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題名:老人日間照顧服務輸送品質之研究
作者:林明禛 引用關係
作者(外文):Lin, Ming-Chen
校院名稱:東海大學
系所名稱:社會工作學系
指導教授:黃源協
學位類別:博士
出版日期:2007
主題關鍵詞:社區照顧品質老人日間照顧日間托老服務輸送體系community care qualityday care qualityservice delivery
原始連結:連回原系統網址new window
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二十一世紀世界各國面臨共同問題-老人人口遽增與照顧衝擊的議題,先進福利國家危機發展經驗,福利多元主義崛起,去機構運動的發展,有別於全控式機構照顧的社區照顧理念成為潮流;在台灣大多數老年人仍以選擇居家式養老,政府近年來已逐漸重視並且擴充對老人的長期照顧型態,尤其從社區照顧基礎理念出發,運用多元服務輸送策略,包括福利社區化、來自機構的社區照顧、在機構的社區照顧等。回顧台灣十年來福利社區化政策的推動足跡,走來固然踉蹌,然耙梳當中的契機,看到注入社區組織一股久已褪藏的活力外;而近年來訴求滿足服務消費使用者需要的取向,更也喚起對契合度、適當性與否的品質意涵之重視。社區照顧「服務輸送」無法背離「品質」而論述,「效率與效能」亦難能抽離「管理」而單獨揭櫫;鳥瞰先進國家社區照顧的典範-英國,整個公共社會服務的發展背景與過程,從強制性競標到最佳價值、效率到民主觀點,鑲崁著濃厚的「品質」暨「管理」的概念訴求。
本研究採「質量並用」方法,先從國內外數十篇社區照顧品質的研究發現整理,歸類老人日間照顧27項品質成效關鍵因素,並篩選成17項與使用者相關基本要素,運用量化問卷,調查台灣北中南東四區約110個服務使用者,分析對日間照顧的品質要素組成看法與評價;次則採質性方法,深度訪談8位老人日間照顧方案管理者瞭解提升服務品質的作法;亦冀從「服務輸送體系」變項觀點,檢視不同輸送體系與服務滿意。
研究發現老人對於日間照顧品質要素的重要性認知,可分為三類成分組合:首要以人際對待、身體安全、空間完善等的「基本友善」要素最為重視;次以服務內容穩定、實質水準、需求配合等的「服務水平」要素為次要重要認知;三則勉可將日間照顧基本功能的「功能實用」要素列入。以往文獻理論強調社區照顧的可近性、可負擔性的重要性在本研究中並未獲得證實;服務距離的可近性、收費的可負擔性二項相對於其他品質項目要素而言並不重要,時空背景轉換、文明提升進步,品質要素需求有可能轉變。以社區活動中心的就近照顧意涵,作為日間照顧服務空間的品質滿意是有疑慮;研究結論作成對政府日間照顧政策規劃、實務操作品質、理論文獻思維等建議。
The tremendous increase of the elderly people and the growing needs of long-term care for them are the issues that the Government have to face for all over the world in the 21st century. In advanced nations, with the crisis of welfare state, multiple welfare delivery and deinstitutionalization etc. have become main issues. However, the main way of long-term care for the elderly people in Taiwan is either living with families or living alone in their communities. With the overwiew of change from Compulsory Competitive Tendering(CCT) to the Best Value in England, as the paradigm of community care, responding to the needs of users has been the basic concept of quality management.
This study aims to understand what the quality component of day care for the elderly people is from the perspective of service users. The method adopted is to collect the essentials of the community care from some relative literatures, and referred to the social needs classifying of Brashaw, and the concept of the definition for the social service by Donabedian. These might be classified and named by researcher as: Social Function quality, Perception quality, and Estimation quality. There’re also 17 items from the classified which fit for the service users. According to the result of the factor analysis, three main dimensions of the concept for the elderly people at day care are named, including “the safe and friendly factor ” , “the service level factor” and “the function and utility factor”. If the service manager can emphasize on them, they may become the decisive factors to enhance the satisfaction of day care for the elderlt people. The accessibility and the affordability, which have been emphasized by researchers, as we’re known commonly in service delivery for day care, aren’t confirmed in this study. Because of the convience of traffic transportation and the professional assistance such as budget dealed by social worker for the users’ need, the accessibility and the affordability have become less important than the others.
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