机构养老的老年人医养结合服务需求分析——基于日常生活能力评估

目的:了解河南省不同失能等级老年人的医养需求特点,为未来机构养老的发展提出合理化建议.方法:采用多阶段整群抽样方法,在河南省抽取57家养老机构,对入住老年人进行面对面问卷调查.结果:医疗服务方面,老年人相对更需要医疗巡诊、临床治疗、医学护理服务;健康管理方面,更需要建立健康档案、健康体检;生活服务方面,更需要助浴、助厕...     

The Israeli Long-Term Care Insurance Law: selected issues in providing home care services to the frail elderly

The paper describes and analyses selected issues related to the provision of home care services to frail elderly people following the Israeli Long-Term Care Insurance Law (1988). The goals and principles of the Law, which mandates the provision of home care services to frail elderly people, are presented. The paper also evaluates its contribution toward enhancing the well-being of elderly clients. Several major dilemmas that arose following implementation of the Law are analysed and evaluated in comparison with other countries that have enacted and implemented similar laws. These dilemmas are community vs institutional care; services in kind vs monetary allowances; service provision through contracting out with nongovernmental agencies; unstable and unskilled labour force; and service quality. Finally, policy implications are discussed, mainly in the following areas: investment in human resources as a condition for achieving high service quality, and the need for coordination between the agencies that provide long-term care services to elderly people.     

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.     

上海市长期护理保险服务提供现状及监管对策分析

目的:梳理当前上海市长期护理保险服务提供现状,并从服务环节涉及的各个主体及其相互之间的关系入手,为切实提高服务质量提供可行的监管对策。方法:运用政策梳理、二次数据采集以及与关键知情人访谈的方法,为评价长期护理保险服务环节的成效、经验及潜在监管问题提供证据支撑。结果:截至2020年底,上海市长期护理保险共服务失能老人55.58万人,每千名户籍老人可拥有10.25个养老护理员(医疗照护)。制度设计中各类服务标准规范、细则和惩罚措施还不够完善,监管APP的功能有待进一步强化。结论:对服务提供方增加规制并为护理机构赋权,同时,积极引入视频监控、RFID电子标签等新技术,充分发挥信息化监管的力量。     

Developmental services in primary care for low-income children: Clinicians’ perceptions of the healthy steps for young children program

Difficulties with providing quality primary health care for low-income Americans have been well documented. Few studies have addressed the challenges faced by pediatric clinicians serving low-income families or whether practice-based interventions improve clinicians’ ability to provide quality preventive health services. We investigated if, over time, the Healthy Steps for Young Children program affected the practices and perceptions of clinicians in pediatric primary care practices serving low-income families compared to practices serving more affluent families. Self-administered questionnaires were completed at baseline (N=104) and at 30 months (N=91) by clinicians at 20 pediatric practices participating in the Healthy Steps program. Practices were divided into three groups: those serving families with low, middle, and high incomes. Barriers to providing care, provision of preventive developmental services, and perceptions of care were assessed at baseline and at 30 months after introducing the program. Across all income groups and over time, clinicians were more likely to report the provision of preventive developmental health services. Clinicians in low-income practices reported increased problems with both reimbursement and time barriers; clinicians in high-income practices reported increased problems with reim-bursement. At 30 months, clinicians serving low-income families reported the greatest positive changes in their perceptions about the quality of care provided by their practices. They also were more likely to strongly agree that they gave support to families and to be very satisfied with the ability of their clinical staff to meet the developmental needs of children. We found that Healthy Steps was successful in universally increasing developmental services despite the reported practice barriers for both low- and high-income practices. The Healthy Steps program enabled low-income practices to achieve similar levels of clinician satisfaction as middle- and high-income practices despite having reported lower levels at the beginning months of the program. The Healthy Steps for Young Children Program is a program of the Commonwealth Fund, local funders, and health care providers across the nation. It is cosponsored by the American Academy of Pediatrics. Funding for the Healthy Steps National Evaluation is being provided by the Commonwealth Fund, the Robert Wood Johnson Foundation, the Atlantic Philanthropic Foundation, and local funders. The views presented here are those of the authors and not necessarily those of the funders, their directors, officers, or staff.     

