| BackgroundChina's aging population growth has become one of the fastest in the world.Although the aging problem of China has a relatively shorter history compared to the developed countries,it seems to become more severe due to the main features of fast growth,large scale and growing old before it grows wealthy.Findings revealed that the life quality of the urban elderly belongs to mid-low level in the aging society.Home-based care is a preferred and dominant way in Chinese long-term care system.In the traditional way of home-based care,family member,mainly sons and daughters totally undertake the responsibility of caring for their parents.However,traditional home-based care fails to meet the demand of long-term elderly care,for present family structure mainly consists of only child and empty-nest elderly.Thus,it is urgent to explore a new pattern of home-based care system with the help of social strength,which make the socialized provision follow to elderly households,so as to adapt to the ever-increasing amount of advanced aged,disabled and empty-nested elderly and meet the demand of the rapid development of China's aging society.ObjectiveBased on scientific analysis and research of home-based care systems home and abroad,this thesis investigated the demands and influencing factors of home-based care for elderly people of urban community,the problems,ways of development,and solutions of home-based care system for the elderly of Chongqing urban communities.Establishing a feasible home-based care system suitable for Chongqing from the aspects of supplier,service contents,the way of supply and supporting measures based on its socioeconomic status,demographic characteristics and relative policies.And providing some policy-making suggestions for an efficient,economic and equal service supply to make effort for advancing the development of China's long-term elderly care career.Contents and methods(1)Status analysis of home-based care systems home and abroadBy studying literatures on the origin and development of home-based care system in several countries and regions,analysing the status and problems of Chinese home-based care system,this thesis used the experience of these developed countries and regions for reference and designed home-based care system suitable for Chongqing urban community.(2)Status and problems of Chongqing home-based care service systemFocus groups interview was used to acquire the suppliers? understanding on service supply,utilization situation and the influencing factors of home-based care service;collect their opinions on current policies and their suggestions on establishing home-based care system of Chongqing urban community and figuring out the problems,ways of development and solutions of home-based care service system.In each target districts,selecting 1 staff with relative experience from each Health and Family Planning Commission,Civil Affairs Bureau and Bureau of Finance,1 to 2 persons in charge from each community,community hospital and institutions for the aged to conduct focus groups interview.Each group consists 6 to 10 persons and 8 groups weree interviewed.(3)Demands and influencing factors of home-based care for elderly people of Chongqing urban communityWith multistage stratified cluster random sampling,this thesis classified all the districts in Chongqing according to the economic level and then selected 2 to 3 districts in each level conducting on-site investigation in order to understand the utilization situation and demands on home-based care service.According to the principle of free will,totally 1635 elderly aged above 65 fulfill the self-designed questionnaire,including general information,health condition and demand of elder care service.The main statistical methods including: descriptive statistics analysis,chi-square test,single factor analysis and logistic regression.Statistical software SPSS21.0 was used for statistical analysis.(4)Establishment of home-based care system of Chongqing urban communityBased on theoretical research and empirical research,combining with socioeconomi c status,demographic characteristics and relative policies of Chongqing,a feasible home-based care system consisting of supplier,service contents,the ways of supply and supporting measures was designed with the guidance of ERG(Existence,Relatedness,Growth,ERG)theory,New Public Management Theory,Community-care Theory,and so on.Results(1)The home-based care system in Japan,three countries in Northern Europe and America is featured with improvement in related laws and regulations,perfection in servi ce system,diversity and profession in content and well performed of non-profit organizations.While in the analysis of home-based care system in Qingdao,Zhejiang and Hong Kong,we found problems in service utilization,degree of social attention,types of service and service level.(2)Results of focus groups interview:(1)The principle that long-term elderly care should based on home-based care,supported by community-based care and replenished with institution-based care which advocated by our country met the practical requirements,but there has not been ready-made one suitable for Chongqing.(2)Content of requirements: medical care,health management,daily care,entertainment,spiritual consolation,palliative care and funeral service.(3)Problems: no suitable model;shortage of resources;separation of medical treatment,nursing,rehabilitation and long-term care resources;low social awareness;not attractive enough for elderly and social resources.(4)Impact factors of quality of care: atmosphere of respecting for the elderly;laws and regulations;publicity;supporting resources and thoughts.(5)Suggestions: improving laws and regulations;integrating resources;cultivating and attracting professionals;fostering long-term care market and guiding the change of thoughts.(3)1553 valid questionnaires were collected with effective recovery of 94.98%.Investigation revealed that,55.96% interviewees selected home-based care,29.49% selected combination of home-based care and community-based care.Gender,health condition,literacy,health-payment system,number of children,distance from children and monthly income were the impact factors.50.80% have taken advantage of community elderly service and of those 63.22% were very satisfied or satisfied with it.42.37% hoped for long-term service,41.08% required for emergency service and 16.55% wanted short-term service.The top three service types were health guidance(63.43%)?life care(53.77%)?dietary instruction(40.37%)?33.29% expressed the willingness of purchasing home-based service and health-payment system,of which monthly income and health condition were the impact factors.(4)Designing a feasible home-based care system suitable for Chongqing from the aspects of supplier,service contents,the way of supply and supporting measures.Government,social organizations,non-profit organizations and families are basic suppliers.The service contents should includ medical care,health management,daily care,entertainment,spiritual consolation,palliative care and funeral service.Taking "Internet +" as a way of supply,using Internet technology to provide a comprehensive,efficient,flexible and low-cost home-based care service.To make a series of mate safeguard measures starting with perfecting the relevant laws,regulations and supporting policies,integrating suppliers? resources and provides human resources.Conclusion(1)The experience of developed countries and the coastal areas of eastern China in home-based care can be used for reference.But the patterns and experiences of these countries and regions cannot be replicated directly due to the different economic level of Chongqing.(2)The problems existing in home-based care for aged in Chongqing urban community can be solved by improving laws and regulations,integrating resources,cultivating and attracting professionals,guiding the change of thoughts and fostering elderly care market.(3)The caring service for elderly is impacted by a number of factors which presents in multi-level and diversified.The most urgent need is to provide perfect health support.Socialization of home-based care service should be strengthened to the public.In order to attract more professionals,service content and the ways of supply should be optimized.(4)A home-based care system is established from the aspects of supplier,service contents,the way of supply and supporting measures.The study provides some policy-making suggestions for home-based care system of Chongqing urban community and a feasible framework suitable for Chongqing is also provided. |
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