Self-Reliance Support in Home Care: Establishment and Evaluation

[[abstract]]背景與目的：長期照顧需求隨著人口高齡化成長，如何落實在地老化，提升失能者的能力為長期照顧服務的新趨勢。本研究目的為建構居家服務的自立生活照顧模式，藉由居家服務過程以復原日常生活活動與工具性日常生活能力，以目標導向訓練，提供個別化需求計畫服務，並評估此自立照顧模式之效能。 方法：自立生活照顧模式研究採用準實驗研究法之前後測設計方式進行研究，以居家服務為場域，選取桃園市一家居家支援中心為實驗組，由自立生活照顧服務模式介入居家服務的過程，參與者包含20位居家服務員以及33組服務使用者及其家庭照顧者。對照組則來自苗栗縣某居家支援中心，參與者包含20位居家服務員以及40組服務使用者和家庭照顧者。實驗組的自立支援照顧模式開發由研究者對居家服務員進行自立生活照顧概念訓練及共同討論開發照顧計畫，對照組則採用原本的居家照顧模式。資料收集時間為介入前測一次(106年10月)、後測第一次(107年1 月)、與長照支付新制執行後之後測第二次(107年5月)，本研究透過廣義估計方程式進行分析。 結果：分析結果顯示自立生活照顧提升居家服務員的職場滿意度及成就感，服務使用者及家庭照顧者的相互支持及獨立能力上升，服務使用者獨立功能上升及生活品質改善，服務使用者及家庭照顧者的壓力也下降。長照支付政策執行論項目計酬方式改革後，對照組在政策實施後使用者之滿意度和生活品質下降；而實驗組除了居服員在各項指標顯著下降外，實驗組使用者的依賴程度仍持續減少，實驗組家庭照顧者的相互支持也持續上升、壓力下降。 結論：自立生活照顧提升居家服務員成就感以及服務使用者的生活品質，並且降低家庭照顧者的照顧壓力。建議運用政策為誘因，鼓勵自立生活照顧的執行，最終達到獨立及在地老化的目標。 Background and purpose: The needs of long-term care grow as population is aging. The latest trend of providing long-term care to achieve aging in place is by improving the self-care ability of the disabled people. The purpose of this study was to build a home-based self-reliance support care model with reablement concept, which provide goal-oriented training in activities of daily living (ADLs) and instrumental of daily living (IADLs) on personalized needs-based home care plan, and to evaluate the effectivenss of this self-reliance home care model. Methods: The study used a quasi-experimental research. The experimental group participated in the self-reliant care model, including 20 care attendents, and 33 pairs of home care users and family caregivers from one home-care agency in Taoyuan city. The control group received the usual home care, with participants of 20 care attendents and 40 pairs of home care users and family caregivers from another home care agency in Maiolee city. The experiemental group applied the self-reliance hoem care model, which was built by the training of the researcher on the home care attendants, and discussing of development in self-reliance home care plans. The control group applied the usual home care model. The data were collected by pretest (October 2017), 1st post-test (Janaury 2018), and 2nd post-test (May 2018), when the long-term care payment reform was conducted since 2018. The generalized eatimating equation (GEE) was used for analysis. Results: Self-reliance home care model improved the occupational satisfaciotn and achievement for home care attedants, improved the mutual support, independence, and quality of life among the users, and reduced the stress of the users and family care. After the long-term care payment reform, the satisfaction and qualife of life reduced after reform for the control group. Regarding to the experimental group, most outcome decline after the reform for the home care attendatns, while the users’ dependence continued to decline, and family caregivers’ mutual support continued to increase and the stress continued to reduce. Conclusions: Self-reliance care enhances the sense of accomplishment of home attendants and the quality of life of service users, and reduces the care pressure of family caregivers. It is recommended to use policies as incentives to increase the implementation of self-reliance care, and ultimately to achieve the goal of independence and aging in place