老年护理医院病人长期护理服务模式的研究

我国老年护理实践起步晚,患者在老年护理医院需要接受何种护理服务,并没有明确的标准。本文分析了我国老年护理医院长期护理服务模式的发展现状和存在不足,提出老年护理医院应建立针对老年、慢性病、临终关怀患者的长期医疗护理服务模式,从转变传统护理服务观念,探索助理护士管理模式,合理配置护理人力资源,建立老年护理质量评价体系等方面着手,构建适合国情的老年护理医院长期护理服务模式的建议,对提高老年护理病人生活质量和促进护理事业发展具有现实意义。     

公共财政视角下长期护理保障的国际比较及对我国的启示

自1960年起,OECD国家65岁及以上老年人数量和比重始终处于持续增长状态,长期护理服务的需求日趋增多,多数成员国都在长期护理方面投入了大量经费。澳大利亚、奥地利、加拿大、德国、爱尔兰、日本、卢森堡、英国、美国、荷兰、挪威和瑞典等国在公共长期护理服务体系建设以及老年人家庭护理保障支持制度安排上,已经走在了世界前列。研究这些国家长期护理服务的需求引致因素以及政府在长期护理保障方面的制度安排,对建立和完善我国的老年护理保障体系具有重要的借鉴意义。     

高龄护士向长期护理服务领域有序流动的可行性探讨

通过查阅文献了解发达国家高龄护士的角色和工作状态,结合我国快速老龄、高龄空巢和家庭核心化引发的老年长期服务需求与专业护理人力资源缺乏的现实,对经验丰富的高龄护士转岗原因、影响其向基层医疗机构和养老服务机构流动的因素等进行分析,提出建议和对策,旨在为涉老服务体制机制创新和政策制定提供参考。     

中国老年人口的健康、负担及家庭照料

随着我国人口的老龄化，失能老年人口数量和比重将会有较大程度的增加，有更多的老年人需要长期护理与照顾。由家庭提供长期护理越来越难以维持，因此，由正式机构提供的长期护理将会有很大的发展空间，我国对于老年人口长期护理的负担将会有很大的增长。     

我国老年长期护理服务质量及其影响因素分析——基于上海市的实证研究

利用上海市调研数据,以60岁及以上老人为研究对象,基于SERVQUAL模型和有序多分类逻辑回归方法分析我国老年长期护理服务质量及其影响因素。研究发现:老人对长期护理服务质量评价不高,且常用临床护理服务质量略低于基本生活照料服务质量。供给方因素中护理机构基础设施、管理水平、护理人员专业水平对长期护理服务质量的提升具有正向激励作用。需求方因素中老人养老金水平对长期护理服务质量的提高具有显著正向激励,而老人的失能程度对服务质量具有显著负向影响,且与男性老人相比,女性老人对长期护理服务质量评价显著更高。研究结果为精确地评估我国老年长期护理服务质量提供了科学依据,对提升失能老人的生活质量,促进我国长期护理服务产业的发展具有重要的政策启示。     

长期护理保险对居家社区护理需求的规范与引导：国际经验及启示

为贯彻“以人为中心”的服务理念、增强长护服务体系的可持续性,世界各国纷纷在配置使用公共长护资金时,有侧重地进行待遇设计,以规范、引导长期护理需求,发展居家社区护理。本文基于服务购买理论,将典型国家的长期护理保障待遇模式总结为“机构待遇资格限定型”与“居家待遇水平倾斜型”两类,并介绍了其待遇设计。我国长期护理保险正处于起步阶段,应通过公共保险购买机制优化服务利用结构、引导资源合理配置,有机结合待遇资格限定、差异化待遇水平、额外支持等多元待遇设计,建立健全以居家为基础、社区为依托的多层次长护服务体系。     

我国长期护理保险典型发展模式研究

随着我国人口老龄化速度不断加快,老年护理的需求越来越大,我国自2016年开始长期护理保险的试点工作。通过对长期护理保险各试点地区的发展模式进行研究,认为目前我国长期护理保险主要有3种发展模式:政府管理、民营机构参与经办模式,政府主导的社会保障模式,商业保险模式。本文选取了3种模式的代表性地区青岛市、上海市和北京市海淀区进行比较研究,并结合国外长期护理保险的发展经验,旨在探索出适合我国长期护理保险发展的模式。     

基于离散选择实验的老年居民长期护理保险选择偏好研究

目的：分析老年居民对于长期护理保险不同属性的偏好、支付意愿以及偏好异质性，为构建符合需方偏好的长期护理保险制度提供参考。方法：利用离散选择实验方法设计问卷，以260名老年居民作为研究样本，构建混合Logit模型进行偏好分析。结果：老年居民倾向于在社区/家庭、由高级养老护理员提供“日常生活照料+康复护理+精神护理”的综合服务且报销比例为90%的长期护理保险，为此老年居民分别愿意多支付110.814元、13.959元、27.928元和31.294元。保险属性相对重要性由高到低依次为照护地点、保险报销比例、照护服务内容、照护者职业技能水平。不同性别、文化、配偶、收入的老年居民长期护理保险选择偏好具有异质性。结论：建议立足需方视角，尊重老年居民偏好，制定多样化长期护理保险方案，增强保险吸引力及发展可持续性。     

