安徽省城市养老模式的现状与对策研究

目的:了解安徽省城市养老模式的现况,发现存在的问题,为制订城市养老规划提供依据.方法:走访有关民政部门、养老机构和社区卫生服务中心并进行座谈.结果:家庭养老经济负担过重,缺乏有力支持;机构养老观念不普及,养老机构不规范;社区养老服务单一,人才队伍不健全.结论:建议完善安徽省城市养老模式应给予财政支持,完善养老保障体系;整合社会资源,加强硬软件建设;规范化管理,建立专业人才队伍.     

新时期信阳养老服务模式的探索研究

面对日益严峻的老龄化趋势,信阳市采取了以居家养老为基础,以社区服务为依托,以养老服务机构为补充的家庭养老模式,在满足老年人养老服务需求和提升老年人生活质量等方面起到了积极作用。但受到家庭结构改变、经济发展落后、社会保障体系不完善等方面的制约,现有的养老模式远不能满足人口老龄化所突显出的问题。为此,分析了信阳市养老服务模式存在的不足和面临的挑战,在借鉴国内外较成熟的养老服务模式的基础上,从改善居家养老服务水平、建立养老服务网络、完善养老服务机制、提升养老护理专业队伍建设等方面,提出能够满足信阳市老年群体养老服务需求的建议,以推动信阳市老年事业的健康发展。     

养老机构膳食营养服务的困境与对策

膳食营养服务是养老机构服务中的痛点与难点。目前,养老机构的膳食营养服务缺乏标准的引领,尚未形成有效的运作体系;机构内部的管理规章制度不全面、不协调,加上缺乏必要的服务技术、人才和质量评估,膳食营养服务是被投诉的焦点和老年人最不满意的服务。因此,加快标准制定,引导养老机构膳食营养服务体系的建立,协调和系统化机构内部的各项规章制度、强化技术和人才要素,推进膳食营养服务质量的评估,才能满足不同需求老年人的精准营养要求,从而促进老年人的健康老龄化,提升养老机构膳食营养服务的能力与水平,使养老机构的膳食营养服务高质量地发展。     

养老机构发展医疗服务的保障机制研究

人口老龄化带来老年人对于医疗服务需求剧增,在养老机构推进并实现养老服务和医疗服务的全面融合,是解决应对当前人口老龄化问题的重要举措之一。国家出台多项政策保障养老机构发展医疗服务,但是在政府部门政策协同、服务人员职业发展、服务项目供给规范和运营资金成本投入等方面仍然存在一定问题,由此提出建立健全医养融合养老机构管理体系、加快形成举办医养融合养老机构的多元化格局、推动养老服务和医疗服务全面对接融合、增加惠及机构入住老年人的资金投入途径、加强医养融合养老服务人才培养培训等建议,以完善养老机构医疗服务供给能力的保障机制。     

福州市社会养老机构现状及提供卫生服务能力的调查分析

目的：通过对福州市区的养老机构资源及利用情况的研究，完善社会养老机构的工作。方法：选择福州市四个区登记在册的养老机构共15家进行调查。结果：福州市区养老机构规模大小不一，资源相对缺乏，入住率不高。大部分养老机构都拥有一些医疗卫生服务的功能，但总体差别很大。结论：社会养老机构的发展具有潜力，应加强对高龄老年人的身心护理，提高养老机构医疗卫生服务的功能，加强与医疗机构的联系。     

甘肃省养老机构老年人健康服务需求及影响因素分析

目的探讨甘肃省养老机构老年人健康服务需求现状及主要影响因素,为健全和完善机构养老服务提供理论依据。方法选取甘肃省兰州市、张掖市和平凉市养老机构的360名老年人作为调查对象,采用自设问卷对其进行调查。结果养老机构老年人健康服务需求总分为28.48±5.78分,地区、家庭类型、文化程度为影响健康服务需求的独立影响因素。欠发达地区,不完整的家庭及文化程度较低的老人对健康服务需求更高。结论应根据不同特征老年人的需求有针对性地提供相关养老服务项目。养老机构应该定期采集老年人的意见,鼓励子女探望,大力开展健康知识宣教,并完善养老与医疗服务机构间的合作机制。     

