讓逝者適得其所－－臺灣長期照護機構推行安寧療護之現況與展望

Realizing the Wishes of Dying Elders- Status and Trends of Hospice in Long-term Care Facilities in Taiwan

全球老人的年齡與數目日益增加，各國逐漸重視老人生活品質直至臨終，為了有效管理醫療資源，紛紛鼓勵長期照護機構提供高品質的安寧療護服務，讓生命末期住民及其家屬在臨終階段能得到更好的生活品質，以期達到善終與生死兩相安的目標。國內因為風俗民情不同，過去長期照護機構通常不是臨終場所的首選；也因為長期照護機構工作人員對提供安寧療護服務的自信度與準備度不足，及家屬「留最後一口氣回家」的要求，反而讓生命末期的住民在臨終階段不適當住院的比率增加。本文以文獻整理方式，瞭解英美兩國在長期照護機構推動安寧療護的經驗，並探討住民及家屬對臨終照護品質、成本分析與醫療資源運用之效益。汲取英美經驗，訂定正確的政策引導與足夠的社會資源支持，生死教育與安寧療護教育課程的提供，才能真正讓長期照護機構住民在期待的場所善終，降低家屬的焦慮與悲傷，並且有效降低醫療資源的耗用。

The aged population is increasing in number and age worldwide. In response to this the governments in many countries are addressing the quality of life for the elderly until they die, by encouraging long-term care facilities to provide high quality hospice care to the residents. The goal of hospice is to improve the life quality of residents and their family by comforting families' during their bereavement and improving the life quality of residents as they reach the end of their life. Due to Taiwanese culture, long-term care facilities are not the best 'place-of-death' choice of most residents. Insufficient preparedness and a lack of confidence in care providers of long-term care facilities, as well as the request of 'holding the last breath until at home' from families, cause an increase in inappropriate admissions of elderly people to hospitals at the end of their life. The article is a literature review of the experiences of long-term care facilities that provide hospice care in the United Kingdom and United States. The article will explore the effects that the quality of care has on residents and their family during the various stages of dying, the utilization of medical resources, and cost analysis. From the experiences gained in the United Kingdom and United States, it is apparent that it is very important to make appropriate policies and provide enough resources for long-term care facilities, continue education conserving life and death, and hospice on-job training for ensuring a higher quality of life for dying residents. Such measures can reassure and comfort families and other loved ones, and reduces the wasteful utilization of medical resource.