HOME AND COMMUNITY-BASED LONG-TERM CARE SERVICES IN TAIWAN: FACTORS AND EFFECTS ASSOCIATED WITH THE UTILIZATION BY COMMUNITY DWELLING DEPENDENT ELDERLY

Long term care;Ten year long term care plan;home- and community-based services;Andersen and Newman Behavioral Model of Health Services Use;Disability;Healthcare Leadership & Management

Chuang, Mei-juHuang, Pien-Chien ;

Johns Hopkins University

关键词: Long term care;    Ten year long term care plan;    home- and community-based services;    Andersen and Newman Behavioral Model of Health Services Use;    Disability;    Healthcare Leadership & Management;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60227/CHUANG-DISSERTATION-2017.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: The growth of population aging in Taiwan is projected to be one of the fastest aging countries in the world. In response to the increased demands of this aging society, the Taiwan government launched the 10-year Long-term Care Program (LTCP) in 2008. A variety of home- and community-based long term care services were provided to the community-dwelling dependent elderly. However, little is known about the factors related to the utilization of the long-term care program.Purpose: To understand the factors and effects of the home- and community-based long term care services utilization among community dwelling dependent elderly in Taiwan.Methodology: The study data were extracted from the database of ;;Long Term Care Plan- Chiayi City”. In total, 1,294 older adults who were newly eligible and applied for the 10-year Long Term Care Plan in 2013-2015 were included to explore the determinants of the factors with the utilization. Among 1,294 older adults, 680 elders who were enrolled from January 2013 to June 2014 were followed until September 2016 to describe the outcome and the utilization. Andersen and Newman’s Behavioral Model of Health Services Use was applied to guide the selection of variables, analyses, and interpretation. Based on the behavioral model, three population characteristics including predisposing, enabling and need-level factors and environmental factors were included in the study model. Simple statistical comparison, multiple logistic regression and Cox proportional hazard model were applied in this study.Results: Of the 1,294 participants in LTCP, 820 (63.37%) of the participants received at least one of home/community based long term care services. Among 9 types of home/community services for disable elderly, the most widely used service was homecare (57.92%) and the least used service was host family (0.37%). As for the item of home/community based long term care services utilization, 83.53% of the users used only one service. The results of logistic regression showed that elders who had lower household income level, having both geriatric conditions and having higher functional limitation were significantly more likely to use home/community based long term care services. While elders with higher education, having severe/critical disability certification, being severe cognitive impairment and unclear conscious were significantly associated with less likely to use home/community based long term care services. In addition, the use of home/community based long term care services only had a positive effect on mortality, and there were no positive impacts on nursing admission and improvement in functional status and caregiver burden.Implications: More research is required for service utilization since diversified home/community based long term care services have not yet gained popularity in Taiwan. More promotion and education for the public to use the home/community based services are also needed. Meanwhile, the policy about foreign worker should be reviewed and modified. Now the long term care plan 2.0 in Taiwan has been launched since 2017, future research can evaluate the effectiveness of the integrated long-term care service model.