盐城建立医养康养相结合的养老服务体系的研究

在人口老龄化逐渐增加的情况下,医养康养相结合的养老服务既能够为老年人提供综合性护理服务,同时也能够满足老人诊疗的便捷性,是我国健康养老服务体系的重要成分。医养康养相结合的养老服务体系需要遵循以人为本,以康为要同时以养为源,以社区作为依托、同时以机构作为补充,建立医养康养相结合的养老服务体系。当前江苏省人口老年化程度逐渐升高,但是养老机构服务不全,市场发育不健全,故而需要采取有效措施如建立医养康养养老新模式解决这些问题。文章布局于盐城健康产业,对盐城养老服务机构进行研究,以期构建起具有江苏特色的康养医养结合新模式,为我国养老事业发展做出贡献。     

宁波市养老机构健康服务供给能力的调研分析*

当前人口老龄化的问题日益加剧,老年人由于年龄增长导致生理机能的下降,因此,健康问题已经成为老年人重点关注的问题。通过对宁波市养老服务机构的抽样调研可知,养老机构老年人对于健康服务需求强烈,但养老机构健康服务供给能力不足,提供的健康服务项目单一,尤其是体制障碍,影响养老机构在健康服务领域的发展。对此,提出了建立养老机构健康服务的政策保障体系、建立具有区域特色的养老机构和医疗机构的合作模式、设计"以需求为中心"的养老机构健康服务项目、加强养老机构复合型健康服务专业队伍建设以及发挥政府与市场在养老机构健康服务领域的双重作用等建议和措施。     

养老服务机构卫生管理制度分析

<正>随着中国人口结构步入老龄化社会,越来越多的老年人选择社会化养老,养老服务机构也不断发展。各养老服务机构发展不平衡,卫生状况也参差不齐,其中部分养老服务机构情况不容乐观。目前,全国无专门系统的养老服务机构卫生管理的法律法规和规范,养老服务机构的食品安全、公共场所、医疗服务监管都处于空白地带。为让老年人拥有一个饮食卫生安全、居住卫生整洁的生活环境,规范养老服务机构的卫生管理迫在眉睫。     

天津老年人对民营养老机构服务情况的满意度分析

目的通过描述养老机构医疗健康服务和后勤服务现状,找出民营养老机构存在问题,据此为完善民营养老机构服务模式提出针对性建议。方法采用一对一访谈形式问卷调查天津市某民营养老机构29名老年人。结果老年人对民营养老机构医疗健康服务和后勤服务情况较为满意。结论民营养老机构应努力提高自身服务水平,以满足老年人的不同需求,同时政府及社会力量应加强对民营养老机构的正面干预。     

Management of pain in older people within the nursing home: a preliminary study

The provision of continuing care for older people has largely shifted from the hospital setting to the community, and nursing homes increasingly provide support for older people, many of whom exhibit multiple pathology and complex health and social care needs. However, the quality of pain management within this setting has been identified as an issue of concern. It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%. However, there exist a number of barriers to the identification and management of chronic pain among older people resident in nursing homes, including sensory impairments in older people themselves and educational deficits among professionals. Such barriers need to be overcome if pain management is to be improved. The present study involved administering a pre-piloted postal questionnaire to the managers of 121 nursing homes within a geographically defined area. Sixty-eight (56%) were completed and returned. The questionnaire broadly covered the following: prevalence of chronic pain and use of interventions; assessment and management strategies; education and training; and communication barriers. Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain (pain lasting longer than 3 months not caused by cancer) and 2% were reported as experiencing chronic malignant pain (pain lasting for more than 3 months caused by cancer). Paracetamol was identified as the most 'often' used analgesia for both pain modalities. Sixty-nine per cent of nursing homes did not have a written policy regarding pain management and 75% did not use a standardised pain assessment tool. Forty-four per cent of nursing homes provided education or training sessions for qualified staff and 34% provided this for care assistants. Forty per cent of qualified staff and 85% of care assistants had no specialist knowledge regarding the management of pain in older people. The present study confirms the need for the development of effective pain management strategies underpinned by appropriate training and education in order to meet the particular needs of older people.     