建立老年护理保险制度初探

人口老龄化使越来越多的老年人需要接受长期的护理服务,而传统家庭护理功能正逐渐削弱,老年人护理费用给家庭造成沉重负担,迫切需要建立老年护理保险制度。本文通过借鉴国外老年护理保险制度实施的经验,提出建立适合我国国情的老年护理保险制度的政策建议。     

城镇居民长期护理保险需求影响因素研究

我国已经进入老龄化社会,老年人口数量不断增加,针对老年人的长期护理保险日趋重要,分析其需求影响因素对我国开展长期护理保险有重要的理论意义和现实意义。本文采用灰色关联模型和广义灰色关联模型,运用2005—2015年全国范围内的数据,将对影响长期护理保险需求的主要因素分为经济因素与非经济因素,通过灰色关联分析发现:经济因素中社会保险支出对长期护理保险的影响更为重要,非经济因素中人均受教育水平和老年人口抚养比对长期护理保险的影响更为重要。根据实证结果,结合我国国情和实际情况,为长期护理保险更好地发展提供一种新的研究方法和思路。     

Implications of long-term care capacity response policies for an aging population: A simulation analysis

Introduction

The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singapore is likely to face increasing demand for both acute and LTC services, this paper examines the dynamic impact of different LTC capacity response policies, which differ in the amount of time over which LTC capacity is increased, on acute care utilization and the demand for LTC and acute care professionals.

Methods

The modeling methodology of System Dynamics (SD) was applied to create a simplified, aggregate, computer simulation model for policy exploration. This model stimulates the interaction between persons with LTC needs (i.e., elderly individuals aged 65 years and older who have functional limitations that require human assistance) and the capacity of the healthcare system (i.e., acute and LTC services, including community-based and institutional care) to provide care. Because the model is intended for policy exploration, stylized numbers were used as model inputs. To discern policy effects, the model was initialized in a steady state. The steady state was disturbed by doubling the number of people needing LTC over the 30-year simulation time. Under this demand change scenario, the effects of various LTC capacity response policies were studied and sensitivity analyses were performed.

Results

Compared to proactive and quick adjustment LTC capacity response policies, slower adjustment LTC capacity response policies (i.e., those for which the time to change LTC capacity is longer) tend to shift care demands to the acute care sector and increase total care needs.

Conclusions

Greater attention to demand in the acute care sector relative to demand for LTC may result in over-building acute care facilities and filling them with individuals whose needs are better suited for LTC. Policymakers must be equally proactive in expanding LTC capacity, lest unsustainable acute care utilization and significant deficits in the number of healthcare professionals arise. Delaying LTC expansion could, for example, lead to increased healthcare expenditure and longer wait lists for LTC and acute care patients.     

Long-term care insurance: Does experience matter?

We examine whether long-term care (LTC) experience helps explain the low demand for long-term care insurance (LTCI). We test if expectations about future informal care receipt, expectations about inheritance receipt, and LTCI purchase decisions vary between individuals whose parents or in-laws have used LTC versus those who have not. We find parental use of a nursing home decreases expectations that one's children will provide informal care, consistent with the demonstration effect. Nursing home use by in-laws does not have the same impact, suggesting that individuals are responding to information gained about their own aging trajectory. Nursing home use by either a parent or in-law increases LTCI purchase probability by 0.8 percentage points, with no significant difference in response between parents’ and in-laws’ use. The estimated increase in purchase probability from experience with LTC is about half the previously estimated increase from tax policy-induced price decreases.     

Financing elderly people's long‐term care needs: Evidence from China

Confronted by accelerated population aging, China is establishing a long‐term care (LTC) system. This study discusses challenges and recommendations for financing China's LTC system. On the basis of the data on elderly people's self‐care ability from the Chinese Longitudinal Healthy Longevity Survey, we calculate the size of the elderly population that need LTC for the period from 2015 to 2030 and analyse the increasing tendency of LTC expenses by considering the impact of price increase. We also analyse the local governments' financial capacity for LTC support by comparing the expense level to the fiscal revenue. The study found that aging will double the LTC expenses by 2030. Therefore, this study suggests the establishment of an LTC insurance system that allocates LTC expenses, which are currently borne by individuals and families, more fairly among the government, individuals, and families. Moreover, with the current LTC reforms, implemented primarily by local governments in China, we believe that the central government should bear some of the fiscal responsibility by conducting fiscal transfers to partially support undeveloped regions that are establishing an LTC system.     

Does independent needs assessment limit use of publicly financed long-term care?

