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委員長部長早 在長照3.0要上路的元年我有很多問題要來請教部長我最近趁著空檔時間 從2月1號到現在我大概走訪不同縣市的長照機構那非都非地區需要長照機構而設立長照機構最大的問題不外乎就是評鑑"},{"start":35.103,"end":48.522,"text":"所以我想先來請教部長有關評鑑的問題台灣已經邁入我們的超高齡社會長照的制度也是進入到今年正式進入到長照3.0目前全台最"},{"start":49.147,"end":69.279,"text":"需要長照服務的人口已經超過了100萬人因此長照服務的品質跟我們的監督機制非常的重要可是我們自己看到就是說最近就有報導指出現行的長照機構評鑑制度出現了文件導向的一個現象甚至延伸出協助機構來撰寫評鑑資料的一個評鑑顧問"},{"start":74.229,"end":98.465,"text":"不曉得你自己有沒有看這樣子的一篇蠻冗長報的那收費呢從10到50萬不等所以部長你知道這件事情嗎這樣子的一個評鑑制度到底是要在提升照顧品質還是在檢查文件品質這事實上是由來一直以來的問題我想不是只有長照過去托嬰中心幼兒園也都是這樣就是有寫手來幫忙幫你"},{"start":100.259,"end":120.089,"text":"整套的東西都整理好可是到底真實的事實上是機構的品質嗎可是如果評鑑事實上是如果做文件的話一定會拿到優好如果一旦發生問題的時候很常政府就會被批評說他都是優啊那他為什麼會這樣為什麼發生不幸的事件呢好所以不知道你知道這樣的狀況嗎"},{"start":121.549,"end":141.68,"text":"我想跟委員說明,那麼為了提升這些照護的品質,我們經常都是採用兩個手段,一個就是督導考核,那一個就是用這個評鑑的方式。那當然評鑑是比較軟性啦,那但是呢,它的標準上呢,就可以可能會朝向這個一直在優化。"},{"start":143.481,"end":164.393,"text":"確實在過去從醫院評鑑可能做了比較久大家也可以看得到這個後來也是出現有這個文件paperwork太多反而造成臨床上的壓力所以我想這個長照的評鑑我們也一樣會跟目前在做醫院評鑑改革的精神是一樣的盡量去降低"},{"start":165.814,"end":184.202,"text":"這個文件這個paperwork盡量能夠降低但是也導入一些智慧化因為我們也不想只是因為一日的評鑑當天的評鑑那很多就是一日表現很好但是平常不好所以還是要建立過去用文件就是說可能當天"},{"start":184.842,"end":199.18,"text":"一天的評鑑怕失準所以才會準備一堆長期的文件那如果我們能夠建立起自廠的監測機制那麼我想這個文件的要求就可以下降當然在"},{"start":199.7,"end":212.151,"text":"我們的長照機構跟醫院不同的是說它的小規模的很多所以它本身的資訊能力也比較有落差所以我們會盡量來協助改善"},{"start":214.633,"end":228.448,"text":"所以我最擔心的就是說第一線公眾員反映說有些機構就是文書人員很多幾乎都在做文書可是照顧人力很少照顧員必須花很大量的時間將近大概要花35%時間來處理重複的一些記錄"},{"start":230.63,"end":248.177,"text":"反而壓縮了照顧長者的時間更可能找所謂的我們的評鑑顧問來代寫我覺得先個案紀錄找評鑑顧問來代寫實在是坦白講有點離譜就是說我從A機構評鑑的時候看到的跟B機構寫的個案紀錄完全一模一樣這真的是讓我們覺得說那這樣子的"},{"start":249.878,"end":273.669,"text":"品質何在呢所以想問部長說目前評鑑指標當中我們的文書記錄跟實際照顧品質的比重各自是多少為什麼因為有時候評鑑幾乎委員都在看黨本資料很少去看到現場現場也有些樣板的給你看甚至記錄都有樣板的給你看所以政府是否評估過這種過度化的反而是讓增加第一線的一些負擔"},{"start":275.082,"end":276.869,"text":"詳細的評鑑的過程我是不是請長照司的副市長來補充"},{"start":282.034,"end":310.12,"text":"謝謝 謝謝委員這邊的垂詢關心那我們其實非常看這種評鑑的實質到底評到了什麼所以你們只有60項可是那指標真的都是在文書因為有分專業組跟經營管理組那委員剛剛說只看文件不看現場那個是經營管理組因為他確實要看他整個機構的管理的部分去抽那些相關人員排班的一些狀況那另外三個全部是看現場市長你知道這些也是可以做出來的嗎"},{"start":311.26,"end":339.118,"text":"看現場的部分其實是當場抽個案然後當場這個要求這個照顧的人那一個行為動作讓他當場做出來所以其實這樣子其實是可以看到所有的現場的照顧的人力有沒有能力去處理這些相關的事實上我想這個評鑑應該講不是只有長照連我覺得很多的機構評鑑都落入到這問題所以我只是希望你們"},{"start":340.319,"end":358.608,"text":"不管照顧小的照顧老的真的機構在照代為照顧的時候真的要去把關那另外衛福部也透過我們的住宿型機構的照顧品質獎勵計畫來鼓勵提機構提升品質這很好啊這報導也指出說有些機構在申請補助時只有針對"},{"start":359.868,"end":380.735,"text":"少數的樣板個案