[[alternative]]Long-term Care Utilization Approaching to The Patients With Home Care: In Case of a Local Hospital in Northern Taiwan.

[[abstract]]居家護理本質上屬醫療之延伸、非生活參與之必然。自1980年成型發展以來， 居家護理呈連接醫院與返家後之持續性醫護照護之服務型態。除了基本之護理職掌，居家護理協助個案依病況之需要及病患自身生活參與的需求安排、選擇合宜的照護事宜，以維持其生活品質及生命尊嚴。此時台灣之時空以醫療延伸為本質之居家護理在長期照護中的角色功能就顯得重要。 本研究旨在探討居家護理個案的社會人口學特性、健康功能特性、 其他相關或中介變項(使用管路、身心障礙等級、居家護理收案年月、照顧端是否完備等)對長期照護型態(機構與居家社區式)利用之影響。本研究以居家護理服務之個案為收案對象， 採問卷調查法，總計收案人數為120人。以SPSS套裝統計軟體 進行分析與統計。研究發現社經地位、罹病指數、日常生活活動功能及家庭功能與長期照護型態之利用高度相關。接受居家護理服務個案以置放鼻胃管居首位、氣切管居末，其家庭功能以中度障礙者居多。樣本對象中，機構式個案年齡偏大、管路種類較多；而居家照護收案對象較短、合併罹病症較重、外省籍貫，且多另聘人協助照顧。另一方面， 身心障礙等級和居家護理之收案年月亦具有顯著相關。 居家護理是在病患生活居住地提供整合性健康支持性的延伸服務。1995年全民健康保險開辦後陸續將護理之家、養護機構及長期照護機構比照居家護理納入保險給付範圍，因此，居家護理服務的對象因政策之影響而分佈在居家或機構中，與居家護理成立的目的是相矛盾。居家社區式之長期照護老人對長期照護服務的需求及選擇，服務地點也應跟隨生活居住地。未來長期照護相關政策擬定， 應加以考量相關之定義，再定決策及規劃。[[abstract]]Home (nursing) care has been an extending medical care service rather than A & P (activity & participation) engagement. It had connected hospitals and patients at home ever since 1980s, and it helped patient to pick suitable care, to maintain their dignity, and life quality. Then, in addition to basic nursing care, home (nursing) care could intervene meeting the care needs, its role and function of home (nursing) care in long-term care system has become unique and important. This study tried to explore the long-term care(LTC) patterns, among the home care receivers, and the linkage to sociodemography, health status, and leveling of the relative variables among those involved in home care such as tubing, certified disability level, service starting time and care side status. This study used a questionnaire and collected 120 sample cases currently taking home (nursing) care. The data was analyzed by using SPSS software. The results show that the selection of LTC patterns has been highly correlated with the socio-economic class, morbidity index, ADLs level, family function. Majority of those receiving homecare patterns with nasogastric tube insertion lead the way, yet with the tracheostomy tube insertion sporadically distributed; also significant percentage with moderately family function impaired. However, institutional residents aged in advance generalizedly, with tubing. On the other hand, for those stayed at home, complex morbidity, with the domiciles other than Taiwan, with the presence of hired care giver or worker. Rather, the disability level certified and home care starting time be also correlated significantly. Home (nursing) care provides integrated services just at the accommodated & living site/place to proceed supporting service. Since 1995, the National Health Insurance had launched, then soon covered the home (nursing) care in the hospitals and care facility settings, i.e. to mixing or overlapping even intermingling extending medical home (nursing) care and home based care around LTC. Hence, currently in Taiwan, with mixing or overlapping even intermingling of them both paradoxically. Any matured society& country, there has been mandatorily (acute) medical care, community-based care and home-based care scheme, to plan and organize the health & living care net or web. The appropriate defining and positioning should be settled then referring policy making and organizing planning