Resource management in community residential facilities for adults with learning disabilities.

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.     

Elderly people with cognitive impairment: costing possible changes in the balance of care

The objective of this paper is to investigate the service needs and support costs of elderly people with cognitive impairment on hospital and community health services, primary health care, social services, and informal carers in England. It examines the resource consequences of major changes in the provision of care, exploring the implications for both cost and effectiveness. The study was designed to provide a secondary analysis of the OPCS disability surveys in order to estimate the balance of care, and current provision of services. It also estimates of costs of present provision and potential policy options. Results show large scale improvements in the provision of care for people living in private households and local authority homes require significant increases in funding, but reductions in the provision of long-stay hospital beds can significantly reduce the cost burden to the public purse. Given the increasing demand pressure on health and social care expenditure, it seems unlikely that large scale improvements in the care supplied to elderly people with cognitive impairment can be achieved without some change in the balance of care. The cost of implementing improvements in care for the 200000 people living in private households and the 45000 people in local authority homes could be offset by reducing the provision of costly long stay hospital provision with alternative institutional care such as NHS nursing homes.     

A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation

A coordinated emergency management response to disaster management in nursing homes is desperately needed globally.During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents.The responsibility for the management of nursing homes during the pandemic was multifaceted, and responsibilities lay at the national, jurisdictional, and regional levels. Success in managing COVID-19 in nursing homes required all these levels to be aligned and supportive, ideally through management by an emergency response leadership team. However, globally there is a paucity of effective management strategies.This article uses the example of the COVID-19 pandemic to propose a risk stratification system to ensure timely and appropriate allocation of resources to nursing homes during disaster preparation and management. Nursing homes should be risk-stratified according to 4 domains: risk of intrusion, capability for outbreak containment, failure in organizational capability, and failure in the availability of community and health care supports. Risk stratification should also consider factors such as current levels of community transmission, if applicable, and geographic location of nursing homes and services.Early identification of nursing homes at risk for infectious disease, or disasters, and targeted allocation of resources might help reduce the number of outbreaks, lower the mortality, and preserve community supports such as acute hospital services. The next step is to debate this concept to validate the selected variables and then develop and pilot test a risk stratification tool for use.     

Community care for the elderly: Costs and dependency

The aim of the paper is to examine the costs of care of elderly persons who live in their own homes as compared to those in residential homes. This is seen as a necessary first step in any planning process. From a survey of elderly persons in Britain, the levels of domiciliary services provided to those in their own homes was ascertained, and unit costs of each service was applied. Costs were based on the economic concept of social opportunity costs, so that all costs were included, and not just those accruing to the local authority. Recognising the fact that the costs of care in the community were likely to vary with the level of health of the elderly person, an attempt was made to categorise elderly persons into various levels of dependency. Secondly, regression techniques were used to ascertain whether the level of dependency did significantly affect the costs of care. It was found that variations in the average costs of care were significantly explained by both physical and mental characteristics of the elderly person. In addition, sex was important, as well as the elderly person's area of residence. This has important implications by itself for planning care services. It was also found that very few persons who were sampled in the community had a total cost of care greater than the average cost found in residential homes.     

Prevalence of methicillin-resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom.

OBJECTIVE: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among older residents of care homes in Leeds, United Kingdom, and to identify resident and care home risk factors for carriage. DESIGN: We conducted a cross-sectional prevalence survey of 715 residents from 39 care homes. All participants were tested for nasal colonization with S. aureus, including MRSA. A short questionnaire was completed about each participant and each care home. A multivariable model was used to determine which risk factors were independently associated with MRSA colonization. SETTING: Care homes for older residents in Leeds, United Kingdom. PARTICIPANTS: All residents in participating homes who were able to give informed consent. RESULTS: A total of 159 of 715 residents tested positive for MRSA, for a prevalence of 22% (95% confidence interval, 18%-27%) The resultant multivariate model showed that residence in a home with a low ratio of nurses to beds, residence in a care home in a deprived area, male sex, presence of an invasive device, and a hospitalization duration of more than 10 days during the previous 2 years were independently associated with MRSA colonization. CONCLUSIONS: This study found a large reservoir of MRSA within the care home population. Control strategies need to be coordinated between care homes and hospitals. Increasing the ratio of nurses to beds, reducing the duration of hospitalization, and improving the management of invasive devices could help reduce the prevalence of MRSA colonization. Further research is required to ascertain the potential health benefits of reducing the rate of MRSA colonization among care home residents.     