來展示他的照顧成果所以要問的是衛福部如何確保這些補助真正能夠反映到整體的照顧品質是不是有事後的追蹤跟我們的隨機抽查像剛剛部長也講不能一天好其他天事實上都沒辦法事實上是滿足"},{"start":381.455,"end":392.404,"text":"照顧品質所以我不知道說你們事後有沒有做一些追蹤或者是抽查因為報導裡面反映的是說當天大家都表現得很好可是後邊呢並不是這樣子做"},{"start":395.215,"end":424.277,"text":"就像我剛剛提到的我們大概有三個機制嘛一個就是這個年度的督導考核嘛那一個就是評鑑這個是定期的那還有一種就是不定期的抽查制度啦那我想剛剛委員所提到的這個為了避免只是在當天的樣板個案那可能要去強化這種外部專家的這個審視的能力第二個就是抽查啦"},{"start":425.037,"end":453.375,"text":"所以部長我還是認為未來真的長照3.0應該從文件治理走向品質治理減少文書型的一個指標強化實地訪查來讓我們的住民跟家屬有回饋機制讓長照真的是去能夠提升品質再要問的是就是說我們的長照3.0到底誰在使用為什麼這樣講因為我常常是說政策制定一定要回到真正的使用者的一個經驗首先"},{"start":453.975,"end":469.104,"text":"依據衛福部資料顯示大概112年的長照服務使用者當中失能的人照顧的大概將近八成可是50到64歲的身心障礙大概兩成是最低的所以現在超過七成的長照服務使用者都是"},{"start":470.584,"end":486.213,"text":"輕中度的失能者這就代表我們現在的長照服務的主要對象其實都是輕中度失能者問題就在這裡真正照顧壓力最大的其實是重度的失能家庭而這些家庭往往不是靠長照制度"},{"start":486.673,"end":511.422,"text":"而是靠家人自己在乘或者是聘僱外籍看護工來做照顧所以看統計目前台灣就是全台大約有21.4萬名的一個失能者的一個聘僱外籍家庭的看護移工而其中大約有4成同時使用長照服務可是更值得注意這4成當中因為去年開始外聘我們的"},{"start":512.922,"end":528.002,"text":"看護移工的時候還是可以用你的長照服務可是值得注意這四層裡面只有三分之一其實只有用一項服務不然這代表什麼這是不是代表我們的長照制度的一個設計可能沒有真正貼近重度家庭的需求"},{"start":528.683,"end":543.703,"text":"政府現在公布的長照服務涵蓋率其實是不是高就是你高估了制度真正要滿足需求的程度為什麼現在滿意度很高可是滿意度是不是有用的人可是有很多人事實上是沒有在使用你的需求的評估"},{"start":544.904,"end":566.1,"text":"的狀況是什麼否則的話你現在的滿意度事實上是有用的人嘛所以好像沒辦法真正的事實上知道說到底那個需求到底是什麼那這會造成什麼問題當長照服務滿意度越來越高時這些需要長照資源的重度家庭可能因為沒有被知道沒有在使用你的資源而且"},{"start":566.7,"end":585.621,"text":"部長當長照服務滿預度越高不是應該會減少照顧者的照顧壓力嗎那為什麼我們還是依然發生了照顧殺人的悲劇依然持續在發生所以要問是如何提升從那個重度失能者使用長照的比例讓政府接住照顧者"},{"start":586.541,"end":602.794,"text":"也跟委員說明一下 按照我們的統計在幾支戶的使用比例裡面大概重度的是佔20%然後中度的40%那當然還有40%是屬於輕度的大概是這樣的分佈那麼比較tricky的就是這個重度的"},{"start":603.674,"end":625.389,"text":"有一部分其實是到這個住宿式機構去的這個大概差不多12萬人那還有一些是在家裡的所以我們在居家的部分怎麼去強化這個支持就是剛剛回應到最後這個長照悲劇的部分其實就是那個重度在居家的部分怎麼去強化這個support包含喘息的還有這個社區裡面的照顧者的資源"},{"start":632.413,"end":660.569,"text":"服務這些我們在長照3.0裡面會特別希望部長我這以下有三個建議請你大概一個月內給我這個報告也就是政府應該建立我們重度施能優先支持的一個服務設計然後降低申請門檻像可不可以增加我們的夜間或者是喘息服務而且要簡化我們的申請流程第二個就是政府應該思考整合移工跟長照制度不要讓家庭自己有外聘"},{"start":661.149,"end":687.21,"text":"移工的時候自己呢獨自要去照顧的時候以為反正他有移工可是實際上基本上他的負擔還是大的可能去思考到這個兩者是不是可以怎麼協作那政府也需要建立真正反應需求的政策指標所以你現在用的長照的服務的涵蓋率來說明你的政策成果可是真正要被服務的人可能重度的事實上是沒被你納入"},{"start":688.257,"end":711.669,"text":"好 以上 跟委員再補充其實我們長照3.0已經把那個有移工 聘這個我剛也講過他們用的比例事實上非常的低你還是要去瞭解為什麼用的比例這麼低再來瞭解一下使用率低的所以部長是不是可以一個月月提供這些評估報告這三項可以啦 好 謝謝部長謝謝 