中華心理衛生協會

This study examined the use and evaluation of the day care centers (DCCs) in two Taiwanese communities. DCCs were given prominence in a recent initiative: The Pilot Program of Long Term Care of the Executive Yuan set [Aging in place] as the primary goal and planned to construct the system strategically in three years. DCCs were prioritized for Dementia patients as among other nine newly developed facilities or service programs for the disabled elderly in two experimental communities.The study used Donabedian's approach to measure the quality of care in terms of structure, process, and outcome. Subjective evaluation of user satisfaction was the methodological component of the study. In the evaluation of two DCCs, current primary caregivers were surveyed by using semi-structured questionnaire, including service content cited in the contract and in the literature. Providers were also interviewed about their experiences and difficulties in providing day care services as well as the resolution of difficulties. Focus groups of community care managers and secondary data from two DCCs were also utilized. In addition, factors of whether or not services were used were also explored.Two Centers with different organizational models were used as study sites. Chiayi Day Care Center was affiliated with a hospital and adopted the medical adult day care model. This model focused on patients care, rehabilitation and health evaluation. San-Ying Day Care Center, not affiliated with a hospital, adopted the social adult day care model, and prioritized a variety of social activities. There were important differences between the two centers in the flow of patient referrals, the underlying rationale for providing services and the overall costs of providing service. At least one explanation of the differences may be related to different levels of socio-economic status of the two communities.Highlights of important findings were:(a) Reasons for using DCCs included lowering burden of caregivers, substituting for care during daytime;(b) Reasons for not using DCCs when needed were: Barthel's index score being below 70, families being resistant taking the elderly to do dementia evaluation, having family members to care, feeling DCCs as one kind of institutionalization, having doubt with DCCs' caring capability, and feeling the expenses being too high;(c) When caregivers used Day care centers, almost all of them were satisfied with the center and services provided quantitatively, except some opinions where we used open questions.The policy implications from these results were discussed.