| [Purpose]Based on the rule of the disability status transition of the elderly in our country,this study established an assessment tool for the level of disability,and established the content and standard of care service according to the needs of different levels of disability.From the perspective of the three main bodies of the long-term care service system,the policy suggestions for improving the long-term care service were proposed so as to optimize the long-term care service system for disabled elderly.[Method](1)Through literature review,we reviewed the research on disability assessment at home and abroad,and initially established the theoretical basis of disability evaluation.By using the data of China Health and Retirement Longitudinal Study in 2011~2015,the present situation and characteristics of the disability of the elderly in China were analyzed by descriptive statistics.On this basis,the law of disability of the elderly in China was found through the survival analysis.Combined with the theory we studied to give the classification of disabled elderly.According to the result of Markov transfer matrix,we further found out the change rule of disability level of the elderly.(2)On the basis of literature review and Expert forum,we formulated the evaluation indicators for long-term care services for disabled elderly.By Delphy meathod,16 experts engaged in clinical nursing,medical insurance,medical service and other related fields were consulted.Through the two rounds of collection,feedback and modification of expert opinions,the index system for the long-term care needs of the disabled elderly was constructed.(3)A questionnaire survey was conducted on the nursing staff of public pension institutions and private pension institutions in Wuhan.The questionnaire design adopted the simulation scenario method to establish the corresponding service projects,time andfrequency of service scenarios under different levels of disability,so as to build long-term care for the elderly with different levels of disability.Service grade standard were compared with the actual care time in 2015.(4)Through the interview of key people,from the three perspectives of the supplier,the demand side and the manager,the qualitative analysis is used to find out the factors that may affect the long-term care service of the disabled elderly,and the improvement strategy of long-term care service is put forward.[Results](1)Through literature research,it is found that ADL and IADL are usually used for disability assessment at home and abroad,and IADL occurs before ADL.It is generally believed that IADL can be divided to cognitive impairment,which can be reflected by three items of general call,drug use and money management,followed by functional disorders,such as shopping,doing housework,laundry and so on.According to the data analysis of CHARLS in 2011~2015,the ADL disability of the elderly people in our country is in the order of toilet,bath,bed,clothes,control and stool.According to the order between the ADL and IADL,then the 5 disability grades were divided.Markov matrix found that the disability of grade one to grade three was most likely to recover.Grade four and grade five are more likely to deteriorate or die rather than to improve.(2)The evaluation index system included three primary indicators of daily living activities care,instrumental daily activities,and medical care,and 14 secondary indicators and 72 items and three indicators.(3)After sorting five energy levels from low to high,the corresponding daily requirements for nursing service equivalent were 5.12,27.62,50.80,100.35,118.81.The allocation coefficients of nurses were 0.10,0.43,1.04,2.06 and 2.44,respectively.There are differences in the time and frequency of service items under corresponding service levels.The average IADL incompetent elderly had the average time of care service more than the standard,and the average daily care service for the elderly with ADL disabilitywas lower than the standard time.(4)In the long-term care service systems,the demand side was mainly influenced by the state of physical function,followed by the characteristics of demographic and economics.In the supply side,the service level of the pension institutions was limited by the total amount of medical services and the lack of professional nursing staff;another,the professional identity,workload and economic income of the nurses had influence on the supply and quality of the service.For managers,long-term care insurance has an important impact on the fairness of service prices,quality and security services,and the coordination of different care models also affects service delivery.[Conclusions](1)The evaluation index system included three primary indicators of daily living activities care,instrumental daily activities,and medical care.At present,however,the need for instrumental life care is relatively inadequate,and social services are difficult to provide part of the project;the need for daily care increases with grades,but not all of them are transformed into needs;care services present the characteristics of combination of care and support,but medical care is still the biggest shortage.(2)Through the assessment of the disability level of the elderly,the difference between the service users can be accurately identified and the mechanism of long-term care insurance fund raising and payment also can be clarified.Then,linked up with standardized service levels and service specifications,nursing staff will be guided flexible and long-term care services be also standard.According to different service levels,we should rationally allocate care human resources and drive professional talents training.(3)Long-term care services should be closely related to the needs of life care and medical care.The policy of medical and nursing integration should be enlightened.Service levels should be changed dynamically adjusted to the disability level.We should improve the sense of recognition among nurses and promote the enthusiasm of nursing services. |
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