The small group home: needed option for the poor elderly.

This paper covers the possibilities of organizing community services and obtaining funding to make small group homes available to the poor. Statistics show that many frail elderly in nursing homes could function well in less protected environments if transition options for housing and services were available, such as the small group home, which fosters self-direction and "mainstreaming" of older persons in an age-integrated community. It fills a major gap in the continuum of health services at about 2/3 the cost of nursing home care. Only a few states are experimenting with alternative Medicaid regulations which permit payment for health related services, maintenance, homemaking and ADL assistance. None are known to be testing the small group home concept. Thus many older persons requiring some services must be institutionalized, although there may be no need for intensive nursing care or 24-hour supervision. The poor older person's choice, in particular, is restricted by Medicaid regulations. Demonstration small group homes are proving both cost and care effective. Home Care Research in Frederick, Maryland has several such homes. Such alternative "family style" living, with health related services, should be made available to all persons who qualify, regardless of income.     

Feasibility of quality indicators for the management of geriatric syndromes in nursing home residents

PURPOSE: The assessment and management of dementia, falls and mobility disorders, malnutrition, end-of-life issues, pressure ulcers, and urinary incontinence have been identified as important quality improvement targets for vulnerable elders residing in nursing homes. This study aimed to identify valid and feasible measures of specific care processes associated with improved outcomes for these conditions. METHODS: Nine experts in nursing home (NH) care participated in a modified Delphi process to evaluate potential quality indicators (QIs) for care in NHs. Panelists met and discussed potential indicators before completing confidential ballots rating validity (process associated with improved outcomes), feasibility of measurement (with charts or interviews), feasibility of implementation (given staffing resources in average community NHs), and importance (expected benefit and prevalence in NHs). The NH panel's median votes were used to identify a final set of QIs that were subsequently reviewed by a clinical oversight committee. RESULTS: Sixty-eight geriatric syndrome QIs were identified as valid and important in NH populations. Panelists assessed 12 (18%) of these QIs as having questionable feasibility to implement in average community nursing homes trying to provide quality care. Nine (13%) would not be included in systems assessing quality of care for persons with advanced dementia or poor prognosis. CONCLUSIONS: Steps of care critical to the assessment and management of geriatric syndromes in NHs were identified. Feasibility is an important issue for a significant number of these, indicating that much remains to be done to design systems that efficiently and reliably implement these care processes.     

A feedback system to improve the quality of nutritional care

ObjectiveThe main objective of this study was to develop a feedback system that improves the translation of malnutrition performance data from the Dutch National Prevalence Measurement of Care Problems (LPZ) into relevant evidence- and practice-based interventions in care homes.MethodsThe process consisted of two stages. The first was the development of a feedback system. Twenty-four interviews were held with health care professionals in care homes that participated in the LPZ to gain insight into needs regarding the translation of performance data into relevant improvement interventions. Subsequently, three multidisciplinary focus groups discussed how to develop a feedback system to deal with those needs. In the second stage, the feasibility of this system was evaluated via a questionnaire (N = 93) that was sent to care homes participating in LPZ.ResultsIt was important that performance data be more transparent regarding which information was relevant and that insight was gained into how to improve nutritional care. To address these needs, a dashboard was developed to present performance data in a transparent way. Subsequently, a decision tree was developed that links LPZ dashboard outcomes to evidence-based nutritional interventions for care homes. Forty-seven respondents (50.5%) evaluated the new feedback system (the dashboard and the decision tree) as feasible. The content and design were perceived to be very useful. Half of the participating institutions had already started working with improvement activities.ConclusionThe developed feedback system was evaluated as useful for improving nutritional patient care in the future. This system will also be developed for other health care settings.