第二章 連續性照護的客戶 授課名稱：長期照護服務 授課名稱：長期照護服務授課教師：陳芬如老師 學生：李御嘉、黃倩盈 學生：李御嘉、黃倩盈 學號： M 、 M 學號： M 、 M 報告日期： 2008/04/10

2 Summary  The clients who can benefit from the continuum of care encompass a broad range of individuals who require formal and/or informal care over an extended period of time.  Those who use the continuum of care represent a mosaic of subgroups.  Projecting the total demand for the continuum of care is like constructing an intricate jigsaw puzzle, with overlapping colors but separate pieces.

3 DEFINITIONS AND NATIONAL PROFILE (1/6)  Chronic is defined as a condition that has a of more than three months (NCHS,1995).  Chronic is defined as a condition that has a duration of more than three months (NCHS,1995).  Chronic conditions are not life-threatening.

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5  Chronic conditions affect people of all ages, are more common among older people. (Table 2.1)  Chronic illness also affects people of all ethnic and racial groups, although some conditions are more prevalent in some groups than in others. DEFINITIONS AND NATIONAL PROFILE (2/6)

6  Impairment is defined as “a chronic or permanent defect, usually static in nature, that results from disease, injury, or congenital malformation” (NCHS,1995).  Disability refers to “any long-term or short-term reduction of a person’s activity as a result of an acute or chronic condition” (NCHS,1995,p.5). Figure 2.2 Figure 2.2 Figure 2.2  Functional status is the primary consideration that makes an individual appropriate for long-term care. DEFINITIONS AND NATIONAL PROFILE (3/6)

7  Functional ability has multiple dimensions ： physical, cognitive, emotional, and social.  People with the same chronic (or acute) condition may function at different levels.  The most commonly used measure of physical function is the assessment of basic activities of daily living (ADLs) scale. (ADLs) (ADLs) DEFINITIONS AND NATIONAL PROFILE (4/6)

8 DEFINITIONS AND NATIONAL PROFILE (5/6)  A person’s ability to perform each activity was assessed according to one of four categories ： 1. Totally independent 2. Requiring mechanical assistance only 3. Requiring assistance from another person, or 4. Unable to do the activity at all  Instrumental activities of daily living (Lawton & Brody,1969).  Instrumental activities of daily living (IADLs) comprise basic activities that one must be able to perform to live independently in the community (Lawton & Brody,1969).(IADLs)

9  Some people with the same conditions may be users of formal continuums of care, whereas others rely solely on informal support or assistive devices.  Figure 2.3 shows the multiple ways that a person might ultimately come to need long-term care from formal or informal sources. DEFINITIONS AND NATIONAL PROFILE (6/6)

10 Need v.s Demand (1/2)  need  A need is considered to be the result of a professional judgment that a specific service or treatment should be provided to an individual to improve his or her condition.  demand  A demand is an individual’s overt request for a service or treatment, presumably stimulated by a perceived deficit and a belief in the benefits of the requested service or treatment.

11   Sometimes a potential client may express premature demand and at other times fail to appreciate or recognize a real need.   In the context of fee-for-service (FFS) health care delivery, the financial incentives are to stretch the boundaries. Need v.s Demand (2/2)