[ 摘要 ]

隨著長期照護的多樣化與民眾自主權的提升，民眾對長期照護的選擇在政策擬定上也越趨重要。本篇研究的主要的目的是探討影響照顧者選擇現金或服務的情形與其相關因素。

研究資料來自行政院衛生署在西元2000-2004年執行的「全國長期照護服務需求評估調查」，針對其中有9,765位有照顧者的失能者，進行次級資料分析。資料內容包含照顧者的社會人口學特質、社會支持、照顧負荷、自評健康、提供照護工作及照護時間等；失能者的社會人口學特質、問題行為及護理需求等。採用的統計方法有描述性分析、卡方檢定、T檢定、邏輯迴歸。

結果發現選擇現金的人有73.6％，選擇服務的人有26.4％。在控制其他因素後發現當照顧者年齡越大、學歷越高、家庭月收入60000元以上、照顧負荷較大、家人支持度低、照顧對象為男性、出現危險行為及有2項以上護理需求時，照顧者則較傾向選擇服務。而當照顧者是閩南人及原住民、女兒、財務負荷較大及需要幫助失能者洗澡時，則較傾向選擇現金。

本篇研究結果發現選擇長期照護方式隨著照顧者與失能者情況不同而有所差異，未來在相關配套措施健全時應可考慮將服務選擇權開放給家庭，讓其有權利且有能力選擇最適切的長期照護方式。國內現金給付至今並未有明確的規範，這是政府相關單位未來需要再評估與努力的方向。

[ 英文摘要 ]

As the society offers more options regarding long-term care services, and as the general public seeks more autonomy in selecting services, how people choose long-term care services has significant policy implications. The purpose of this research is to assess the prevalence of caregiver preference (cash or service) and to identify relevant factors affecting the decision making.

Data used in the study come from the “National Long-term Care Needs Assessment” study, conducted from 2001 to 2003. Secondary data analysis was conducted on the 9765 caregivers and disabled elderly living together in the community. Caregiver characteristics used in the analysis included socio-demographics, self-rated health, caregiver burden, social support, and care-giving activities. Characteristics of disabled elderly included socio-demographics, functional ability, nursing care needs, and problem behaviors.

The research results showed that 73.6% of caregivers prefer cash while 26.4% prefers services. After controlling for other variables, it showed that older, higher educated, higher income, higher burden (social, emotional, and time), lower social support, male recipient of care, problem behaviours, and nursing care needs were associated with service preference. On the other hand, ethnicity (Fukienese, and aborigines), caregiver who is a daughter to the disabled, more financial burden, and assisting the disabled with bathing were associated with cash preference.

This research shows that personal, social, and care-situation characteristics would affect the choice of caregivers. With appropriate guidelines and monitoring, the government could someday allow the caregivers to choose between services benefits or cash reimbursement in order to meet their own needs. However, there is not a guideline in issuing cash reimbursement for long-term care in Taiwan. Before cash reimbursement can be implemented, more work should be carried to assess the needs and the effects of cash reimbursement.