A Study On The Demand Status Of Long-term Caregivers And The Evaluation Of Care Insurance Level

Objective:To master the current situation of long-term caregivers’needs in Shangrao City,Jiangxi Province,and formulate a long-term care standard system and rating standards to provide a basis for formulating relevant regulations for long-term care insurance in Shangrao City,as well as provide references for other similar regions to develop long-term care insurance systems.Methods:A cluster sampling method was used to randomly sample 1,165 long-term caregivers from 12 counties(cities,districts)in Shangrao City,Jiangxi Province to conduct a questionnaire survey.The survey was completed by uniformly trained investigators in a household-based manner.The contents of the survey include:general characteristics of long-term caregivers,needs for care purposes,needs for chronic disease care,needs for care aids,current home situation of long-term caregivers,assessment of daily living ability,assessment of cognitive ability,and measurement of disease status.Statistical methods such as F-test,T-test,?~2 test and multiple linear regression analysis were used to analyze different needs and causes.The health dimension principle is used to determine the care evaluation system,the percentile digit method principle is used to divide the care grade standard,and empirical data is used to verify the rationality of the grading standard.Result:(1)The status quo of long-term care needs.(1)Ability of daily living care needs.The top 10 care needs were:eating and excretion 72.7%,body bathing 46.8%,sitting up 44.2%,home care 39.5%,outdoor movement 31.9%,dressing and washing 28.9%,clinical care 8.6%,disease treatment 8.7%,rehabilitation training 6.4%,indoor walking 6.6%.The average score of the ability of daily living was 70.7±21.3.The main factors influencing the ability of daily living were age(95%CI:0.692-1.851),normal communication disorder(95%CI:17.301-23.651),high education level(95%CI:1.397-3.152),indoor armless(95%CI:8.115-14.089),rural household registration(95%CI:3.587-14.137),and living far away from relatives(95%CI:1.234-4.435).(2)Chronic care needs.The top 10 chronic disease care needs were:hypertension 42.4%,cerebral infarction 31.8%,cerebral hemorrhage 15.2%,diabetes11.9%,senile dementia 11.8%,coronary heart disease 8.9%,lower extremity fracture8.2%,chronic obstructive pulmonary disease 7.1%,Parkinson’s syndrome 4.9%,advanced tumor 3.7%.The average score of comprehensive care needs of patients with the first 10 diseases was 30.30±20.21.(3)Need for care aids.The top 5nursing needs of assistive tools were wheelchair 69.8%,urine/stool pad 43.6%,crutch 13.6%,bedsore prevention mattress 7.6%and denture 3.0%.(2)Care standard system and insurance level standard.(1)Standard system of care.Two standard systems of care have been constructed.One is the standard system of care,which is dominated by physical health and centered on the scores of daily living ability and chronic disease impact.I includes 18 life abilities and 10 major diseases.The second is the standard system II,which is dominated by physical and mental health and centered on the scores of daily living ability,cognitive ability and grade chronic disease impact,including 18 life abilities,5 cognitive abilities and 10 major diseases.(2)Standard of care insurance rating.Set up the scoring standards of 33 indexes such as turning over and standing.According to the percentile method and the principle of the most detailed classification,the 8-level insurance care standard of the nursing system I was determined for the two nursing standard systems.The empirical data verification found that there were significant differences between the 8-level care scores(F=707.5764,P<0.001),and there were differences between the groups(all P<0.001);there were significant differences between the 8-level insurance care scores of the nursing standard system II(F=699.6198,P<0.001)There were differences between the two groups(P<0.05).Conclusion:(1)According to the long-term care needs assessment,the main needs of daily living ability care are feeding and excretion,body bathing,turning over and sitting up,home care,outdoor movement,dressing and washing,clinical care,disease treatment,rehabilitation training and indoor practice.The demands of chronic disease care are mainly hypertension,cerebral infarction,cerebral hemorrhage,diabetes,Alzheimer’s disease,coronary heart disease,lower extremity fracture,chronic obstructive pulmonary disease,Parkinson’s syndrome and advanced tumor.(2)The standard system of care can be carried out according to the care standard system I,which is simple and easy to operate,with physical health as the leading factor and daily life ability and chronic disease impact score as the core,or according to the care standard system II,which is relatively complex to operate,with physical and mental health as the leading factor and daily life ability,cognitive ability and chronic disease impact score as the core.(3)The classification of long-term care insurance should be based on 8 levels,which is scientific and reasonable.In the era of high intelligence,it will not bring complexity to the measurement of insurance compensation.The classification of care insurance level is conducive to the realization of the fairness of insurance compensation.