Assembling their own care packages: payments for care by men and women in advanced old age

A study of 93 households containing only people over 75 indicated that 74% chose to buy some form of care from the private or voluntary sector. The study included households in a middle class and a working class ward of an outer-London borough where few elderly people had children or other relatives living within walking distance. More private services were available in the middle class area but frail elderly people who needed services, such as cleaning, gardening, grocery delivery or car hire, as necessities had to compete with younger, very much more affluent households who bought the services as amenities. Personal care was less used by those interviewed, but 28 people paid for chiropody, either because they were ineligible for a free service or because the free service was inadeaquate for their needs. Paying for care did not bring market power. Elderly people were marginal customers and usually did not feel able to complain if they got poor service. The study indicates that there is a demand for care which helps frail elderly people to continue as respectable members of their communities. At present these services are not provided by the state and are in short supply in less affluent areas. Community care policies which were user-led, or which aimed at preventive care, would expand the provision of such services.     

Perceptions of unmet needs for community social care services in England. A comparison of working carers and the people they care for

Previous UK research has found expressed unmet need for services by unpaid working carers and among disabled and older people. There are, however, suggestions from research that views on unmet needs for services differ between carers and care‐recipients. Working carers in the UK say that the care‐recipient is sometimes reluctant to accept services and the few international comparative dyad studies that have been carried out find that carers perceive higher unmet need than care‐recipients. Recent policy discussions in England have also recognised that there may be differences of opinion. We collected data in 2013 from working carer/care‐recipient dyads in England about perceived need for services for the care‐recipient, disability, unpaid care hour provision and individual and socio‐demographic characteristics. We find that care‐recipients as well as their carers perceive high unmet need for services, although carers perceive higher unmet need. For carers, unmet need is associated with the disability of the carer‐recipient and being the daughter or son of the care‐recipient; for care‐recipients it is associated with unpaid care hours, carers’ employment status and carers’ health. The majority of dyads agree on need for services, and agreement is higher when the working carer provides care for 10 hours or more hours a week. Services for care‐recipients may enable working carers to remain in employment so agreement on needs for services supports the implementation of legislation, policy and practice that has a duty to, or aims to, support carer's employment.     

基于缺口分析的北京市老年居家医疗护理服务研究

对北京市及各城区老年居家医疗护理服务的供需现状及缺口情况进行分析。结果显示:北京市老年居家医疗护理服务需求旺盛,但城区之间服务供给不平衡,多数城区“供不应求”。应建立多元主体的服务提供与协调机制、“按需定供”的资源配置机制以及其他配套机制,促进老年居家医疗护理服务的供需平衡,增进老年人福祉。     

Variations in care for the elderly in Wales.

The counties of Wales were examined and relationships sought between the socioeconomic status and the per caput expenditure on health and social services by each county, the services provided for the elderly and their outcome measured as a standardised mortality ratio and a simple measure of long-term disability. Counties with a high socioeconomic status provided more residential services, those with low status more home helps. There were no other significant relationships between provision of services and status, nor any correlation between provision of services and expenditure. There was an inverse relationship between high status and the mortality and disability measures. In general at county level the social services appear to be responding more appropriately to the needs of the elderly than the health services.     

Developing a uniformed assessment tool to evaluate care service needs for disabled persons in Japan

Until recently, the care services for disabled persons have been under rigid control by public sectors in terms of provision and funding in Japan. A reform was introduced in 2003 that brought a rapid increase of utilization of services and serious shortage of financial resources. Under these circumstances, the "Services and Supports for Persons with Disabilities Act" was enacted in 2005, requiring that the care service provision process should be transparent, fair and standardized. The purpose of this study is to develop an objective tool for assessing the need for disability care. In the present study we evaluate 1423 cases of patients receiving care services in 60 municipalities, including all three categories of disabilities (physical, intellectual and mental). Using the data of the total 106 items, we conducted factor analysis and regression analysis to develop an assessment tool for people with disabilities. The data revealed that instrumental activities of daily living (IADL) played an essential role in assessing disability levels. We have developed the uniformed assessment tool that has been utilized to guide the types and quantity of care services throughout Japan.     

