[[alternative]]Performance Evaluation of Home Care Service--A Case Study of Chia-yi

[[abstract]] 我國近幾年來對老人居家服務方案的大力推展，可以視為中央政府政策引導之下的產物，其前身可以追溯自民國七十二年即開始辦理的「老人在宅服務」和「居家老人服務」等方案。不過從相關文獻與執行成果來看，似乎只有台北市與高雄市在過去十幾年間有較足以稱道的發展歷史，其他各縣市則多半是自民國八十六年老人福利法修正後，才有較多資源的投入。 國內有關居家服務的研究中，針對單一縣市個別情況的描述並不多見。因此研究者以地利之便選擇嘉義市作為研究場址，藉由瞭解嘉義市老人居家服務的歷史和現況，進而從供給和需求兩分面來討論嘉義市老人居家服務未來發展的可能性。本研究以我國社政單位所指稱的居家服務作為研究分析的出發點，試圖探討老人居家服務的執行，有以下幾個目的：一、檢視嘉義市老人居家服務的執行，包括：老人居家服務提供單位的興起背景、服務與人力的供給情況，二、分析嘉義市老人居家服務的供需狀況，並探討切合嘉義市需求之老人居家服務供給模式。三、提出適當建議，供作日後政策擬定之建議或規劃方案之參考。 目前為止嘉義市有三個老人居家服務的供給單位，分別是：嘉義市政府居家老人志工組、弘道老人福利基金會嘉義志工站、以及嘉義市政府委託嘉基來承辦的居家服務中心。三個組織在老人居家服務的項目名稱上雖然略有差異，但在執行時所提供的服務內容，基本上是以關懷訪視、陪同就醫與家務協助為主。若從老人自我照顧功能、家庭照顧通能、與家庭照顧負荷三個面向來思考居家服務的利益，本研究發現不同的服務對象所需要的服務照顧模式也不同，制式的服務較無法滿足多樣性的老人需求。事實上所謂的「居家服務」應該是指服務提供場域即為「需求者的家宅」，因此從服務使用者的角度來看，只要是能夠對家庭中失能老人及照顧者有所助益的服務，舉凡醫療衛生與社會心理層次等方面的需求，都應該屬於居家服務的提供範圍。因此，以現今嘉義市的地理範圍和人口規模來看，並不需要細分到社政和衛政兩部分的居家服務，而由單一機構或組織來協調服務的提供，或許更能掌握老人的狀況，並針對失能老人提供更具彈性的多元服務。[[abstract]] Aging population brings the changes of health care styles of the elderly and demand of welfare service for a long period of time, especially the need of home service. The concepts of “de-institution alization”, “aging in place” and “community care” in recent years, also, increase the supply of home service for the elderly. The supply of home service can help elderly disabled persons and the aged who live alone in their familiar surroundings. Government and many private institutions are now more willingly to invest social resources to supply the aged with home service. Owing to the disconnection of traditional administrations, the differences of professional principles, limited social resources and shortage of integrated and effective plans, the performance of home service for the aged has faced many difficulties. Due to the differences between environments and culture, we select Chia-yi city to be the study object. The purpose of this study is to explore the current service situation of systems concerning the home services of the aged in Chia-yi city. We will analyze the supply and demand of the home services in Chia-yi city to find the types of services suitable for the aged and the effectiveness of resource allocations. According to the study, we propose the reinforcement of the followings: the coordination of home service for the aged, diversity of projects, resources and information, the monitoring system of individual cases, computer link of organizations, and administrative integration. However, both the resources and obstacles during the process of reorganization should be considered. We also suggest that: 1.for policy perspective, it is necessary to define the home service contents for the aged (including the means of names, standard laws, the source of the aged, qualification, service manpower, service items…etc.) 2.to enlarge the target client group to serve more old people who require home service.3.to strengthen the coordination and negotiation between main caregivers and service personnel. 4.to strengthen the establishment of coordination, cooperation and reorganization among the various systems which offer the home service for the aged. 5.to establish the link among organizations. 6.to introduce operation of management system for individual cases. 7.to coordinate between the departments of social service and health