In health care the assessment of patients’ needs is typically entrusted to health care providers. By contrast, in publicly financed long-term care (LTC) needs assessment is often delegated to an independent assessor. One rationale offered for independent needs assessment in LTC is to limit the scope for moral hazard and supplier-induced demand, which may be particularly strong in case of public LTC insurance. We study whether independent needs assessment restricts use of publicly financed LTC at the intensive margin (i.e. after people are being assessed to be eligible for receiving care). Therefore, we link nationwide Dutch administrative datasets about individual LTC use and eligibility decisions by the independent assessment agency in 2012. We find for virtually all types of care, all population subgroups, and all regions that LTC use by patients was substantially less than the maximum amount of care allowed by the independent assessor. This suggests that in the Netherlands independent needs assessment in LTC does not impose a binding constraint on use once a person is considered eligible for care. Still, independent needs assessment may have reduced LTC use at the extensive margin. A significant proportion of the applications for care (16 %) was rejected. In addition, the independent assessment may deter some people from applying.     

Financing long-term care for frail elderly in France: The ghost reform

Like many welfare states, France is faced with increasing demand for long term care (LTC) services. Public LTC coverage has evolved over the past 15 years, reaching a coverage depth of 70%. Nonetheless, it does not provide adequate and equitable financial protection for the growing number of frail elderly individuals, who are expected to constitute 3% of the population by the year 2060. Since 2005, various financing reform proposals have been debated, ranging from a newly covered risk under the social security system to targeted subsidies for private LTC insurance. However, to date no reform measure has been enacted. This article provides a brief history of publicly financed LTC in France in order to provide a context for the ongoing debate, including the positions and relative political power of the various stakeholders and the doubtful short-term prospect for reform.     

Review of Nutrition Screening and Assessment Practices for Long-Term Care Residents

Abstract

The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.     

The non-take up of long-term care benefit in France: A pecuniary motive?

With aging populations, European countries face difficult challenges. In 2002, France implemented a public allowance program (APA) offering financial support to the disabled elderly for their long-term care (LTC) needs. Although currently granted to 1.2 million people, it is suspected that some of those eligible do not claim it—presenting a non-take-up behavior. The granting of APA is a decentralized process, with 94 County Councils (CC) managing it, with wide room for local interpretation. This spatial heterogeneity in the implementation of the program creates the conditions for a “quasi-natural experiment”, and provides the opportunity to study the demand for APA in relation to variations in CCs’ “generosity” in terms of both eligibility and subsidy rate for LTC. We use a national health survey and administrative data in a multilevel model controlling for geographical, cultural and political differences between counties. The results show that claiming for APA is associated with the “generosity” of CCs: the population tends to apply less for the allowance if the subsidy rate is in average lower. This pecuniary trade-off, revealed by our study, can have strong implications for the well-being of the elderly and their relatives.     

China's policy experimentation on long‐term care insurance: Implications for access

China's population is aging rapidly, while the traditional long‐term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long‐term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural–urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.     

Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data

Physical frailty and sarcopenia (PF&S) has received growing attention in empirical models of health care use. However, few articles focused on objective measures of PF&S to assess the extent of care consumption among the frail population at risk of dependency. Using baseline data from the SPRINTT study, a sample of 1518 elderly people aged 70+ recruited in eleven European countries, we analyse the association between various PF&S measures and health care / long term care (LTC) use. Multiple health care and LTC outcomes are modelled using linear probability models adjusted for a range of individual characteristics and country fixed effects. We find that PF&S is associated with a significant increase in emergency admissions and hospitalizations, especially among low-income elders. All PF&S measures are significantly associated with increased use of formal and informal LTC. There is a moderating effect of income on LTC use: poor frail elders are more likely to use any of the formal LTC services than rich frail elders. Our results are robust to various statistical specifications. They suggest that the inclusion of PF&S in the eligibility criteria of public LTC allowances could contribute to decrease the economic gradient in care use among the elderly community-dwelling European population.     

Long‐term care services expenditure projection in South Korea from 2015 to 2050

South Korea has been undergoing significant change in its population structure over the past three decades. Within 10 years, South Korean baby‐boomers will reach the age of 65 years and accelerate this change. This trend in population structure is crucial, because an aging population may increase medical demand, especially that for long‐term care (LTC) services, which would create a financial burden on society. This study estimates total LTC expenditure in South Korea from 2015 to 2050 by modifying the method proposed by the UK Personal Social Science Research Unit, the seminal study on projecting costs of LTC services. Using population data from the projections of the Korean Statistical Information Service, I stratify the projected population by gender and age, using the groups 65–69, 70–74, 75–79 and 80 or over and divide LTC services into two categories, namely facility and home care. South Korea's total LTC expenditure is predicted to continuously increase and then reach 4.2% of GDP in 2050. Expenditure on LTC services for women is higher than that for men. Moreover, the increase in total expenditure is dramatic after 2040 for home‐based services but is constant for facility services. This study shows that the presence of baby‐boomers heavily influences LTC expenditure in South Korea. Copyright © 2013 John Wiley & Sons, Ltd.