The Demand And Supply Of Elderly Care In Shanghai

BackgroundNowdays, aging is one of the most important social issues in the world. Shanghai is the first city that enters into the aging society in China and now steps into rapid development period of aging.There are four characteristics of aging in Shanghai, the first is the huge population base of the elderly, the second is rapid development of the population, the third is the big number of elder elderly, and the fourth is more and more families only composed with the old people, espacialy the elderly living alone. According to the forecast from Shanghai Population Department, the population of the elderly in Shanghai will keep increasing until 2030.As well as aging is a kind of signal of Shanghai economy and medical care improvement, it brings the more cost of medical care, the more pressure of social security, and so on. The most important challenge is the care for the elderly. More and more incapable elderly needs care services. Traditional function of home care by family members is weaken, while social services are more needed. The cost of care puts big burden on the old persons and their families. It is predicted that the number of the elderly will achieve a peak from 2020 to 2030.Based on the experiences from the developed countries, most of governments dominate to set up long-term care systems, and transit the family responsibility of home care to social responsibility step by step. Observing the status of Shanghai, the aging has already reached the level of developed counties, kinds of social problems caused by aging has already been raised. With the development of social and economy, it is necessary and possible of Shanghai to study how to set up the long term care system for the elderly according to the experiences of developed countriesPurpose This study tried to present a counter measure for the aging and the long term care in Shanghai by analyzing and considering the actual status of demands and services systems in order to find a path of setting up a long term care system of Shanghai itself.MethodsThree study methods were used in the research process including:1. Literature review. Literatures of long term care, home care and community care and documents of demographic statistics, policies and laws were collected to analyze the aging status and policy background.2. Questionnaire survey. There were 2 parts of survey. One was the survey of care services demands.1270 elderly aged 60 and above from four communities (subdistrict or town) in Shanghai were surveyed about their demographic, economic, health, and self-management status and demands for care services based on a typical sampling method. The other was designed for the supply status of care.24 units of hospitals, nursing homes and community care organizations in the four communities were surveyed on capital, economic, employee and management information.3. Key informant interview. Officials of Shanghai Human Resource and Social Security Bureau, Shanghai Civil Affairs Bureau, Shanghai Health Bureau, home care service direction centers and home care stations, gerontologists and some elderly were interviewed to explore policy-making background, actual problems of home care and their solutions.ResultsUnder the endeavor of Shanghai government, many kinds of care for the elderly were useful to meet the care needs. But, there is still a big gap between the demand and supply of the services.There were main factors on care services problems for the old people from the analysis. One was the care costs was heavy for the elderly which accounted for 12.7% among the old persons whose incomes was around RMB1000 per month, even lower, 34.5% among those whose incomes was RMB1500 or lower,79.9% whose incomes was RMB2000 or lower. And the average spending by out-of-pocket was RMB1208 for the investigated persons. The second was it was lack of the standard on care demands of the elderly. Becuase there was no reasonable classification on the care demands, and there was no clear function limit between medical care and home care, the services resources would not be utilized efficiently. The third was that the composition of care services organizations was not balance. The beds of hospitals and nursing homes were full of old people in metropolitan, at the same time the usage of the beds was very low in the countryside. It was always found some hospitals and nursing homes reduced the beds even shutout by facing the morass of running. The fourth was the management of care service need make progress. The issues of long term staying at hospitals, family beds usage, policy support for home care stations and care services quality, need more considerations and better arrangements.ConclusionIt is predicted that the rapid development of aging would cause serious economic and social problems on medical treatment and long term care, which will be a big challenge for Shanghai social security system. It is suggested that the government would consider to integrate current resources to make the care services plan, set up long term care system, develop the manpower of services, build the standard of needs, and try to meet the demands of the elderly.