謝謝委員謝謝林玉琴委員"}],"gazette":[{"speaker":"林委員月琴","start":"2026-03-18T09:10:42.988000+08:00","guessed":false,"end":"2026-03-18T09:10:43.168000+08:00","text":"主席，麻煩請石部長。","quality":0.75},{"speaker":"主席","start":"2026-03-18T09:10:43.168000+08:00","guessed":true,"end":"2026-03-18T09:10:44.168000+08:00","text":"請部長。","quality":0},{"speaker":"石部長崇良","start":"2026-03-18T09:10:43.188000+08:00","guessed":false,"end":"2026-03-18T09:10:43.208000+08:00","text":"委員早。","quality":0.667},{"speaker":"林委員月琴","start":"2026-03-18T09:10:43.208000+08:00","guessed":false,"end":"2026-03-18T09:10:43.248000+08:00","text":"部長早。","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:10:43.308000+08:00","guessed":false,"end":"2026-03-18T09:10:43.888000+08:00","text":"在長照3.0要上路的元年，我有很多問題要來請教部長。","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:10:43.888000+08:00","guessed":false,"end":"2026-03-18T09:11:15.850000+08:00","text":"我最近趁著空檔時間，從2月1日到現在，我大概走訪了不同縣市的長照機構，非都會地區需要設立長照機構最大的問題不外乎就是評鑑，所以我想先請教部長有關評鑑的問題。","quality":0.958},{"speaker":"林委員月琴","start":"2026-03-18T09:11:15.850000+08:00","guessed":false,"end":"2026-03-18T09:11:53.431000+08:00","text":"臺灣已經邁入了超高齡社會，長照的制度今年也正式進入到長照3.0，目前全臺最需要長照服務的人口已經超過了100萬人，因此長照服務的品質跟我們的監督機制非常地重要，可是我們自己看到，最近就有報導指出，現行的長照機構評鑑制度出現了文件導向的現象，甚至衍生出協助機構撰寫評鑑資料的評鑑顧問，不知道部長自己有沒有看過這篇冗長的報導？","quality":0.918},{"speaker":"林委員月琴","start":"2026-03-18T09:11:54.672000+08:00","guessed":false,"end":"2026-03-18T09:12:00.296000+08:00","text":"收費從10到50萬不等，部長知道這件事嗎？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:12:00.296000+08:00","guessed":false,"end":"2026-03-18T09:12:06.160000+08:00","text":"這樣子的評鑑制度到底是要提升照顧品質，還是在檢查文件品質？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:12:06.160000+08:00","guessed":false,"end":"2026-03-18T09:12:21.422000+08:00","text":"事實上這是由來已久的問題，我想不是只有長照，過去托嬰中心、幼兒園也都是這樣，就是有寫手來幫忙，幫你把一整套的東西都整理好，可是這到底就是機構真實的品質了嗎？","quality":0.845},{"speaker":"林委員月琴","start":"2026-03-18T09:12:21.742000+08:00","guessed":false,"end":"2026-03-18T09:12:32.107000+08:00","text":"如果評鑑事實上是在做文件的話，一定會拿到「優」，但一到發生問題的時候，政府就很常會被批評，它都是優，那它為什麼會這樣？","quality":0.863},{"speaker":"林委員月琴","start":"2026-03-18T09:12:32.107000+08:00","guessed":false,"end":"2026-03-18T09:12:33.928000+08:00","text":"為什麼還會發生不幸的事件呢？","quality":0.846},{"speaker":"林委員月琴","start":"2026-03-18T09:12:35.708000+08:00","guessed":false,"end":"2026-03-18T09:12:36.089000+08:00","text":"部長知道這樣的狀況嗎？","quality":0.8},{"speaker":"石部長崇良","start":"2026-03-18T09:12:37.549000+08:00","guessed":false,"end":"2026-03-18T09:12:48.815000+08:00","text":"我想跟委員說明，為了提升這些照護的品質，我們經常都是採用兩個手段，一個就是督導考核，一個就是用評鑑的方式。","quality":1},{"speaker":"石部長崇良","start":"2026-03-18T09:12:49.376000+08:00","guessed":false,"end":"2026-03-18T09:12:57.660000+08:00","text":"當然評鑑是比較軟性的，但是它在標準上就可能會朝向一直優化。","quality":0.926},{"speaker":"石部長崇良","start":"2026-03-18T09:13:00.342000+08:00","guessed":false,"end":"2026-03-18T09:13:10.587000+08:00","text":"過去醫院評鑑可能做了比較久，大家也可以看得到這個，後來也是出現有文件的paperwork太多，反而造成臨床上的壓力。","quality":0.981},{"speaker":"石部長崇良","start":"2026-03-18T09:13:11.328000+08:00","guessed":false,"end":"2026-03-18T09:13:27.456000+08:00","text":"我想長照的評鑑也跟目前在做醫院評鑑改革的精神是一樣的，會盡量去降低文件的paperwork，同時也導入一些智慧化。","quality":0.926},{"speaker":"石部長崇良","start":"2026-03-18T09:13:27.856000+08:00","guessed":false,"end":"2026-03-18T09:13:54.218000+08:00","text":"因為我們也不想只是因為一日的評鑑、當天的評鑑，很多就是一日表現很好，但是平常不好，所以還是要建立……過去用文件就是怕可能只有評鑑當天一天的評鑑會失準，所以才會準備一堆長期的文件，如果我們能夠建立起日常的監測機制，我想對文件的要求就可以下降。","quality":0.918},{"speaker":"石部長崇良","start":"2026-03-18T09:13:54.959000+08:00","guessed":false,"end":"2026-03-18T09:14:08.131000+08:00","text":"當然我們長照機構跟醫院不同的是小規模的很多，它本身的資訊能力也比較有落差，所以我們會盡量協助改善。","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:14:10.713000+08:00","guessed":false,"end":"2026-03-18T09:14:19.242000+08:00","text":"我們最擔心的就是第一線工作人員反映的，有些機構就是文書人員很多，幾乎都在做文書，可是照顧的人力很少。","quality":0.87},{"speaker":"林委員月琴","start":"2026-03-18T09:14:19.923000+08:00","guessed":false,"end":"2026-03-18T09:14:33.593000+08:00","text":"照服員必須花很大量的時間，將近要花到35%的時間來處理重複的紀錄，反而壓縮了照顧長者的時間，更可能找所謂的評鑑顧問來代寫。","quality":0.927},{"speaker":"林委員月琴","start":"2026-03-18T09:14:33.593000+08:00","guessed":false,"end":"2026-03-18T09:14:38.014000+08:00","text":"我覺得像個案紀錄找評鑑顧問來代寫，坦白講實在是有點離譜。對啊！","quality":0.786},{"speaker":"林委員月琴","start":"2026-03-18T09:14:38.634000+08:00","guessed":false,"end":"2026-03-18T09:14:46.498000+08:00","text":"我在A機構評鑑時看到的，跟B機構寫的個案紀錄完全一模一樣，這真的讓我們覺得這樣子的品質何在？","quality":0.977},{"speaker":"林委員月琴","start":"2026-03-18T09:14:46.858000+08:00","guessed":false,"end":"2026-03-18T09:14:53.581000+08:00","text":"所以想問部長，在目前的評鑑指標當中，文書紀錄跟實際照顧品質的比重各自是多少？","quality":0.914},{"speaker":"林委員月琴","start":"2026-03-18T09:14:54.482000+08:00","guessed":false,"end":"2026-03-18T09:14:55.162000+08:00","text":"為什麼？