| BackgroundBased on the definition of world health organization (WHO), an Aging society is when the elderly (more than65years old) population is more than7%of the total population; an aged society is when the elderly population is more than14%of the total.It takes decades or a millennium to become an aging society according to the data of developed countries. For instance, French115years, Swiss85years, Great Britain80years, while USA60year. However, it takes only18years (from1981to1999) for our country to reach aging society while the speed of aging population is constantly increasing.Take Shanghai for example; there are14.2693millions of census population as dated2012/12/31. The elderly population (65years and up) is2.4527million and is consist of17.2%of the total population. The population of whom is more than80years old is0.6703million, which consist of18.2%of the population who is more than60years old and4.7%of the total population. Those who is more than100years old is1251, while male is282and female is969There is a high demand for elderly hearth care system due to the great number of elderly. According to the6th population census of Shanghai, health and basically health elderly is consist of87.3%of the total. Not health but able to manage daily life independently is consist of9.0%of the population. Those who have deficiencies in activity and daily life consist of3.7%of the total elderly. Those who are more than80years old and have deficiencies in activity and daily living consist of13.1%of the total population. Ministry of Public Health announced the Basic Standard of Elderly Nursing Hospital (2011version) in March15,2011. The elderly nursing hospital is defined as "facilities that provide health care, rehabilitation, and hospice care service to Long-Term Bedridden patients, palliative care patients, chronic disease patients, deficiencies in activity and daily living patients, and other patients that require long-term nursing care. The investigation and study of Shanghai elderly nursing hospital can accurately reflect the current status and trend of elderly nursing, the current situation of the resources and utilization of elderly nursing hospital, and the development of elderly nursing hospital has a significant impact on the elderly patients.ObjectiveReferring to the basic standards formulated by the Ministry of Public Health(2011version), investigating the basic condition of elderly nursing hospital and the demand and willingness of the inpatients. Analyzing the demand and supply of the nursing system and use related experience and practical result from local and oversea as example and to provide the recommendation and suggestion for the elderly nursing hospital development strategy.Method1. Document study:Collect and study the document from local and oversea which regarding elderly nursing, nursing hospital, long-term care. Also study and collect government policy regarding elderly care, nursing care and nursing hospital.Searching information provided by the website of http://www.stats-sh.gov.cn/、 http://wsj.sh.gov.cn/、http://www.shrca.org.cn/. Searching the data related of elderly demography, health care service, nursing hospital and elderly health insurance policy.2. Survey:Survey is divided into two target group1) Nursing care hospitals:The study surveyed at least one nursing hospital in each district of Shanghai. Due to the vast number of population of Yangpu and Pudong District, the study surveyed3hospitals in Pudong and2hospitals in Yangpu district. And the survey covered the topic of a) basic information, b) departments and building and layout of hospital, c) human resource and salary, d) equipment, e) balance of payment of nursing hospital f) service efficiency.2) The demand and willingness of elderly nursing inpatient survey. Based on the income level and density of the nursing hospital of each district,10nursing hospitals is selected and randomly select100inpatients in each hospital. The survey covers the topic of a)inpatients’basic information, b) why choose nursing hospital, whether the inpatients will choose nursing hospital if they are in stable physical status, c) subsidies and willingness to accept home care nursing, d) other medical care needed that is not provided currently.ResultThere are76elderly nursing hospitals,57public and19private. It plays a role in reliving the demand of health care and nursing of the elderly to some extent. However, the study result shows that there are still some problem in the current Shanghai elderly nursing hospitals. Refer to the standard of elderly nursing hospital(2011version) and the demand of the patients. The problems are as follow.First, the distribution of nursing hospitals is not balanced. The number of hospital and its potential base of patients vary from one district to another. For Chongming、Huangpu、Xuhui、Hongkou、Yangpu and Jinshan District, each hospital needs to handle a larger elderly population. In comparison to the population in Fengxian、Qingpu、Pudong、Songjiang districts,each hospital face a lower average elderly population.Second, the hospitals don’t provide enough beds and the beds turnover rate are low. The average length of stay of inpatients in the21hospitals is193.4days. The average bed availability rate is104.2%. The average turnover rate of bed is lower than2times a year.Thirdly, the government financial subsidy for nursing hospitals is not enough. Some of the hospitals are running under heavy deficit. Based on only income and expense, only4out of21hospitals have a positive earning. The rest17hospitals all run under deficit.14of the21hospitals receive government subsidy. The loss of the hospitals will be ever great if excluding the subsidy.Fourth, the hospitals does not meet the requirement of basic standard of elderly nursing hospital (2011version). The standard set basic standard and requirement for elderly nursing including clinical medicine, medical technology, physical therapy, specialty, building, equipment and management. None of the surveyed hospital meets 100%of the requirement. For example, only28.6%of the hospitals set the hospice department, and the attached Accompanying family room, just one hospital established.Fifth, there is a huge difference between the medical staff on the professional skill and the quality of service. Also, the number of nurses and nursing aide is far from enough. There are not enough registered nurses, technicians and nutritionists. Based ratio of bed/nurse requirement stated in the standard, there is a shortage of407nurses and1498nursing aide.The patient’s survey shows that as follow, First, more than80%of the inpatients income is at average level with higher expense on hospital care, inpatients have heavy economic burden. Second, inpatients begin to rely on nursing hospital psychological, more than80%of the inpatients still choose to live in nursing hospital even if they are in stable physical status. Thirdly, high proportion of inpatient reimbursement of medical expenses, the grown up children have no time to take care of their parents, no medical conditions at home, do not know the correct nursing method are the main factors for the inpatients to choose nursing hospitals. Fourth, nearly50%of the inpatients think the hospital shall set up other specialties, nearly1/3of the inpatients think the hospital shall improve the quality of medical and nursing. Fifth, inpatients are not willing to be discharged, which is resulting in the saturated utilization of the hospital resources and the patients who really have requirements for professional nursing can not be admitted in.ConclusionThe aging population in Shanghai is growing rapidly. The nursing hospitals shall readjust and set up the clinical medicine, medical technology, physical therapy, specialty, building, equipment and management refer to the basic standards. To satisfy inpatient’s diversity and complexity by improving nursing hospital’s specialty. Shunting and separating the inpatients and establishing comprehensive rehabilitation care mode, while increasing the number and medical quality. Set the standards of level of nursing and standards for admission and discharge, increase the number of qualified heath care provider, hospice service and nutritionist specialist shall be provided, also the mental health of the elderly shall be highlighted and service to maintain the mental health shall be provided for the disable, serious chronic disease, and critical elderly patients. In order to enrich the function of elderly nursing hospital, government should provide subsidy for nursing hospitals with planed subsidy budget and formulate the elderly nursing care policy with all relevant government departments involved. |
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