現行長期照護評估工具的問題與因應

Issues of Current Assessment Tool for Long-term Care in Taiwan

10.6317/LTC.201012_14(3).0002

林麗嬋(Li-Chan Lin)；吳肖琪(Shiao-Chi Wu)；蔡誾誾(Yin-Yin Tsai)；張淑卿(Shu-Ching Chang)

長期照護 ； 評估工具 ； 失能分級 ； long-term care ； assessment tool ； level of care

長期照護雜誌

14卷3期（2010 / 12 / 01）

254 - 265

繁體中文

雖然各縣市採用綜合性評估量表進行失能評估，改正過去各縣市長照評估工具與分級標準不一的限制。不過，資格評定仍以日常活動功能和工具式日常活動功能的限制為準。但評估量表有下列幾個問題：1.量表項目選取的原則待確立；2.獨立與依賴的定義待釐清；3.輕症重判待改進；4.工具式日常活動功能的性別影響待評估；5.認知功能障礙者長期照護需求的評估工具待建構。對未來之建議：1.使用巴氏量表計分，避免輕症重判；2.對2010年全國長期照護需求調查做工具式日常活動功能性別差異檢定；3.在長期照護保險開辦前進行失能評照顧項目資源耗用之研究，以供更適切的失能分級強化給付的公平性。

Although every city and county uses comprehensive long-term care assessment tools to help determine a patient's disability level, eligibility for long-term care, and as an aid to further improve various assessment tools, the primary eligibility criterion is still based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Current assessment tools have limitations that can include a lack of clear principles of item selection, ambiguous definitions of independence and dependence, issues with upcoding the severity of disability, items that contain gender bias, and a lack of appropriate assessment tools for people with cognitive impairment. Further recommendations include using the Barthel Index's scoring key to avoid upcoding the severity of disability, testing of gender difference or bias by using the National Long-term Care Survey in 2010. It is also suggested that prior to the implementation of long-term care insurance, a resource utilization study for long-term care is undertaken to develop appropriate rankings for long-term care and establish reimbursement equity.