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:14:55.162000+08:00","guessed":false,"end":"2026-03-18T09:15:00.805000+08:00","text":"因為有時評鑑委員幾乎都在看檔案資料，很少去看到現場。","quality":0.833},{"speaker":"林委員月琴","start":"2026-03-18T09:15:00.805000+08:00","guessed":false,"end":"2026-03-18T09:15:09.669000+08:00","text":"現場也有一些樣板的給你看，甚至連紀錄都有樣板給你看，所以政府是否評估過，這種過度文書化的事實上反而會增加第一線的負擔？","quality":0.836},{"speaker":"石部長崇良","start":"2026-03-18T09:15:11.082000+08:00","guessed":false,"end":"2026-03-18T09:15:12.849000+08:00","text":"詳細的評鑑過程，我是不是請長照司的祝司長來補充？是。","quality":0.87},{"speaker":"祝司長健芳","start":"2026-03-18T09:15:18.034000+08:00","guessed":false,"end":"2026-03-18T09:15:24.836000+08:00","text":"謝謝委員這邊的垂詢、關心，我們其實非常看重評鑑的「實質」到底評到了什麼。","quality":0.968},{"speaker":"林委員月琴","start":"2026-03-18T09:15:24.836000+08:00","guessed":false,"end":"2026-03-18T09:15:27.836000+08:00","text":"所以你們只有60項，可是那個指標真的都是在文書資料……","quality":0.864},{"speaker":"祝司長健芳","start":"2026-03-18T09:15:27.836000+08:00","guessed":false,"end":"2026-03-18T09:15:44.600000+08:00","text":"因為有分專業組跟經營管理組，委員剛剛說只看文件不看現場，那個是經營管理組，因為確實要看整個機構管理的部分，要去抽查那些相關人員排班的一些狀況，至於另外三個組全部都要看現場。","quality":0.912},{"speaker":"林委員月琴","start":"2026-03-18T09:15:44.700000+08:00","guessed":false,"end":"2026-03-18T09:15:46.120000+08:00","text":"司長，你知道這些也是可以做出來的嗎？","quality":0.938},{"speaker":"祝司長健芳","start":"2026-03-18T09:15:47.260000+08:00","guessed":false,"end":"2026-03-18T09:16:06.213000+08:00","text":"看現場的部分其實是當場抽個案，然後當場要求這個照顧的人把一個行為動作當場做出來，所以這樣其實是可以看到現場所有照顧的人力有沒有能力去處理這些相關的日常照顧。","quality":0.907},{"speaker":"林委員月琴","start":"2026-03-18T09:16:06.713000+08:00","guessed":false,"end":"2026-03-18T09:16:23.923000+08:00","text":"司長，我想這個評鑑應該不是只有長照，我覺得很多機構的評鑑都有落入這個問題，所以我只是希望你們不管是照顧小的、照顧老的，機構在代為照顧的時候真的要去把關。","quality":0.914},{"speaker":"林委員月琴","start":"2026-03-18T09:16:24.203000+08:00","guessed":false,"end":"2026-03-18T09:16:30.906000+08:00","text":"另外衛福部也透過我們的住宿機構照顧品質獎勵計畫來鼓勵機構提升品質，這樣很好。","quality":0.972},{"speaker":"林委員月琴","start":"2026-03-18T09:16:31.926000+08:00","guessed":false,"end":"2026-03-18T09:16:46.652000+08:00","text":"可是報導也指出，有些機構在申請補助時，只有針對少數的樣板個案來展示他的照顧成果，所以我要問的是，衛福部如何確保這些補助真正能夠反映到整體的照顧品質上？","quality":0.943},{"speaker":"林委員月琴","start":"2026-03-18T09:16:46.652000+08:00","guessed":false,"end":"2026-03-18T09:16:50.773000+08:00","text":"是不是有事後的追蹤跟隨機抽查？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:16:51.213000+08:00","guessed":false,"end":"2026-03-18T09:17:02.199000+08:00","text":"像剛剛部長也講，不能一天好其他天事實上都沒辦法滿足照顧品質，所以我不知道你們事後有沒有做一些追蹤或者是抽查？