武汉市失能老年人长期照护现状调查

[目的]了解武汉市失能老年人长期照护的现状及需求,为构建适合武汉市市情的失能老年人长期照护模式提供依据和参考。[方法]采用自行设计的失能老年人长期照护现状及需求调查表对武汉市813例失能老年人进行问卷调查。[结果]813例失能老年人中居家照护者492例(60.5%),机构照护者321例(39.5%),其中养老机构照护者216例,医疗机构照护者105例。由家属照护者308例(37.9%),由家属和陪护共同照护者204例(25.1%),自我照护者158例(19.4%),由陪护照护者143例(17.6%)。照护需求方面:784例(96.4%)能得到生活照料服务,176例(21.6%)能得到医疗康复护理服务,76例(9.3%)能得到精神慰藉服务,61例(7.5%)能得到社会交往服务。729例(89.7%)对长期照护服务有需求。494例(60.8%)希望接受居家照护,224例(27.6%)希望接受社区居家照护,95例(11.7%)希望接受机构照护。失能老年人最希望社区提供的照护服务是生活照料,其次是医疗康复护理、精神慰藉和社会交往,以补充和支持居家照护。[结论]轻度、中度失能老年人以居家照护为主,重度失能老年人以机构照护为主;失能老年人的家属是其主要照护者;失能老年人对长期照护服务有需求,并希望社区能够提供长期照护服务。建议政府大力发展社区居家照护,逐步建立以居家照护为基础、社区居家照护为支撑、机构照护为补充的失能老年人长期照护体系。     

基于Web of Science居家护理研究热点分析

目的分析近10年居家护理的研究热点。方法基于文献分析软件Citespace,对Web of Science数据库2009至2018年收录的1466篇与居家护理相关的文献,从年发文量、地区、研究热点等方面进行知识图谱分析。结果近年来居家护理领域发文量呈上升趋势,发文量最多的国家是美国,其次为加拿大、瑞典;发文量最多的研究机构是多伦多大学;最新的研究热点为安宁疗护、痴呆照护、老年照护、抑郁、沟通和非正式照护等。结论近年来居家护理受到持续关注,欧美国家研究较多;居家护理领域的6个研究热点可为居家护理的科研探索与临床实践提供借鉴与参考。     

失能老年护理专业养老模式的研究进展

目的：综述国内外失能老年专业养老模式的研究进展,为我国失能老年专业化养老模式发展提供参考。方法文献回溯搜集失能老年养老护理模式相关资料,归纳总结当前最新研究结果。结果国内失能老年长期护理的模式有家庭式、机构式、居家-社区式三种,2014年我国学者提出“类家庭”长期照护模式的构想及医养结合专业养老模式。国外的失能老年长期护理模式主要有日本的介护服务模式、加拿大的人文关怀融入的康复护理环境中失能进展过程模式及备用房屋模式、美国的高级实践护士主导的成人发展性失能家庭干预模式。结论我国失能老年护理专业养老模式的建立需要体现本国文化的特殊性,建立失能进程的预防体系及完善的监督评价体系,建立辅以符合国情的护理保险或补贴制度,建立有效运营的管理机制和标准化的社会养老服务。     

失能老人居家护理需求的研究进展

对居家护理的概念、失能老人居家护理的现状和需求、满足失能老人居家护理需求的措施进行综述,建议通过组建多学科医护团队、实施四元联动整合照护模式、推广长期护理保险等措施满足失能老人的居家护理需求,为探索适合我国国情的失能老人居家护理模式提供参考。     

国内外中期照护发展现况及启示

文章综述了国外居家医院、护士主导的病房、社区医院、老年日间病房、医护疗养所5大模式的中期照护实施方式、内容及效果,结合我国中期照护的现况及特点,提出建立多元化中期照护服务模式、加强中期照护团队人员培养、提高各类照护机构在中期照护中的利用度等建议,旨在为中期照护在我国的发展提供新的思路。     

美国家庭护理模式及其付费体系对我国老年家庭护理的启示

通过介绍美国家庭护理服务的定义、服务内容、服务提供者,分析家庭护理需求评估体系和费用支付系统,学习美国较为完善的家庭护理服务模式为构建我国特色的老年家庭护理服务制度提供借鉴.     

