Huang Jing-Juin, Lin Kuan-Chia, Li I-Chuan
Chung-Huwa University of Medical Technology, Taipan, Taiwan.
J Clin Nurs. 2008 Jan;17(1):99-108. doi: 10.1111/j.1365-2702.2007.01974.x.
The purpose of this study was to quantify the service needs of residents in community-based long-term care (LTC) facilities and to determine their predictors.
Disabled older family members in Taiwan are often eventually sent to community-based LTC facilities. Many service needs of these residents are likely to go unmet.
A cross-sectional survey was used. This involved purposive sampling of 132 residents from 10 LTC facilities in Taipei City. A previously developed LTC service need assessment scale was used to collect information about the residents' needs in terms of five kinds of LTC services, namely health education, skilled nursing services, referral services, activities of daily living (ADL) assistance and instrumental activities of daily living assistance.
The mean age of residents was 75.2 years. The average period of institutionalization was 21.93 months. Overall, 70% of the residents had either complete or partial ADL function dependency. Among the specific ADL function dependencies of the residents, inability to take a bath was the most common. The most significant predictors of service needs were health status, age, number of children, number of medical diagnoses and whether the stay is self-choice. These combined variables explained between 25.5% and 41.6% of the variance of the need for LTC services.
The findings of this study show that age, health status, number of children, number of medical diagnoses and whether the stay is self-choice are significant determinants of residents' needs in terms of LTC. Assessment of the extent to which facilities meet the residents' needs is the first step in providing the most cost-effective allocation of scarce resources.
It is suggested that, if reimbursement by the National Health Insurance system of physician visits, including psychiatric visits, to LTC facilities were allowed, this would improve quality of care.
本研究旨在量化社区长期护理（LTC）机构中居民的服务需求，并确定其预测因素。
台湾残疾老年家庭成员最终往往会被送往社区长期护理机构。这些居民的许多服务需求可能无法得到满足。
采用横断面调查。对台北市10家长期护理机构的132名居民进行了目的抽样。使用先前开发的长期护理服务需求评估量表，收集居民在健康教育、专业护理服务、转诊服务、日常生活活动（ADL）协助和日常生活工具性活动协助这五种长期护理服务方面的需求信息。
居民的平均年龄为75.2岁。平均入住机构时间为21.93个月。总体而言，70%的居民存在完全或部分ADL功能依赖。在居民具体的ADL功能依赖中，无法洗澡最为常见。服务需求的最显著预测因素是健康状况、年龄、子女数量、医疗诊断数量以及入住是否为自主选择。这些综合变量解释了长期护理服务需求方差的25.5%至41.6%。
本研究结果表明，年龄、健康状况、子女数量、医疗诊断数量以及入住是否为自主选择是居民长期护理需求的重要决定因素。评估机构满足居民需求的程度是实现稀缺资源最具成本效益分配的第一步。
建议如果国民健康保险系统允许报销包括精神科就诊在内的到长期护理机构的医生出诊费用，这将提高护理质量。