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:17:02.640000+08:00","guessed":false,"end":"2026-03-18T09:17:08.384000+08:00","text":"因為報導裡面反映的是，當天大家都表現得很好，可是後邊卻不是這樣子做。","quality":0.968},{"speaker":"石部長崇良","start":"2026-03-18T09:17:11.215000+08:00","guessed":false,"end":"2026-03-18T09:17:23.484000+08:00","text":"就像我剛剛提到的，我們大概有三個機制，一個就是年度的督導考核，一個就是評鑑，這是定期的，還有一種就是不定期的抽查制度。","quality":1},{"speaker":"石部長崇良","start":"2026-03-18T09:17:24.785000+08:00","guessed":false,"end":"2026-03-18T09:17:40.037000+08:00","text":"我想剛剛委員所提到的，為了避免只是在看當天的樣板個案，可能要去強化這種外部專家的審視能力，第二個就是抽查……","quality":0.98},{"speaker":"林委員月琴","start":"2026-03-18T09:17:41.478000+08:00","guessed":false,"end":"2026-03-18T09:17:58.068000+08:00","text":"部長，我還是認為未來的長照3.0應該從文件治理走向品質治理，減少文書型的指標，強化實地訪查，讓住民跟家屬有回饋的機制，讓長照真的是能夠提升品質。","quality":0.984},{"speaker":"林委員月琴","start":"2026-03-18T09:17:58.068000+08:00","guessed":false,"end":"2026-03-18T09:18:03.271000+08:00","text":"再來要問的是，我們的長照3.0到底是誰在使用？","quality":0.895},{"speaker":"林委員月琴","start":"2026-03-18T09:18:03.851000+08:00","guessed":false,"end":"2026-03-18T09:18:05.432000+08:00","text":"為什麼要這樣講？","quality":0.857},{"speaker":"林委員月琴","start":"2026-03-18T09:18:05.432000+08:00","guessed":false,"end":"2026-03-18T09:18:09.215000+08:00","text":"因為我常說，政策制定一定要回到真正使用者的經驗上。","quality":0.957},{"speaker":"林委員月琴","start":"2026-03-18T09:18:09.215000+08:00","guessed":false,"end":"2026-03-18T09:18:33.768000+08:00","text":"首先，依據衛福部自己的資料顯示，在112年的長照服務使用者當中，照顧失能的人大概將近占八成，可是50歲到64歲的身心障礙者大概占兩成，這是最低，所以現在超過七成的長照服務使用者都是輕、中度的失能者，這是不是代表我們現在長照服務的主要對象其實都是輕、中度的失能者？","quality":0.868},{"speaker":"林委員月琴","start":"2026-03-18T09:18:34.469000+08:00","guessed":false,"end":"2026-03-18T09:18:48.875000+08:00","text":"但問題就在這裡，真正照顧壓力最大的其實是重度的失能家庭，而這些家庭往往不是靠長照制度，而是靠家人自己在撐，或者是聘顧外籍看護工在照顧。","quality":0.935},{"speaker":"林委員月琴","start":"2026-03-18T09:18:49.155000+08:00","guessed":false,"end":"2026-03-18T09:19:02.860000+08:00","text":"看統計，目前全臺大約有21.4萬名失能者聘僱外籍家庭看護移工，可是其中大約有四成同時使用長照服務。","quality":0.93},{"speaker":"林委員月琴","start":"2026-03-18T09:19:03.440000+08:00","guessed":false,"end":"2026-03-18T09:19:16.592000+08:00","text":"但更值得注意的是，在這四成當中，因為去年開始外聘看護移工的時候還是可以用長照服務，可是在這四成裡，其實有三分之一只用了一項服務。","quality":0.831},{"speaker":"林委員月琴","start":"2026-03-18T09:19:16.913000+08:00","guessed":false,"end":"2026-03-18T09:19:17.834000+08:00","text":"部長，這代表什麼？","quality":0.714},{"speaker":"林委員月琴","start":"2026-03-18T09:19:17.834000+08:00","guessed":false,"end":"2026-03-18T09:19:23.982000+08:00","text":"這是不是代表我們的長照制度設計可能沒有真正貼近重度家庭的需求？