A Study of long-term care needs and development for different urbanized areas in Pingtung County

本研究主要研究問題，是探究屏東縣不同都市化地區未來長期照顧需求與發展，採用量化與質性並行的研究方法。在量化研究部分，先進行屏東縣33 鄉鎮不同都市化層級之集群分析；然後，根據不同都市化層級進行未來10 年老人失能人口數與失能率之推估、長期照顧資源盤點；在量化研究部分，進行三場焦點團體，請屏東縣長照專員及督導分享他們對於目前屏東縣長期照顧服務輸送的觀察，以及對於未來屏東縣長期照顧服務政策推動之建議。 本研究結果是採用了人口密度、高教育程度人口比、工商業產業人口比三個指標，透過群集分析將屏東縣33 個鄉鎮劃化分成七層不同都市化程度之地區。本研究結果發現，未來10 年老年失能人口數的增加，在2016 年推估整體屏東縣老人失能人數是23,591 人，經過推估，10 年後是增加了7,862 人，成長率33.33%；並且不同都市化地區的失能老人人口成長率、年齡結構、性別比是有差異。在長期照顧資源盤點部分，發現資源項目建置完整度是以高度都市化地區的屏東市相對最完整，長期資源的建置項目完整度確實存在著所謂城鄉差異；居家服務員人力或是在地居家服務人力的不足，幾乎是不同都市化地區皆會面臨的困難；隨著都市化層級愈低，日間照顧中心的資源似乎愈短缺，也就是愈需要社區型照顧資源。另外，服務使用多數出現居家服務與機構式照顧兩極化現象；中低低、低度都市化地區，的確是因為服務輸送距離、服務內涵造成的障礙，使得居家護理、居家復健、交通服務等、居家無障礙環境改善等資源項目，無法到位。 根據上述之研究發現，分別對屏東縣政府與中央政府提出見解。在屏東縣政府部分：（一）積極推動社區居民的健康自我管理，凍結老人失能率；（二）擬定照顧人力再造計畫，使服務人力可以到位；（三）因地制宜，開展多元的服務提供者；（四）服務內容應該融入當地的生活型態，使照顧模式更具在地性；（五）依照本地失能老人家庭照顧者之需求，提供更多元的支持性服務；（六）以在地化、社區化、便利性、行動化為服務輸送之基礎，排除目前的服務障礙。在中央部分：（一）重新思考長期照顧服務的績效指標；（二）中央政府的健康政策與長期照顧政策之間是有對話；（三）日間照顧中心設置法規應更具彈性，積極建置社區型照顧資源；（四）居家服務項目再設計，將居家服務應更專業化；（五）重新檢視服務輸送的順暢度與合適性。This study mainly uses both quantitative and qualitative research methods to investigate future long-term care requirements and development of different urbanized areas of Pingtung County. In the part of quantitative research, this study conducts cluster analysis of different urbanized levels of 33 towns in Pingtung County. Then, estimation of number of disabled old people and rate of disability for the next ten years as well as resources inventory of long-term care is done according to different urbanized levels. For qualitative research, three focus groups are performed. Long-term care specialists and supervisors of Pingtung county are invited to share their observations of current long-term care service delivery of Pingtung County and suggestions for promoting future long-term care service policies of Pingtung County.Results of this study adopt three indicators: density of population, proportion of highly-educated people, and proportion of commerce and industry population. Through cluster analysis, 33 towns of Pingtung County are divided into seven different levels of urbanization. According to findings of this study, number of disabled old people of the whole Pingtung County in 2016 is estimated at 23,591 and this figure is expected to increase by 7,862, indicating a growth rate of 33.33%; furthermore, areas of different urbanization levels are different in population growth rate, age structure and sex ratio of disabled people. Through long-term care resources inventory, it is found that Pingtung City with high degree of urbanization shows the highest completeness of resource item establishment, and that there are rural-urban differences in completeness of long-term resource item establishment. Insufficient home service person or localized home help person is a difficult problem for areas of different urbanization levels. It seems that lower level of urbanization is associated with more serious shortage of daytime care center resources and more urgent need of community-based care resources. In addition, service use mostly shows polarized phenomenon of home service and institutional care. For areas of medium and low urbanization levels, service items such as home care, home rehabilitation, transportation service and barrier-free home environment improvement are not available because of obstacles caused by service delivery distance and service connotation.Based on above findings, suggestions for Pingtung County Government and the Central Government are proposed respectively. Suggestions for Pingtung County Government include: (1) actively promote self health management of community residents and freeze the disability rate of old people. （2） Develop programs for caregiver resource reengineering so that sufficient service persons are available. (3) Adjust measures to local conditions and cultivate diversified service providers. (4)Service contents should be integrated into local lifestyle so that care mode is more localized. (5) Provide more diverse supportive services in accordance with requirements of family caregivers of local disabled old people. (6) Service delivery should be based on principles of localization, communitization, convenience and mobilization to remove existing service obstacles. Suggestions for the Central Government include: (1) re-think about long-term care service performance indicators. (2) Achieve communication between health policies and long-term care polices of the Central Government. (3) Make the laws and regulations for setting of daytime care center more flexible, and actively establish community-based care resources. (4) Re-design home help items so that home help is more professional. (5) Re-consider smoothness and appropriateness of service delivery