社区卫生服务中心参与医养结合服务现状研究

目的:分析社区卫生服务中心通过不同方式参与医养结合服务的主要做法,为社区卫生服务中心参与医养结合服务提供建议。方法:采取目的抽样法,在东、中、西部各选取开展医养结合服务且具有代表性的上海市、武汉市、重庆市共6家社区卫生服务中心进行现场调查。运用主题框架分析法对资料进行分析。结果:调研地区社区卫生服务中心参与医养结合服务主要包括社区卫生服务中心参与居家养老、社区养老、养老机构养老以及社区卫生服务中心提供养老服务等。每个调研地区社区卫生服务中心参与不同种类医养结合服务的服务对象、主体、方式和内容均有所不同。目前社区卫生服务中心参与医养结合尚缺乏统一的行业标准,部门间仍需要进一步协同,社区卫生服务中心参与医养结合服务的程度有限。结论:顶层设计需要考虑到社区卫生服务中心辖区居民的需求以及机构服务能力,制定老年人统一照护需求评估标准,确定社区卫生服务中心提供服务的内容与对象,同时加强信息化建设,提高社区卫生服务中心的服务效率。     

老年人养老规划对社区养老服务需求与利用影响研究

目的：分析养老规划对城镇老年人社区养老服务需求和利用的影响,为老年人社区养老服务供给政策的针对性和有效性提供依据。方法：利用中国老年社会追踪调查(CLASS)2018年数据,建立Probit模型和倾向值匹配法(PSM)分析。结果：我国城镇老年人的社区养老服务需求和利用水平较低;养老规划对城镇老年人社区养老服务利用具有显著的挤压效应,对需求具有显著的促进效应;不同养老规划内容对城镇老年人社区养老服务需求和利用影响不同,流动资金和风险防范类规划的影响更大;养老规划对城镇老年人社区养老服务利用的挤压效应和对需求的促进效应在低受教育水平老年人中更强。结论：政府应当重视养老资源供需不对接问题,提高社区养老服务质量和效率,关注老年人的需求特点,提供与老年人需求对等的养老服务,关注老年人风险防范需求。     

基于整体性治理理论的医养结合服务研究

我国在未富先老的情况下步入老龄化社会,人均寿命延长、家庭结构小型化、城市化及人口流动加速等因素对养老提出了挑战。与此同时,失能老年人占老年人人口的比重较大,而且老年人两周患病率、患慢性病率高。老年人需要养老服务,又需要医疗服务(即医养服务),但是政府、社区、养老机构、家庭尚未为老年人建立完善的医养体系,主要体现为养老机构不整合医养服务。文章运用整体性治理理论,分析了目前老年人的医养问题,认为医疗机构应该承担医养服务的重任,并提出为老年人提供医养服务的对策建议,为相关部门制定政策及实施提供理论参考。     

Government subsidies for dental care in Australia

OBJECTIVES: To evaluate the impact of recent changes in public subsidies for oral health care in Australia, and to propose more effective and equitable uses of Commonwealth Government subsidies. METHODS: Review of literature and Australian Research Centre for Population Oral Health information. RESULTS: Commonwealth subsidies for oral health care services in Australia have been moved from public dental services to private dental health insurance. This has resulted in a redistribution of funds from people on low incomes with poor oral health, to people on middle to high incomes with relatively better oral health. CONCLUSIONS: Public funding for dental care in Australia favours the financially and orally better off at the expense of disadvantaged and orally unhealthy Australians. Current approaches to public funding for oral health services in Australia are unlikely to result in a substantial improvement in oral health. IMPLICATIONS: Maximum gains in oral health are likely to be achieved by a reorientation of Commonwealth subsidies towards preventive and basic treatment services. This reorientation needs to occur within a primary health care framework. Whereas the Commonwealth plays a national leadership role in the provision of general health services, this is not apparent in relation to oral health. This lack of leadership leaves many vulnerable Australians without basic preventive services and at high risk of losing teeth that might otherwise have been preserved. Channelling the funding now used to subsidise private dental services for the well off and dentally healthy to community-wide and targeted preventive services for vulnerable and low-income Australians would have a larger impact on oral health and represent a more equitable use of these funds.     

关于完善老年服务和长期护理制度的思考与建议

我国以家庭为基础,社区为依托、机构为补充、医养结合的多元福利体系已经建成。本文认为与医疗有关的长期护理应纳入基本医疗保险,与生活有关的长期照料属私人事务,当私人在经济上和服务上不能提供有效供给时,政府需要"兜底线",瞄准对象,建立长期照护津贴制度,为弱势家庭提供长期生活照料的帮助;财政支出政策应由"补供方"为主转向"补需方"为主。文章认为现阶段社会长期护理保险不适合中国国情,建议完善健康养老、积极养老政策降低失能概率;构建"支持和维护家庭"的养老和长期照护政策体系。     