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:19:24.683000+08:00","guessed":false,"end":"2026-03-18T09:19:32.333000+08:00","text":"政府現在公布的長照服務涵蓋率，是不是高估了制度真正要滿足需求的程度？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:19:32.593000+08:00","guessed":false,"end":"2026-03-18T09:19:33.454000+08:00","text":"為什麼？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:19:33.454000+08:00","guessed":false,"end":"2026-03-18T09:19:41.885000+08:00","text":"現在的滿意度很高，可是滿意度是由有在使用的人給的，可是有很多人事實上是沒有在使用的，所以你對需求評估的狀況是什麼？","quality":0.811},{"speaker":"林委員月琴","start":"2026-03-18T09:19:41.885000+08:00","guessed":false,"end":"2026-03-18T09:19:51.032000+08:00","text":"否則的話，你現在的滿意度事實上是來自有在用的人嘛，所以好像沒辦法真正知道那個需求到底是什麼。","quality":0.93},{"speaker":"林委員月琴","start":"2026-03-18T09:19:51.392000+08:00","guessed":false,"end":"2026-03-18T09:19:53.073000+08:00","text":"這會造成什麼問題？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:19:53.073000+08:00","guessed":false,"end":"2026-03-18T09:20:08.787000+08:00","text":"當長照服務滿意度越來越高時，但這些需要長照資源的重度家庭可能沒有被知道他們並沒有在使用資源，而且部長，當長照服務滿意度越高，不是應該會減少照顧者的照顧壓力嗎？","quality":0.932},{"speaker":"林委員月琴","start":"2026-03-18T09:20:09.247000+08:00","guessed":false,"end":"2026-03-18T09:20:14.793000+08:00","text":"為什麼照顧殺人的悲劇依然持續在發生？","quality":1},{"speaker":"林委員月琴","start":"2026-03-18T09:20:15.274000+08:00","guessed":false,"end":"2026-03-18T09:20:21.601000+08:00","text":"所以要問的是如何提升重度失能者使用長照的比例，讓政府接住照顧者？","quality":0.967},{"speaker":"石部長崇良","start":"2026-03-18T09:20:22.662000+08:00","guessed":false,"end":"2026-03-18T09:20:35.151000+08:00","text":"跟委員說明一下，按照我們的統計，在給支付的使用比例裡面，重度的大概是占20%，中度的40%，還有40%是屬於輕度的，大概是這樣的分布。","quality":0.889},{"speaker":"石部長崇良","start":"2026-03-18T09:20:36.812000+08:00","guessed":false,"end":"2026-03-18T09:21:00.148000+08:00","text":"比較tricky的就是重度的有一部分其實是到住宿式機構去了，這部分大概是12萬人，還有一些是在家裡的，所以在居家的部分我們要怎麼去強化支持，就是回應到最後所講的長照悲劇的部分，其實就是針對重度居家的部分怎麼去強化support……","quality":0.887},{"speaker":"林委員月琴","start":"2026-03-18T09:21:00.148000+08:00","guessed":true,"end":"2026-03-18T09:21:01.148000+08:00","text":"對，部長，上次我質詢也講過這個。","quality":0},{"speaker":"石