探討非醫院體系經營銀髮住宅之健康照護模式

Abstract

背景：全球政府單位單位在衛生環境的改善及不斷進步的醫療科技，人類的壽命愈來愈長壽，高齡者原本的居住環境和社會運作已難以滿足其健康、自立、自主的生活需求。然而，在政府推動政策之前，許多高齡者對友善生活社區的需求已經出現。為此，潤泰集團和長庚醫院等業者率先設立了中高齡銀髮住宅或養生村，以滿足這些需求。然而，近年來銀髮住宅需求增加，許多非醫院體系的業者推出了各類住宅產品，並且提供多樣化的服務，包括房務、飲食管理、社會連結、健康促進等，期望能滿足高齡者多樣化的需求。由於銀髮住宅在醫療服務需要之專業度極高，也是極為重要的服務向度，其中非醫療體系業者所經營的銀髮社區，並未具有醫療服務資源，必須向外尋求資源來因應其住民之各類醫療需求，其服務銜接或許未若醫院體系經營的銀髮社區來得順暢，故有必要研究非醫院體系在銀髮住宅所提供醫療照護的重要性。 目的：探討非醫院體系經營臺灣銀髮住宅之健康照護服務現況，並建構未來非醫院體系經營銀髮友善住宅之健康照護服務模式。 方法：研究採用半結構式個人深度訪談收集研究資料。研究對象採立意取樣方法招募經營銀髮友善住宅二年以上資歷之專業經理人進行質性訪談，並以內容分析法來施行資料彙整了解。 結果：本次訪談北、中、南區共計9位的非醫院體系銀髮住宅的專業經理人。分析結果顯示，有與醫院合作的機構提供較完善的服務，而無醫院合作之機構對於住民在一般就醫、慢性病就醫、牙醫及中醫就醫上所提供的服務稍嫌薄弱緊急就醫在各機構主要依賴國家緊急救護系統，較特別的是有些機構會選擇當住民急病發生且生命跡象穩定時，則會與民間救護車公司合作。此外，在預防醫學和健康管理在各家機構所提供給住民的程度差異較大，並且已經有機構已經全面導入科技生理量測並結合雲端數據整合，已達到完整的個人健康數據。而各家機構所規劃健康促進活動設計多元，讓住民體現社會參與，增加個人自我價值。最後在機構提供住民長照服務銜接服務上，其機構本身已有養護中心能完整讓住民得到後續完善的養護照顧。 結論：本研究探討銀髮住宅在疾病照護、預防醫學、健康管理、健康促進活動和長照服務銜接等方面的模式。透過本研究可以得知非醫院體系所經營的銀髮住宅本身缺乏醫院醫療資源的即時協助，但在與醫院合作時，所提供給機構內的住民在就醫安排、健康照護上能更完善；此外，透過多樣化和個性化的健康促進課程活動服務，有效滿足高齡住民的需求；隨著機構內住民的身體機能退化更須考量並規劃後端的長照服務資源來做住民退化時的銜接；此研究對於非醫院體系經營銀髮住宅之經營者做進一步在機構內的省思，進而提供更完善周延的健康照護模式，並且讓未來有意投入銀髮住宅業者能將此健康照護模式作為經營參考。

Background：With significant improvements in global public health and advances in medical technology, the average lifespan has gradually increased. However, the original living environment and social operations for the elderly are no longer sufficient to meet their needs for health, independence, and autonomy. Even before the government began implementing relevant policies, many elderly individuals already expressed a need for friendly living communities. In response, companies like Run Tai Group and Chang Gung Hospital established senior housing or wellness villages to meet these demands. Recently, the demand for senior housing has surged, prompting many non-hospital-operated enterprises to launch various residential products offering diverse services, including housekeeping, dietary management, social connections, and health promotion, to cater to the multifaceted needs of the elderly. Given the high professional standards required for medical services in senior housing, non-hospital-operated communities must seek external resources to address residents' medical needs. Their service integration may not be as seamless as hospital-operated senior communities. Therefore, it is necessary to study the importance of medical care provided by non-hospital-operated senior housing. Objective：To explore the current status of health care services in non-hospital-operated senior-friendly housing in Taiwan and to construct a future health care service model for such housing. Methods：The study employed semi-structured in-depth personal interviews to collect research data. Purposive sampling was used to recruit professional managers with over two years of experience in managing senior-friendly housing for qualitative interviews. Data analysis was conducted using content analysis methods. Results：The study interviewed nine professional managers from non-hospital-operated senior-friendly housing in northern, central, and southern Taiwan. The analysis showed that institutions with hospital collaborations provided more comprehensive services. In contrast, institutions without hospital collaborations offered weaker services for general medical care, chronic disease management, dental care, and traditional Chinese medicine. Emergency care in various institutions primarily relied on the national emergency medical system. Some institutions partnered with private ambulance companies for stable emergency cases. There were significant differences in the level of preventive medicine and health management provided, with some institutions fully integrating technology for physiological measurement and cloud data integration to achieve comprehensive personal health data. Health promotion activities were diverse, encouraging social participation and enhancing personal self-worth. Lastly, institutions with their own care centers provided complete long-term care services for residents, ensuring continuous and comprehensive care. Conclusion：This study explored the models of disease care, preventive medicine, health management, health promotion activities, and long-term care integration in senior housing. The findings indicate that non-hospital-operated senior housing lacks immediate medical assistance from hospital resources but provides more comprehensive medical and health care services when collaborating with hospitals. Additionally, diverse and personalized health promotion activities effectively meet the needs of elderly residents. As residents' physical functions decline, it is crucial to plan and integrate long-term care resources. This study offers insights for non-hospital-operated senior housing managers to reflect on and improve their health care models, providing a reference for future senior housing operators.