養護機構小單元照護研究：以屏東縣某老人養護中心為例

Research of Unit Care in the Medicare Institution: A Case Study in Pingtung

10.6171/ntuswr2008.16.04

黃松林(Song-Lin Huang)；劉慧瑩(Hui-Yin Liu)；許秀月(Hsiu-Yueh Hsu)

養護機構 ； 小單元照護 ； 老人照護 ； 老人福利 ； medicare institution ； unit care ； time for willingness of residents leaving beds ； daily steps of care workers

臺大社會工作學刊

16期（2008 / 01 / 01）

129 - 166

繁體中文

屏東縣迄至2006年底老人人口已占總人口之11.75%，當前縣內已有老人養護機構50家，大多數安養護老人是居於小型老人養護中心，極多學者認為老人養護中心適合推展日本小單元照護照護失智症老人。本研究就屏東縣某一養護機構規劃日本小單元照護模式提供護理與社會照顧服務，其後針對員工步伐數做測量以了解小單元照護實施對照護者的工作負擔情形；以住民長輩主動離床時間參與互動及滿意度問卷調查亦為其指標，以測量其服務品質。研究發現如下：施後第一週至14週有增加情形，其後在執行五個月後逐漸減低，在第20週後甚至低於實施前之步伐數，顯示方案執行後期員工之工作負荷降低。另針對院民主被動離床時間、滿意度做測量，初期院民主動離床時間有增加情形，其後有降低之情形，但五個月後仍維持在相當高的程度；而其受服務滿意度，後測亦有增加的趨勢，此一結果與日本相關小單元照護服務相互呼應考。

The elderly population in Pingtung County has risen to 11.75 per cent of the total population. There are more than 50 homes for the elderly in Pingtung County. Most of them are small medicare homes with less than 50 beds. Since 2000, the 'unit care', which has been promoted for several years in Japan, is regarded as a unique one for caring for disabled elderly people today. It is especially appropriate for elderly people with dementia. This research tried to promote a Unit Care Model Project and it included social and nursing care services. In this research, daily steps of care workers were taken into account to measure the work load under the Unit Care Model Project. In addition, time for willingness to leave beds of residents to join interactions and an investigation of satisfaction with services were also utilized to measure the quality of service. Findings were illustrated as follows: daily steps of care workers kept rising from the first week to the 14(superscript th) week and lessened after the 15(superscript th) week. After the 19(superscript th) wee, it was even less than the beginning of the project. This shows that the work load of care workers has been lower than at the beginning of the project. In addition, time for willingness of residents leaving beds increased significantly during the first two weeks and then gradually decreased. The scores were significantly higher than at the beginning of the project. Our findings were similar to the researchers in the Japanese study. Suggestions to institutions were given in the conclusion.

1. 翁福居、林財源(2004)。失智概念與團體照護。臺灣智能障礙研究中心期刊，2(1)，57-66。
   連結：
2. 莊秀美(2005)。「團體家屋」模式運用於失智症－老人照護服務推動之探討。東吳社會工作學報，12，75-113。
   連結：
3. 許佩蓉、黃耀榮、林健群、李世代、陳永煌、羅慶徽(2004)。居住型態對照護機構內失智症患者問題行為之可能影響。臺灣家醫誌，14(1)，13-24。
   連結：
4. 楊培珊(2000)。機構式失智症照顧中社會工作的執行。社會政策與社會工作學刊，4(1)，199-236。
   連結：
5. Bellew, J. R.,Mink, G.(1996).Case management in social work-developing the professional skills needed for work with multi-problem clients.Springfield, IL:Charles C. Thomas.
6. Donabedian, A.(1980).The definition of quality and approaches to its assessment.Ann Arbor, MI:Health Administration Press.
7. Holt, B. J.(2000).The practice of generalist case management.Boston, MA:Allyn & Bacon.
8. Martin, D. L.,Cheyer, A.,Lee, G. L.(1996).Paper presented at proceedings of the first international conference on the practical application of intelligent agents and multi-agent technology.London:
9. Zeithaml, V. A.,Parasuraman, A.,Berry, L. L.(1990).Delivering Quality Service: Balancing customer perceptions and expectations.New York:Free Press.
10. 中村英三(2004)。於福利設施的組合照顧方式的實施與團體收容所的癡呆性老人家的照顧。2004年亞洲之長期照顧與福利產業國際學術研討會會議手冊，台中縣草屯:
11. 身心障礙福利統計資料
12. 內政部統計處(1997)。老人狀況調查報告。台北:內政部。
13. 九十六年八月內政統計通報
14. 日本厚生勞動省社會保障審議會介護保險部會(2003)。2015年?高?者介護～高?者?尊??支?????確立?向??～。
15. 外山義(2002)。個室化。日本:綜合株式會社。
16. 行政院衛生署
17. 呂寶靜(2001)。老人照顧：老人、家庭、正式服務。台北:五南。
18. 李光廷(2004)。失智症老人照護模式與日本機構照護革命。臺灣社會福利學刊，5，142-144。
19. 郭銀漢、謝錦鑾(2004)。長期照護機構民營化之實踐，以國立台南護專承包經營署立台南醫院護理之家為例。本土化、民營化、專業化社會福利國際學術研討會，高雄:
20. 黃松林、劉慧瑩(2006)。養護機構單元照護初探。2006健康與社會照顧國際研討會，屏東縣內埔:
21. 萬育維(1994)。福利計畫與評估。中華民國社區發展研究訓練中心。
22. 謝美娥(1993)。老人長期照顧的相關議題。台北:桂冠。

1. 郭慈安、侯建州(2017)。原住民長期照顧管理服務之研究：照顧管理者的服務處境與困境。社會政策與社會工作學刊，21(2)，117-157。
2. (2012)。理想照顧住所的想像─以社會支持觀點檢視老人失智症者「團體家屋（group home）」。社區發展季刊，137，325-341。