试论老年照护体系的构建

介绍了一些国家老年照护体系的构成及建设,其主要的服务内容、服务方式及运作。在分析国外的经验及我国国情的基础上,提出居家养老是我国的主要养老模式,对居家老人尤其是体弱、高龄、独居者需提供充分的支持性服务应建设好各种类型的老年养护机构,以适应健康状况和经济状况不同的老人的需求;应加强对各类养护机构的设置、运作及管理的指导和监控,以保证服务的质量。提出护理专业工作者应学习老年护理的理论、知识和技能,在老年照护体系的构建中发挥专业特长。     

关于养医结合老年护理模式中亟待解决的问题思考与对策

总结养医结合的主要模式,对亟待解决的问题进行思考并提出对策。浙江省养医结合老年护理模式实施过程中存在护理床位总量不足、缺乏统筹和政策支撑、医疗机构动力不足、护理专业人才短缺、养老医疗界定不明及护理保险支付有限等问题。提出构建规范化专业化的机构与照护体系、强化老年护理队伍建设、多渠道分担老年护理的运行风险和需求及更新与转变理念实行智能化养老护理等对策,以期完善老年护理服务。     

互联网+居家上门照护服务的探索与实践——以南京市江宁区为例

在我国老龄化形势背景下,多元化的居家养老服务模式发展为解决养老问题提供了众多思路,本文以江宁区“小江家护”互联网+居家上门照护服务项目为例,探索开展在互联网技术支持下的居家上门照护服务的创新实践,并从互联网技术、医养结合、智慧养老产品、政策支持、复合型人才培养等方面提出分析对策,从而推进居家上门照护服务的高质量发展。     

上海277名老年人家庭照顾者居家康复护理支付意愿及影响因素研究

目的了解老年人家庭照顾者对于支付老年人居家康复服务费用的意愿以及愿意支付多少费用,并探讨其影响因素。方法用条件价值评估法调查了上海市277名老年人家庭照顾者,调查问卷主要包括4个部分:对居家康复护理服务及调查情况的描述,照顾者对居家康复护理服务的支付意愿,照顾者社会经济学特征,对问卷的理解程度。结果绝大多数照顾者对居家康复护理服务持肯定态度,愿意支付一定费用的照顾者有182名(65.7%),159名(87.4%)对每次康复护理的费用愿意支付低于40元。影响照顾者对居家康复护理服务的因素有:年龄、家族疾病史、分担照顾责任的人数、是否和老年人共同居住、家庭人口数、家庭月收入(P<0.05)。结论照顾者对老年人居家康复护理服务持肯定态度,但支付意愿偏低,且支付意愿受到多种因素影响。     

老年患者居家护理服务的发展现状与思考

从应对人口老龄化方面总结了国内外老年患者居家护理的发展过程与现状,提出完善我国老年患者居家护理的几点建议,包括发展医院延伸服务,建立医院-社区-家庭一体化结构,健全长期护理保险制度,培养专业居家护士,发挥中医药特色优势,发展具有中国特色的老年患者居家护理服务模式。     

澳大利亚喘息服务的特征与启示

目的 回顾澳大利亚喘息服务缘起与发展的基础之上,讨论其政策法规以甄别其主要特征,为完善我国喘息服务体系,保障居家养老可持续发展提供借鉴。方法 首先沿袭历史发展脉络,归纳澳大利亚喘息服务特征;然后通过中澳现状对比,提出中国喘息服务体系改革建议。结果 澳大利亚喘息服务具有如下特征：（1）政策法规完善,服务有法可依;（2）政府责任明晰,主导服务实施;（3）服务形式多元,专注服务质量;（4）服务保障规范,保证服务实施。结论 我国喘息服务正处在起步阶段,建议借鉴澳大利亚经验,通过整合多方力量、完善服务政策、规范服务体系、丰富服务形式和加强服务保障等举措完善喘息服务体系,支撑居家养老可持续发展。     

Funding Home Care in a Climate of Cost Containment

The health care industry is preoccupied with increased costs because total expenditures for health services in the United States more than tripled between 1971 and 1981. Policy makers and health providers are looking at what contributes to these expenditures and ways to contain the escalating costs. One solution suggested has been the consideration of alternatives to institutional care, particularly home care. Historically, home care was provided by official or voluntary nursing agencies. Recently, proprietary, private, not-for-profit organizations have entered the home care arena. Home care reimbursement methods are a patchwork, causing confusion and cash flow problems. Public funds are administered by different levels of government, by several agencies within each level, and with various eligibility requirements. Private insurance coverage is uneven and limited.     