部長崇良","start":"2026-03-18T09:21:00.308000+08:00","guessed":false,"end":"2026-03-18T09:21:11.455000+08:00","text":"包含喘息服務，還有社區裡面照顧者的支援服務，這些我們在長照3.0裡面會特別來強化。","quality":0.806},{"speaker":"林委員月琴","start":"2026-03-18T09:21:12.335000+08:00","guessed":false,"end":"2026-03-18T09:21:30.225000+08:00","text":"部長，我以下有三個建議，請你大概一個月內給我這個報告，也就是政府應該建立重度失能優先支持的服務設計，降低申請門檻，像是可否增加夜間或是喘息服務，而且要簡化申請流程。","quality":0.96},{"speaker":"林委員月琴","start":"2026-03-18T09:21:30.966000+08:00","guessed":false,"end":"2026-03-18T09:21:48.218000+08:00","text":"第二個就是政府應該思考整合移工及長照制度，不要讓家庭在有外聘移工但仍要自己獨自去照顧的時候，以為反正他有移工，可是實際上他的負擔還是大的，可能要去思考這兩者可以怎麼協作。","quality":0.925},{"speaker":"林委員月琴","start":"2026-03-18T09:21:49.239000+08:00","guessed":false,"end":"2026-03-18T09:22:04.617000+08:00","text":"再來，政府也需要建立真正反映需求的政策指標，你現在用長照服務的涵蓋率來說明你的政策成果，可是真正要被服務的人，如重度的部分事實上卻沒被你們納入。以上。","quality":0.884},{"speaker":"石部長崇良","start":"2026-03-18T09:22:05.138000+08:00","guessed":false,"end":"2026-03-18T09:22:10.840000+08:00","text":"跟委員再補充，其實長照3.0已經把有移工、有聘外看的部分納入我們的對象。","quality":0.613},{"speaker":"林委員月琴","start":"2026-03-18T09:22:11.461000+08:00","guessed":false,"end":"2026-03-18T09:22:16.243000+08:00","text":"是，我剛剛也講過他們用的比例事實上非常低，你還是要去了解為什麼用的比例這麼低。","quality":0.889},{"speaker":"石部長崇良","start":"2026-03-18T09:22:17.003000+08:00","guessed":false,"end":"2026-03-18T09:22:18.684000+08:00","text":"我們再來了解一下使用率低的原因。","quality":0.667},{"speaker":"林委員月琴","start":"2026-03-18T09:22:19.305000+08:00","guessed":false,"end":"2026-03-18T09:22:21.906000+08:00","text":"部長是不是可以一個月內提供這三項評估報告？","quality":0.85},{"speaker":"石部長崇良","start":"2026-03-18T09:22:23.347000+08:00","guessed":false,"end":"2026-03-18T09:22:23.467000+08:00","text":"好，可以。","quality":0.667},{"speaker":"林委員月琴","start":"2026-03-18T09:22:25.247000+08:00","guessed":false,"end":"2026-03-18T09:22:26.268000+08:00","text":"好，謝謝部長。","quality":1},{"speaker":"石部長崇良","start":"2026-03-18T09:22:26.268000+08:00","guessed":false,"end":"2026-03-18T09:22:27.248000+08:00","text":"謝謝委員。","quality":1},{"speaker":"主席","start":"2026-03-18T09:22:27.248000+08:00","guessed":false,"end":"2026-03-18T09:22:27.669000+08:00","text":"謝謝林月琴委員。","quality":0.857},{"speaker":"主席","start":"2026-03-18T09:22:28.169000+08:00","guessed":true,"end":"2026-03-18T09:22:30.740429+08:00","text":"接下來請陳菁徽委員。","quality":0}]}},"supported_relations":[],"relations":[]}