要數多者，較易聘請看護照顧；而無偶、高教育程度、有社會福利身分、長期照護資源多、失能程度嚴重和護理服務需要多者，較易使用機構式照顧。 至於非原住民方面，低教育程度的失能者較高比例使用社區或居家式服務；高教育程度的失能者則較多使用聘請看護；而使用機構式照護者，多為低教育程度、長期照護資源數少和護理服務需要數多者。 綜合上述所言，可發現兩族群服務使用偏好不同，且影響使用任一類服務的因素也各自不同，故根據本研究結果，提出兩項建議：一是應強化原住民社區內的照護服務資源，依族群文化和生活習性不同，而能有個別性考量；二是應積極檢討現有長期照護資源的配置狀況，補助弱勢的失能者，以落實國家公平原則，保障每個人生活安適的權利。由於本篇研究採現成資料庫進行二手分析，故在研究對象及研究變項上，多有所限制。建議未來除了可增加更多變項，以及將現有變項做更深入的調查外，也可長期追蹤個案，建立完整的原住民資料庫，則必有助於獲得更完整、更豐富的資訊，供未來政策規劃及服務推動時做為參考。

The needs of long-term care have been increasing because of aging of population. However, based on previous literature in Taiwan, aboriginal people need more long-term care than non-aboriginal people. Research on long-term care utilization of minorities also demonstrated that aboriginal people (or subordinate group) prefer community-based and home-based care while non-aboriginal people (or dominant group) prefer institutional services. Data used in this research was collected in the second-stage survey of “ 2001 Long-term Care Need Assessment in Taiwan.” A national representative sample of 550 50-year-old disabled aboriginal people was studied, comparing with non-aboriginal people by the level of dependency. The comparisons between these two people show that: higher percentage of aboriginal people were found in those who were female, young, with no spouse, most with elementary school diploma, not entitled to social welfare benefits, had less long-term care resources, had more children, with equal disable degrees, had less chronic impairment and needs in nursing care. In terms of service utilization, the rate of using no service by aboriginal people is higher than by non-aboriginal people. Also, a multiple logistic regression analyzing the relationship between different ethnics and different services provides significant evidence that aboriginal people prefer community-based and home-based care over institutional services. The Andersen Behavioral Model was used to examine the factors associated with using community-based or home-based care, hiring a foreign care aide or using institutional services among the disabled aboriginal and non-aboriginal people. Bivariable and multivariable analyses showed that after controlling for the level of dependency, factors including material status (with no spouse), education (with no school diploma), entitlement to social welfare benefits, the level of dependency (those who were severely dependent) and needs in nursing care (more needs) were noticeably associated with using community-based and home-based care; factors including marital status (had spouse), education (with high school diploma and above), entitlement to social welfare benefits, abundance in long-term care resources, the level of dependency (those who were severely dependent), chronic conditions (more diseases) and needs in nursing care (more needs) were noticeably associated with hiring care aid; factors including material status (with no spouse), education (high school diploma and above), entitlement to social welfare benefits, abundant in long-term care resources, the level of dependency (those who were severely dependent) and needs in nursing care (more needs) were noticeably associated with using institutional service. As for non-aboriginal people, disabled ones with elementary school diploma were inclined to use community-based and home-based care; however, disabled people who were at least with high school diploma were inclined to hire care aid; and disabled people who were at most with elementary school diploma, had insufficient long-term care resources and had more needs in nursing care were inclined to use institutional care. To sum up, this study concluded that there is difference in using long-term care between aboriginal people and non-aboriginal people. Besides, factors influencing their utilization of long-term care are distinct. Based on these findings, I propose two suggestions: one is the program to strengthen the community resources to aboriginal people according to their culture and lifestyle; the other policy is to review the policy of long-term care in terms of resources distribution by taking into account of the disabled minorities, principle of fairness as well as citizens’ rights to wellbeing. Because this research used the data from secondhand information source, there are some limitations in analyzing these samples and variables properly. I suggest that in the future, researchers could collect more variables and more detailed information, and conduct cohort study to develop a complete database of aboriginal people to serve as a better policy making reference.