機構式長期照護服務使用之相關因素探討：社區環境與個人背景因素的分析

• Main Authors: Su-Fen Tzeng, 曾淑芬
• Other Authors: Shwu-Chong Wu
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/89887061529223092257

博士 === 國立臺灣大學 === 衛生政策與管理研究所 === 93 === The needs of long-term care have been increasing because of elderly people experiencing chronic disability. With the costs and quality of elderly care drawing greater attention, institutional care utilization has become an important issue in long-term care. Previous literature on institutional care utilization was mainly based on individual and familial perspectives, with a lack of incorporating community factors into consideration. Given the complexity of factors in relation to institutional care utilization, an ecological approach to investigating both individual and ommunity effects on utilization will provide valuable implications for long-term care policy in Taiwan. This study aimed to: 1). understand the utilization of institutional care by elderly people in Taiwan, and its distribution by geographic areas; 2). identify individual-level factors of institutional care utilization; 3).examine community-level determinants of institutional care utilization; and 4). Investigate the effects of interaction between individual and community-level factors on institutional care utilization. This research pertained to a cross-sectional design, using data collected in the second-stage survey of “ 2001 Long-term Care Need Assessment in Taiwan” A national representative sample of 12,979 disabled individuals aged 65 were studied, with 11,777 from the community and 1,202 from long-term care institutions. The study performed descriptive, bivariate, logistic regression, and multilevel analyses. The result showed that 11.8% of elderly people had received institutional care in the past year. With respect to the individual-level factors, higher percentages of institutional care utilization were found in those who were 85 years old and over, male, at least with high school diploma, mainlanders, entitled to low-income supplements, with no spouse, with no children, and those who were severely or completely dependent, with profound cognitive impairment, with problem behaviors, in need of nursing care, and had more chronic conditions. In terms of community-level characteristics, utilization was 12% in areas with higher rates of female employment and levels of industrialization. Logistic regression analyses showed that, predisposing factors including age, education, ethnicity, number of children, and marital status were significantly associated with institutional care utilization. After controlling for community-level, the aforementioned effects of individual factors persisted. As far as demand factors were concerned, the level of dependency, cognitive impairment and needs in nursing care were significantly related to utilization. Such associations remained significant after community characteristics were controlled. In terms of enabling factors, the probability of using institutional care was 2.94 times higher for low-income elderly and 3.29 times higher for those entitled to multiple welfare programs, with both individual and community variables controlled. Hierarchical linear regression analyses revealed that female employment and industrialization were significant community-level predictors of institutional care utilization. After controlling for individual characteristics and variables related to community resources, the probability of care utilization was 1.08 greater in highly industrialized areas. Besides, a statistically positive association was found between resources availability and utilization. The odds ratio was 1.37 in high-resource areas compared to low resource areas. Similar pattern was observed with respect to medical care resources, with an odds ratio of 1.12. No statistically significant relationship was found between the availability of community-based services and utilization. Community impacts on institutional care utilization were mediated by individual factors. The results showed that community exerted it effects on individual attributes including age, sex, ethnicity, availability of children, marital status, levels of dependency and cognitive impairment, and nursing care needs, and reinforced the propensity of institutional care utilization. With respect to the interaction effects of dependency with community factors, only institutional and medical care resources were found to have interaction effects on utilization but not community-based services. This study concluded that institutional care utilization was determined both by community and individual-level factors. The findings provided important implications for long-term care policy, particularly directed to the distribution of resources in consideration of community features, and the demand for long term care from the community perspective. In addition, the differential utilization of institutional care suggested that policy planning be concerned about subgroups of elderly people with different individual characteristics through need assessment. It is also crucial for the prediction of future needs in long-term care.