Health policy and the private sector. New vistas for nursing

During the past two decades, the drive to rein in rising health care costs has shifted some of the power in health care policy making from professional groups, government agencies, and not-for-profit health care organizations to large for-profit corporations (1-4). This has been a world-wide phenomenon, as the provision and financing of health care services is shifted from governments to private health care organizations (5,6). In the United States, the shift in power is manifested in profound ways. Market competition and bottom-line economics have permeated the health care system, creating powerful new incentives for mergers, other corporate restructuring, and the shift to for-profit status by formerly not-for-profit insurance companies and providers. Private sector health care is now increasingly influenced by for-profit organizations (3). Moreover, the health insurance industry has been transformed as traditional indemnity insurance is replaced by versions of managed care. The role of government, or the public sector, in setting parameters for health care financing and standards for the delivery of health care services is increasingly outpaced in cost cutting by organizations that directly face the bottom line. In addition, private foundations, many of which are under the auspices of managed care organizations, now fund a large proportion of health care research and demonstration projects, a task once largely within the realm of the government. Through education and experience, nurses have developed political sophistication and understanding of policy making in the public sector (7). The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu. This challenge is particularly crucial for advanced practice nurses, who must survive in a managed care environment.     

Long-term care insurance in Japan: implications for U.S. long-term care policy

The purpose of this article is to review the long-term care insurance program in Japan and the present system of payment of long-term care services in the United States. The long-term care insurance system in Japan was implemented in 2001 for the purpose of promoting independence in older adults with functional disability. It reimburses for both home and institutional care. Several concerns expressed about the Japanese system include increasing applications for nursing home placement, lower use of home care services than anticipated, limited coverage for disabilities for those under 65, regional variations in service, educational preparation for case managers, and access to care for older adults. Revisions to the Japanese system and implications for U.S. long-term care policy are discussed.     

Providing home care services in a for-profit environment

It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care.     

The impact of recent changes in public health insurance on community‐based health‐care in the USA

Recent changes in US government‐funded healthcare insurance are having profound impacts on all types of community‐based health‐care, reducing access to care by vulnerable populations. This article traces the impacts of recent policies on a range of community institutions in which nurses play a critical role, such as health centers, highlighting the effects on access to care and the survival of non‐profit services in less‐advantaged communities. In general, the new policies shifted revenues into fixed payment per client contracts (capitation) paid to for‐profit managed care organizations and away from non‐profit community services. The full impact of this competitive, market‐oriented system of health services has just begun to be felt. The uncertainties and dissatisfactions assure continued activity to change current conditions, including efforts by groups that seek greater access to health services for all populations and security for committed providers and personnel, including nurses.     

基于CiteSpace的延续护理研究热点与前沿可视化分析

目的了解延续护理研究的热点与前沿,为我国开展相关研究提供参考。方法通过Web of Science (WOS)核心数据库检索1988-2018年延续护理相关文献,采用CiteSpace V软件进行知识图谱绘制与分析。结果关于延续护理的文献年度发文量呈逐渐上升趋势,高产国家和机构相对比较集中,并且集中于欧美等发达国家及地区;研究热点不仅包括癌症及老年慢性疾病患者,同时也包括儿童护理干预模式及其效果的研究;研究趋势为重视居家护理以及基于循证延续护理模式研究。结论国外延续性护理研究相对比较成熟,研究方向呈现多样化趋势,我国可结合自身专业特点,以相关理论模型为指导,探寻患者需求,制定科学的、切实可行的延续护理内容,满足患者居家服务需求。     

关于构建我国长期护理保险制度的思考

目的探讨建立我国老年长期护理保险制度,以此应对人口老龄化的快速发展。方法采用对比分析的方法,将德国、日本和美国的长期护理保险制度进行简要介绍与对比,分析了可供我国参考借鉴之处。结果我国的长期护理保险制度既不能完全照搬德国、日本的强制型长期护理社会保险,也不能简单复制美国的商业型长期护理保险。结论我国的长期护理保险制度应立足基本国情,借鉴发达国家经验,从建立政策法规、加强人才培养、完善市场规范等各方面做好相关工作。     

上海市老年人家庭护理服务需求及支付意愿的质性研究

目的探讨上海市居家老年人家庭护理服务需求及支付意愿。方法采用质性研究中的现象学研究法,对10名居家老年人进行半结构式访谈,并运用Claizzi分析程序进行资料分析。结果居家老年人主要希望得到基础护理、康复护理、健康教育、家庭病床等专业化家庭护理服务和家政转介服务、精神慰藉等非专业化家庭护理服务,并存在一定支付意愿,但总体意愿支付值偏低,其中希望以项目形式进行收费者居多。结论老年人对家庭护理服务存在一定的需求及支付意愿,应大力拓展家庭护理服务,适当收费,促进卫生资源的合理分配及家庭护理的可持续发展。