社区失独家庭慢性病老人居家护理直接成本调查与分析

目的调查重庆市某主城区失独家庭慢性病老人居家护理服务直接成本，为社区护理服务成本管理提供参考。方法采用案例调查法和访谈法，以重庆市某主城区3个社区382名失独家庭老人和3个社区卫生服务中心124名护理人员为研究对象，确定失独家庭慢性病老人居家护理服务项目和成本构成要素，核算护理服务项目直接成本。结果共确定了22项护理服务项目，其中，糖尿病8项、高血压4项、冠心病5项、其他疾病5项；生命体征测量项目直接成本最低（1.5元），糖尿病伤口换药项目直接成本最高，在22.8元～57.0元之间。失独家庭慢性病老人居家护理服务项目中血糖监测、PICC维护及引流管护理盈利，其他项目处于亏损状态。结论护理服务项目计价标准较低，未能体现社区护理人员劳动价值；失独家庭扶助金标准较低，难以减轻居民经济负担；社区护理人员学历、职称不高，难以满足失独家庭慢性病老人心理需求。建议动态调整居家护理服务项目物价标准，提高失独家庭老人救助金标准，加强“互联网+社区护理”体系建设，完善人才队伍结构，有效利用社会资源。

Investigation and Analysis on the Direct Cost of Home Care for the Elderly with Chronic Diseases in Community Loss-of-Single-Child Families

ObjectiveTo investigate the direct cost of home care for the elderly from Loss-of-Single-Child families in a major urban area of Chongqing, and to provide reference for the cost management.MethodsThe case study and interview methods were used to investigate 382 elders from Loss-of-Single-Child families and 124 nurses from 3 community health service centers in a major urban area of Chongqing to determine the home care service items and cost components of the elderly, and calculate the direct cost.ResultsA total of 22 nursing service items were identified, including 8 for diabetes, 4 for hypertension, 5 for coronary heart diseases and 5 for other diseases. The direct cost of vital signs measurement was the lowest (1.5 yuan), and diabetic wound was the highest, between 22.8 yuan and 57.0 yuan. Blood glucose monitoring, PICC maintenance and drainage tube care in the home care service for the elderly with chronic diseases from Loss-of-Single-Child families were profitable, while other items were at a loss. Conclusion The price standard of nursing items was low, and it was difficult to reflect the labor value of community nursing staff; the subsidy standard for Loss-of-Single-Child families was low, it was difficult to reduce the economic burden of residents; the educational background and professional title of community nursing staff were not high, and it was difficult to meet the psychological needs of the elderly from Loss-of-Single-Child families. It was suggested that prices of home care services should be adjusted dynamically, subsidies for elderly in Loss-of-Single-Child families should be raised, the "Internet + community care" system should be strengthened, the structure of the talent pool should be improved, and social resources should be effectively utilized.