An investigation of the effectiveness of using bathing car service among Taiwanese elderly

[[abstract]]台灣於2018年3月邁入高齡社會，推估2025年65歲以上人口將達到世界衛生組織定義的超高齡社會。衛生福利部統計資料顯示，65歲以上需要長期照護的失能老人不斷增加，而長期臥床失能人口也逐年增加，因此照護需求亦是逐年上升，其中又以沐浴需求約占失能人口的五成以上，且社區失能5年以上長者超過三成無法自行沐浴洗澡。台灣在2017年開始提供到宅沐浴服務，使用人次已達15萬餘人口，然台灣卻很少研究討論沐浴車服務對高齡者、照顧者及家庭的成效。因此本研究目的旨在瞭解高齡失能者沐浴困難之原因、高齡失能者使用沐浴車服務成效以及對照顧者與家庭的影響。 本研究以中部地區某長照機構使用沐浴車服務超過一個月之65歲以上失能者及其照顧者與家人為研究對象，利用參與觀察法、面對面作深度訪談收集資料，並全程錄音，其過程以質性研究方法之紮根理論研究法進行資料整理與分析。收案時間為2019年5月至2019年12月止，當資料達飽和理論時則停止收案，資料分析是採用持續性重複比較方式。 本研究共訪談七對沐浴車服務個案及其照顧者。研究結果發現造成高齡者沐浴困難的原因包括疾病或意外傷害引起肢體殘障、老化所致腦部退化引起失去自我照顧能力、居家環境沐浴空間受限制等因素。若體力及經濟負荷感到無奈與無法控制因素、親情與社交關係等問題則出現照顧者及家人互動狀況之變化。而當沐浴車服務介入後個案初次體驗之感覺從害怕、轉而期待歡喜，獲得身心舒適愉悅、放鬆舒壓、並能促進正向思考之成效。因此，主要照顧者對研究對象使用沐浴車服務後其看法，能減輕焦慮、壓力以及舒緩情緒、促進血液循環並增加骨骼肌肉的柔韌度，因而減輕了照顧者的體力負荷與得到寬慰。對家庭更有微妙變化且期待生命意義及提升愉悅感之影響。對於沐浴車服務之建議則希望人員不要經常更換、希望附加額外服務、收費便宜些、水溫再調高些或增加保暖設備。 此研究之結論為到宅沐浴車不僅提供失能者身體清潔，亦獲得心理、精神支持與尊重，對失能者及家庭均有重要的影響力。因此，建議業界若能建立良好的制度及人員的體能訓練，將可降低流動率並提升服務品質。在長照主管單位則建議增加沐浴車量及服務次數，提升補助款，加強文宣及醫療機構與長照連結網。對於未來研究建議可針對不同之地理區域，或不同之年齡層來探討沐浴車服務成效，瞭解是否有所差異性，以作為未來長期照顧沐浴政策推展與改革的參考。[[abstract]]In March 2018, Taiwan entered in the aging society, it is estimated that the population aged over 65 will reach the hyper-aged society defined by the World Health Organization by 2026. The statistics from the Ministry of Health and Welfare shows that the number of the aged people over 65 who are in-need of long-term care is increasing, and the number of people with long-term disabilities in bed is increasing year by year. Therefore, the demand of care is also increasing yearly, the demand of bathing accounts for about 50% of the disability population, and more than 30% of disabled elders over 5 years in the community cannot bathe themselves. Taiwan began to provide home bathing services in 2017, and the number of users has reached more than 150,000 people. However, Taiwan has rarely studied and discussed the effectiveness of bathing car services for the elderly, caregivers and families. Therefore, the purpose of this study is to understand the reasons for the difficulty of bathing for the elderly with disabilities, the effectiveness of the use of bathing car services by the elderly with disabilities, and the impact on caregivers and families. For the subject of the study is the elderly over 65 in the long-term care institution in the central region, who has been using home bath car service over one month and their caregivers and families, by the ways of participatory observation, face to face in depth interviews and full recording collection. Data collection and analysis are carried out by the grounded theoretical research method of qualitative research. The acceptance time is from May 2019 to December 2019. When the data reaches the saturation theory, the case will stop. The data analysis uses the way of continuous repeated comparison. I interviewed a total of seven people who using home bath car service and their caregivers as research objects. The result of the study found that the reasons of the difficulty in bathing for the elderly include physical disabilities caused by diseases or accidental injuries, brain degradation due to aging causes loss of self-care, the home environment bath space is limited and other factors; when physical exertion, uncontrollable factors, helplessness, economic burden, affection, social relations and other aspects to show the interaction between caregivers and family members. And when the bath car service intervenes, its effectiveness cases are frightened from the first experience, then look forward to it with physical and mental comfort and pleasure, relax with a nostalgic narrative, it also promotes positive thinking. The primary caregivers had a view of the subjects who had reduced their anxiety, stress and relieve emotions, promotes blood circulation and increases the flexibility of skeletal muscles after using the bath truck service. As a result, the physical load on the caregiver is reduced and comforted. It has subtler changes to the family and expects the meaning of life and enhances the effect of pleasure. As for the suggestion of bathing car service, it is hoped that the staff should not be changed frequently, in addition to bathing, it is hoped that additional services should be added, the fee should be cheaper, the water temperature should be adjusted higher or the heating equipment should be added. The conclusion of this research is that the home bathing car not only provides physical cleansing for the disabled, but also obtains psychological and spiritual support and respect, which has an important influence on the disabled and their families. Therefore, it is recommended if the industry can establish a good system and physical training for personnel, it will reduce turnover and improve service quality. In the health and government unit, it is recommended to increase the number of bathing vehicles and the number of services, increase the subsidy, and strengthen the publicity and the network of medical institutions and long-term care network. Suggestions for future research can be targeted at different geographic regions, or different age groups to discuss the effectiveness of bathing car service, in order to understand whether there are differences, as a reference for the future long-term care and bathing policy promotion and reform