| 摘要: | 中文摘要
論文名稱：影響台灣地區機構式長期照護體系經營效率之相關因素探討
研究所名稱：臺北醫學大學護理學研究所
研究生姓名：盧敏慧
畢業時間：九十一學年度第二學期
指導教授：陳靜敏 台北醫學大學護理學研究所 副教授
本研究旨在瞭解機構式長期照護體系之主要特徵與經營現況、經營時所面對的環境衝擊，與探討影響機構式長期照護體系經營效率之主要因素。應用橫斷性、相關性研究設計，普查全台灣地區於八十九年以前立案之護理之家與養護中心之機構式長期照護體系負責人為對象。研究工具係自擬而成，包括機構特性、經營效率及負責人感受環境衝擊得分等，具合宜專家效度(CVI>.78)及信度(Cronbach’s α=.68~.78)，共回收有效問卷229份(回收率50.22%)。
主要研究結果顯示：護理之家平均佔床率為75.86%，低於養護中心的80.14%。護理之家平均526.4坪、49.02床；養護中心平均284坪、35.95床。護理之家去年護理人員離職率平均為18.76%，相較低於養護中心的21.30%；然而其服務員離職率平均為22.02%高於養護中心的16%。護理之家負責人多數具醫護背景(95.1%)，高於養護中心的51.7%。機構能提供之服務內容以養護中心較護理之家能朝向多角化經營。評鑑結果顯示護理之家有25.5家(30.25%)曾獲中央或地方評鑑優良；而養護中
心則有33家(22.30%)獲獎。
經營者感受之環境衝擊包括七層面，其中以來自客戶方面衝擊的平均得分最高為2.62 (SD=.65)，而來自市場區隔衝擊的得分最低(M=1.68，SD=.45)。房屋所有權以承租者較自有及公有者負責人在感受政策法規、人力資源與資金取得上之衝擊為高。房屋承租者較公有者對經營理念與技術感受衝擊較高。經營理念與技術上感受之衝擊與個案來源、房屋所有權及機構型態有關。收住低收入戶之機構在資金取得感受之衝擊較高。佔床率與負責人年齡及資金取得衝擊呈負相關。
在經營效率方面，佔床率上升者以負責人之學歷是高中者、採單一收費佔最多；佔床率上升者較佔床率下降或持平者感受來自客戶、政策法規、人力資源、資金取得及經營理念與技術等衝擊之得分為低。長期照護機構負責人年齡愈輕，感受資金取得衝擊愈低，屬私人機構、機構面積愈大及服務員人數愈少，則佔床率愈低，上述五變項的組合只可解釋11.0%的變異量。由於長期照護機構多集中在北高兩都會區，研究結果建議需先瞭解各縣市長照資源供需狀況，優先補助供給不足入住率高的地區；供給不足而入住低的地區則輔導機構採多角化經營以提昇競爭力。
關鍵詞：機構式長期照護體系、感受環境衝擊、經營效率
Abstract
Title of thesis : The Study on Factors Affecting the Operational Efficiency
of Long-Term Care Facilities in Taiwan
Institution : Graduate Institute of Nursing, Taipei Medical University
Author : Lu, Min-Haui
Thesis directed by : Ching-Min Chen, RN, DNS, Associate Professor
The primary aims of this study were to examine the major
characteristics, operational efficiency and environmental impact upon long-term care facilities perceived by managers, and further to explore the major factors influencing the operational efficiency of long-term care facilities. The cross-sectional research design was use to mail-survey all managers of nursing homes and care centers licensed by 2000 in Taiwan.
The research instruments were self-developed with acceptable content
validity (CVI>.78) and reliability (Cronbach’s α=.68~.78). A total of 229 effective questionnaires returned (response rate=50.22%).
The average occupancy rate was 75.86% in nursing homes, which was lower than that of care centers (80.14%). The size of nursing homes (526.4 pin, 49.02 beds) in average was much larger than that of care centers (284
pin, 35.95 beds). In last year, the average turnover rate in nursing homes was 18.76%, and 21.30% in care centers ; However, for nursing aids, the turnover rate was higher in nursing homes (22.02%)than16% in the care centers. Majority (95.1%)of nursing homes managers with medical background, in contract, only half (51.7%) in care centers. Compare to nursing homes, care centers in general provided more diverse services. In last year, 30.25% of nursing homes surveyed was accredited by federal & state governments, however, only 22.3% of care centers was accredited.
Among 7 domains of environmental impacts on facilities, the managers perceived highest impact from the customers (M=2.62 , SD=.65) and lowest from the marketing (M=1.68, SD=.45). Those facility house were rented felt higher impact on policy laws, human resources and available bankroll than private owned and public funded facilities. Those rented perceived higher impact on operational management than the public funded. The perceived operational management impact was related to consumer source, housing status and facility type. The facilities taking low-incoming clients felt higher impact on available bankroll. The occupancy rate and manager’s age were negatively correlated with available bankroll of the environmental impact.
In term of operational efficiency, the facilities with improved occupancy rate tended to be high-school graduates, with set charge and perceived less impact on customers, policy laws, human resources, available bankroll and operational management. The manager’s age, perceived impact on available bankroll, size of the facility and private facilities, were negatively predicting occupancy rate. However number of nursing aids was positively correlated with occupancy rate .The above combination of five variables only explained 11.0% of variation on occupancy rate, Because a lot of long-term care facilities were centralized at southern and northern urban cities, suggestions were made to explore the supply and demand of long term care in every county in order to subsidize those in deficit and to guide those facilities in lower operational efficiency to adapt the diverse services contents.
Keywords: Long-term care facilities, Perceived of environmental impact, Operational efficiency |
