| With the acceleration of population ageing and deeply aging,the number of disabled elderly people in China has increased sharply,from 33 million in 2010 to 40.63 million in 2016,and is expected to further increase to 61.68 million by 2030 and 2050 And 97.5 million people.The large-scale disabled elderly and the irreversibility of the risk of disability and dementia not only test the effectiveness and sustainability of the traditional family care model,but also put forward higher requirements for the construction of a long-term care service system for the elderly in China.Based on the era background of China’s population aging,family structure and function changes,and changes in the main body of social welfare production,through a review of a large number of domestic and foreign literature,it combines the theory of intergenerational exchange,group cooperation,and welfare triangle theory.The analysis framework provided,this article established the following theoretical analysis path:Starting from the logical starting point of whether there is no filial son in front of the chronic illness bed,that is,the empirical review of the "loss of family care function" described in the speculative study in the context of children caring for the disabled elderly.Immediately put forward the need to dialectically look at the relationship between "children are still the mainstay for disabled elders" and "children are unsustainable to care for the elderly" and"children use financial support to replace care services",and refine the methods that affect "care effectiveness" Change "factor.Further,changing the perspective from micro to macro,and analyzing the forms of public and market care services and their impact on child care is a typical path to promote the increase in the total number of care services.Although a series of empirical evidence shows that children’s care faces various practical difficulties,based on considerations of institutional inertia and cultural constraints,it is considered that instead of “ignoring and replacing the family care model”,it is not as good as "supporting the increased and enhanced family care model",and it needs to learn from this process.The advanced practices of the international community are prudently embedded in China’s relevant policies.Based on the above theoretical analysis,this article decided to use the Chinese elderly health tracking survey data(CLHLS)based on the selection of many databases,focusing on answering the following five questions,namely(1)the composition of the main body of the disabled elderly,the role of children and their changes trend?(2)What are the factors that affect the effectiveness of children’s caring for the elderly and their factors?(3)Does the relationship between children’s financial support for disabled elders and care provision work?(4)What impact has the development of the market and public care services had on child care?(5)What are the models of family caregiver support policies in typical countries and what are the implications for China?The research results show that: First,the analysis of dynamic data from 2005 to 2014 shows that 80% to 90% of disabled elderly people are cared for by family subjects such as children,spouse,daughter-in-law,son-in-law,grandchildren,etc.,showing a “family-oriented” trend.In the “family-oriented” trend of disabled elder care,70% to 75% of disabled elders rely on the daily care provided by the offspring consisting of sons,daughters,daughter-in-law and son-inlaw.Similar to foreign research,there is also a trend of “feminization” in the care of disabled elders in China.Secondly,although more than 80% to 90% of children show willing attitudes and behaviors in the process of caring for the disabled elderly,more and more(more than 20%)of children have become older as the elderly’s disability lengthens.In the process of care,negative emotions such as “unwillingness/impenitentness”,“inability to help”,and“helplessness” appear,which implies that the phenomenon of "no filial son in front of a sick bed" exists objectively.The care effect evaluation model taking the elderly’s care satisfaction,self-assessment health and self-care ability as core indicators shows that family endowment,intergenerational relationship,bargaining power,and health behavior and disease characteristics have a significant impact on children’s care effect,and There are some differences in the effects of caring for the children of the elderly with different individual characteristics.Third,the higher the children’s financial support for disabled elders,the lower the probability that disabled elders will be cared for by their children.For the disabled elderly who are cared for by their children,the greater the amount of financial support for their children,the longer it will take them to take care of them.The relationship between the financial support of disabled children and the care services is not a one-way or linear relationship,but a V-shaped relationship.Fourth,the more types of public care services available to disabled elders,the lower the probability that they will be cared for by their children,and the shorter the time it takes for them to take care of their disabled elders.Fifth,the promulgation of support policies for family caregivers in typical countries is in line with the concepts of “developmental social policy”,“multiple subject participation” and “optimization of welfare system efficiency”advocated in the context of global welfare governance.The family caregiver support policy provides some lessons.Based on the results of the above research,we believe that in the current strategy of China’s response to population ageing,in addition to continuing to strengthen the construction of oldage service systems and long-term care systems,this mode of family care has a strong institutional basis and institutional inertia.Give them strong support.Putting aside the indifference and laissez-faire approach to family care,the government should take advantage of the situation to recognize and affirm the role of family care,introduce a solid support policy,and embed it in the current series of policies.Specific directions and measures should include the following aspects:First,establish an elderly service system plan based on needs assessment.Through the use of scientific assessment tools to correctly distinguish the meaning and focus of elderly care services and long-term care services,a classified and accurate elderly service needs assessment system is established.Secondly,promote the trial of the long-term care insurance as soon as possible,and avoid the recurrence of dysentery of “trial and uncertainty”.Drawing on German experience,long-term care insurance should be included in the social insurance system as the“fifth pillar”.In the process,adhere to the general principles of centralization and decentralization of the country,basic universal inclusive benefits,and budget and cost control principles.Third,try to gradually establish a home caregiver support system.Family caregiver support policies and corresponding tools should be based on the overall institutional system of socialized elderly care services in the subdivided areas of community pension planning,government purchase of elderly care services,corporate care leave systems,and women’s workfamily balance promotion.Embed,connect with points,and then integrate into a systematic and institutionalized family support system.Finally,establish policy interventions for health promotion and disability prevention for the elderly.Reversing the current practice of“emphasizing treatment but not prevention” in the current medical and health service system,and focusing on health promotion and disability prevention for the elderly,are necessary measures for upstream intervention and prevention of “increment”.Corresponding approaches include focusing on the prevention and management of chronic diseases from the entire population,the entire life cycle,the provision of primary medical services,the development of healthy behaviors and the improvement of literacy. |
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