日間照顧服務使用對失智老人家庭照顧者影響之評估：不同服務模式之比較

Abstract

老人日間照顧服務由於兼具老人福利服務和家庭照顧者喘息服務之性質，近年來在台 灣，服務提供單位和供給量逐漸增加，且服務模式演變成「獨立型態失智症日間照顧中心」 （一種專門化的失智症照顧模式）及「綜合型態（失智失能混合型）日間照顧中心」。本研 究之目的旨在比較上述兩種服務模式之成效，側重在使用日間照顧服務對家庭照顧者的影 響。 本研究為三年期研究計畫，第一年在方案規劃管理層次，預定深度訪談 15位日間照顧 中心負責人，試圖比較兩類服務模式在方案目標、方案結構特性、過程等層面之異同及可 能產生的成效差異，另也訪問 20位失智老人使用者之家庭照顧者，以探究從家庭照顧者的 角度出發，對老人使用日間照顧服務經驗的考察，以及他們對日間照顧服務對失智老人的 家庭成員及自己之影響。 第二年及第三年採前、後測準實驗設計，預定在 8個月期間，針對 15所日間照顧中心 （兩種服務模式）開案的失智老人使用者之家庭照顧者在三個不同時間點（使用服務前、 使用服務 3個月、及使用服務 9個月），進行面訪問卷調查，以探究日間照顧服務對其壓力 負荷及主觀福祉感之影響。最後依據研究結果，提供建議以供政府制定日間照顧服務相關 政策、及日間照顧中心工作員服務輸送之參考。

Day care service can function as a community-based program for older people as well as a respite care program for the family caregivers, and therefore the supply of day care programs increases greatly in Taiwan. There are two service models for older people with dementia, one is labeled as a special model for the dementia clients, and the other is the general model, serving both the frail elderly and the dementia elderly. This study aims to compare the effects of day care use for caregivers of the dementia clients who use these two different models. This study is a three-year project. In the first year, the task is to compare these two service models at the program level. Hence we plan to interview the worker who charges the day care program. In addition, we use the in-depth interview to collect data from 20 family caregivers of the elderly clients with dementia. In the second and the third year, considering this study aims to examine the effects of day care use on the family caregivers, three interviews with 100 family caregivers of the dementia clients using day care will be implemented before the program (baseline survey), and three months (T1 survey), and 6 months afterwards (T2 survey) during the nine- month period of use. The effects on family caregiver will be measured with respect to their burden, stress, subjective well-being, and quality of life. Secondly, we ask day care center staff to collect informational and behavioral data on the participants at baseline, T1 and T2. The data collected from staff provides an opportunity to investigate the changes in behavior and psychological symptoms for the dementia clients. Finally, according to the results, policy and practice implications will be discussed.