Home Sweet Home? Community Care for Older People in Australia

Community care provision for older Australians is growing in places and options, based on older people's preference to stay in their own homes, coupled with its cost efficiency compared to long-term residential care. Australia's aging population, cultural diversity, and dispersed population in rural and remote areas presents significant challenges in meeting these care needs. The objective of this review is to provide a critical overview of community care services in Australia, from its origin in the 1940s through to the current array of programs that deliver care. Barriers to access for these programs, growth in funding and expenditure, evidence of client satisfaction and the problems of workforce provision are presented. It is not clear how the growing future demands for care programs, resulting from greater client expectation, increasingly complex care needs and a diminishing workforce of paid and unpaid carers, will be met. However, the economic burden is anticipated to be manageable. Despite seemingly well-structured programs, the current multiplicity and rigidity of services means care provided is sometimes unsatisfactory at the point of delivery. It remains to be seen therefore if services can be expanded, modified and developed to address current deficiencies and meet future demands. The reality of timely and equitable care for all older Australians living in the community is elusive at present. The ongoing rationing of residential care beds coupled with people's desires to stay in their own homes means community care is here to stay. The future inevitably presents huge challenges to those planning, implementing and providing care in this setting.     

流动老人基本公共卫生服务利用及影响因素研究

目的:了解流动老人基本公共卫生服务利用情况及其影响因素,为促进公共卫生服务均等化提供数据支持。方法:以安德森卫生服务利用模型为理论基础,使用2015年全国流动人口动态监测数据,结合深度访谈,对影响流动老人卫生服务利用的人群特征及环境因素进行分析。结果:流动老人基本公共卫生服务利用率偏低并在群体内存在差异;户籍类型、居住时长、流动范围是影响流动老人卫生服务利用的主要因素;基层卫生服务机构存在经费拨付与工作量不一致、数据不清、工作不被理解等方面的困难。结论:流动老人基本公共卫生服务可及性较差、健康意识薄弱,应加强健康教育宣传;对农村户籍、居住时间短和流动跨度大的老人给予重点关注;卫生部门应加强针对流动老人的数据统计,改变基本公共卫生服务经费拨付方式,优化信息化建设顶层设计,促进流动老人基本公共卫生服务利用。     

Perceptions of unmet need in four community services for elderly people

Abstract: Home-care services particularly, and food services to a lesser extent, are seen by elderly people as being critically important for their capacity to live independently in western Sydney. Home nursing and transport services are valued but are less critical. Consumers, providers of services and referral agents all identify significant levels of unmet need for community services. The home care service particularly is stretched by pressures which are likely to be exacerbated by demographic change and by cost-shifting between state governments and the Commonwealth Governments.     

Access to paid in-home assistance among disabled elderly people: do Latinos differ from non-Latino whites?

OBJECTIVES. The purpose of this study was to compare the national prevalences and predictors of paid in-home functional assistance among disabled Latino and non-Latino elderly people who receive such assistance. METHODS. Data were derived from the 1988 wave of the National Center for Health Statistics Longitudinal Study on Aging and the 1988 Commonwealth Fund Commission Survey of Elderly Hispanics. Logistic regression was used to model paid care use and to calculate estimated probabilities of such use. RESULTS. Among Latino and non-Latino Whites 74 years of age and older who received functional assistance, similar proportions used paid assistance. Predictors of paid care coincided with established models for non-Latino Whites only. Disabled Latinos had a lower estimated probability of using paid assistance when they were highly disabled and socially isolated but had a higher estimated probability when their children lived nearby. CONCLUSIONS. The effects of disability and social support differ among non-Latino White and Latino elderly people. Latino elderly people with high anticipated needs obtain less paid assistance than similar non-Latino Whites. In addition to a reduction in financial barriers, improving access to long-term care services requires addressing this diversity in service use patterns.     

A survey of survivors of acute stroke discharged from hospital to private nursing homes in Nottingham

Increasing numbers of disabled elderly stroke survivors are being discharged from hospital to Private Nursing Homes. However, there is little data available on which specific guidelines for the care of stroke patients in these homes can be based. A survey was undertaken therefore, to review patients on their discharge from hospital to Private Nursing Homes, and to assess the severity of their disability and handicap before and after entering the home. Nearly all patients were severely disabled on discharge from hospital, and the Barthel Activities of Daily Living scores of the survivors showed no significant change after four months. High levels of emotional distress and loneliness were identified by the Nottingham Health Profile, with little change after four months of nursing home care. The National Health Service has a continuing responsibility for the welfare of such vulnerable elderly people. The findings of this survey indicate that the emphasis of their care should be on the management of severe physical disability, exploitation of opportunities for further rehabilitation, alleviation of emotional distress and loneliness and, where appropriate, the provision of humane terminal care.