研究背景
隨著台灣社會快速老化，台灣將於2025年邁入超高齡社會(國家發展委員會，2020)而大多數的台灣高齡者理想及實際居住模式仍為住在家中(老人狀況調查報告，2017)。因此，為滿足衰弱或失能的長者在地老化之需求，新型居家、社區服務模式－復能專業服務開展。復能服務可協助個案以目標為導向，發揮最大化功能性能力。自2017年底衛福部公告「長照給付及支付基準」，正式從長照1.0「居家復健」轉型為長照2.0「復能專業服務」 (衛生福利部，2017)。長照2.0專業服務推動至今三年餘相關規定與細節仍不斷進行滾動式修正，加上復能的觀念不同於傳統復健，需要與個案、家屬共同合作，才能發揮復能最大價值。因此了解現行長照制度下居家復能使用者的特性，並分析使用者特性與服務利用現況與成效的關聯，是值得思考之議題。
研究目的
本研究擬透過台灣長照體系之照顧管理資訊平台資料庫進行研究分析，了解長照復能使用者特性與服務使用現況及影響復能成效之因素。
研究方法
本研究採用次級資料庫分析，以安德森健康服務利用行為模式作為研究架構，探討使用者特性與服務利用、成效之關係。資料來源為台灣長照十年計畫2.0制度下，2018年1月份至2020年8月份的台南市長期照顧管理中心照顧管理資訊平台資料庫。內容包含申請表、照顧管理評估量表、照護計畫與核銷資料。研究對象為失能等級核定為CMS 2-8級、50歲以上、住在家中並排除住在住宿式機構，有使用長照專業服務者。依據研究目的，擬探討(一)使用者特性與核定專業服務之關係。(二)使用者特性與退出居家復能服務之關係。(三)居家復能成效以及影響成效之因素。以描述性分析及多元羅吉斯迴歸針對三個面向進行分析，以p<0.05表示有統計顯著差異。
研究結果
研究結果分為三大面向，分別為：
(一) 核定專業服務之使用特性：本研究結果發現居住區域為都會核心、A個管類型為醫事個管單位、個案年齡較輕、教育程度較高、家屬照顧負荷較低、有聘請看護、個案失能等級越高等因素能顯著預測專業服務的核定。
(二) 退出居家復能服務個案之特性：年齡越高、與照顧者同住、無聘請看護、失能等級輕中度以及其他長照資源越多能預測個案較有退出居家復能服務可能性。
(三) 居家復能成效以及影響成效之因素：復能介入後可顯著改善失能程度與照顧負荷。發現失能程度改善與否主要會受到個案需求因素的影響，患有失智症、身心障礙者、意識狀態、營養狀態及基期時功能狀態能預測失能程度改善與否；而照顧者負荷改善與否受到使能因素的影響大於個案的需求因素，基期照顧負荷、照顧者健康狀況、與親友聯絡頻率、有聘請看護、個案行動能力等能預測照顧負荷改善與否。
結論
本研究實證結果可以作為未來居家復能服務輸送之參考，希望藉由了解目前居家復能服務推動與服務使用現況；有助提升制度端對於復能專業服務的決策制定並針對民眾推廣復能服務的效益。本研究發現的族群特徵，在需求端也可以做為未來對不同需求之族群建立最有效益介入模式之參考，以符合個案與照顧者需求，協助長照需求個案能參與日常重要活動、提升生活品質及減少照顧者的壓力及負擔。

SUMMARY
This study aims to understand the care recipients’ characteristics of reablement in the home and community-based settings, service use, and the factors influencing their health outcomes by using data research and analysis through the database of the care management information platform of the long-term care system in Taiwan. Descriptive statistics and multi logistic regression were used to analyze the influencing factors that affect outcomes. p<0.05 indicates significant differences. The results are divided into three main categories as follows: (1) This study found factors that significantly influenced approval of the reablement professional services were the residential area, the type of medical management unit, younger age, higher level of education, lower level of caregiver burden, hired foreign care workers, higher dependent level.
(2) The characteristics of care recipients were not only age of the care recipients, living with caregivers, without foreign care workers, mild disability dependency level, but also the more long-term care resources, the more likely to drop-out from reablement services. (3) Effectiveness of reablement and factors influencing the outcomes: The reablement service improved ADLs and reduced the stress of the caregivers. The factors influencing the ADLs outcome were the older adults suffering from dementia or disability, state of consciousness, nutrition, and baseline functional level of the older adults. And whether the caregiver burden reduced or not is mainly affected by the enabling factors, the baseline burden, health status of the caregiver, the frequency of contacting with relatives and friends, if hiring foreign care workers, and the mobility of care recipients. The care recipients’ characteristics and key factors found in this study can be used as the references for long-term care policy to develop effective intervention model for different groups of care recipients in the community in order to meet the needs of the care receipts and their caregivers.

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