碩士 / 高雄醫學大學 / 公共衛生學研究所 / 89 / Corresponding to the increasing demand of long-term care, the number of nursing home has grown rapidly. However, the absence of a fair payment system for nursing homes has provoked the difficulty of their operation. Therefore, the major purpose of this study was to classify the resource utilization groups of nursing home residents as a base of nursing home payment in Taiwan. Specifically, the objectives of this study were four-fold: 1) to compare resident characteristics by region, facility type, and facility size; 2) to examine the relationship among staff time, costs, and resident characteristics in hospital-based and freestanding nursing homes; 3) to analyze the relationship between resident characteristics and their resource utilization; and 4) to develop and compare the case mix index of nursing homes.
The present study was cross-sectional design. The information on nursing home resident characteristics and staff time was collected with retrospective method. The software of Answer Tree 2.0 — CHAID was used as a resident classification tool. There were 27 acceded nursing homes included in this study, which were located in Taichung city/county, Chia-I city, Tainan city, and Kaohsiung city/county. The period of data collection was from December 2000 to Ma- 2001. The study resident were purposively sampled in the study nursing homes. As a total, 1002 residents were included into analysis.
According to the classification rule of resource utilization groups version three(RUG-III ), seven categories of residents were conduced ,that is, rehabilitation, extensive service, special care, clinically complex, impaired cognition, behavior problems and physical functions reduced. As compared to RUG-III in the United State, the status of residents their service utilization in Taiwan significantly differed from the U.S. residents. Besides, in considering resident’s ADL, extensive service, impaired cognition, clinically complex, behavior problems, special care, depress, and nursing rehabilitation, the study residents were classified into 12 groups based on RUG-III. The 12-group model was the optimal classification as found in the study, which explained 10.6% of variance. After adding the variable of region, the explained variances increased to 17.8%. Such result indicated the difference in facility region might be the most important influential factor to resident services utilization.
Moreover, the results also showed that the residents who used more extensive care, and had more clinically complex and higher index of ADL were more likely to use mare service resources, the higher relative resources used. For staff time, each resident received 104.0 minute per day on average, which was higher than Japan (84.4 minute/day), but lower than Sweden, England and Wales, Spain and the United States.
According to the present findings, it is suggested that resident classification criteria is necessary for controlling inducing demand of institutional care. Based on resource utilization, the staff time provided by rehabilitation professionals and foreign aides needs to be taken into consideration for the establishment of nursing home payment system. Finally, the importance of related health professionals in nursing homes needs to be promoted; the task design of nursing aids is also essential.
| Identifer | oai:union.ndltd.org:TW/089KMC00058006 |
| Date | January 2001 |
| Creators | Yang His-Chu, 楊熙姝 |
| Contributors | Chiu Herng-Chia, 邱亨嘉 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 122 |
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