Building a long-term care system for the elderly: Family responsibility, government leading social participation

To solve the problem of insufficient family support capacity, the government leads social participation

Xia Bing, the heroine of the TV series Hot Mom, has a mother-in-law suffering from Alzheimer's disease. On the one hand, the audience is distressed by the hard work of Xia Bing taking care of her mother-in-law, on the other hand, it is very sad to look at her mother-in-law who is seriously ill.

In traditional Chinese society, the care of the elderly is mainly undertaken by the family, and the family's responsibility to support the elderly is the first. However, with the influence of population policy and the intensification of cross-regional social mobility, the traditional pension and security system are encountering great challenges. According to the results of the fourth sample survey of the living conditions of urban and rural elderly in China, the proportion of empty nesters has reached 51.3%. Song Xinming, a professor at the Institute of Population Research at Peking University, said, "From the disabled and mentally handicapped elderly themselves, their care, medical care and rehabilitation require strong professional skills. The establishment of long-term care security system can not only reduce the burden on families, but also enable disabled and mentally retarded elderly people to get better care. In addition, it can not only improve the quality of life of disabled and mentally retarded elderly people, but also has great significance in the development of China's pension service system."

Wang Jianjun, executive deputy director of the National Office for Aging, pointed out that the establishment of a long-term care security system, to correctly deal with the "three relations", that is, the relationship between the government, society and the market, should encourage conditional local first try, on the basis of local practice and exploration, to establish a unified national long-term care security system.

"Building a long-term care security system requires the cooperation of all relevant government departments. Policy making, funding models, evaluation of service quality and supervision of service processes all need to be led by government departments." Chinese Academy of Social Sciences researcher Tang Jun told reporters.

13 Departments jointly issued the "Notice", which fully reflects the importance of the elderly care service industry, and also shows that all departments have a full understanding of the need to form a joint force to promote the long-term care security system.

There are already places to explore. For example, Shanghai, the earliest city in the country with an aging population and the deepest degree of aging. By the end of 2015, the city's registered elderly population of 60 years old and above reached 4.36 million, accounting for 30.2% of the city's registered population. At the end of 2016, a new elderly care institution - "Lujiazui Comprehensive Care Home for the Elderly" was established in the prime area of Pudong, Shanghai. The government provides community resources and social forces provide more efficient and professional elderly care services, which are well received by many elderly people.

Chen Yuebin, director of the elderly work Department of the Shanghai Municipal Civil Affairs Bureau, said in a recent interview with the media that Shanghai is trying to open up the elderly service market and build a diversified elderly service system. "The government mainly meets the basic elderly care services, including the" bottom "of the poor people; To provide elderly care services based on social forces; And let more enterprises "play the leading role" to provide market-oriented elderly care services."

Social forces that fill the gap in elderly care facilities and service teams usher in a new window

Compared with developed countries, China has entered the aging population in less than 20 years, during which time, social wealth accumulation time is short, per capita income is low, and there are still deficiencies in professional service team, reasonable and effective supply of facilities and fund raising, facing old age before rich and old before unprepared.

"China's disabled elderly have exceeded 40 million, 96% of whom are sick and need long-term care. According to the international general requirements, the ratio of disabled elderly and nursing staff is 2:1, but the domestic situation is about 10:1, a difference of 5 times. Even if the ratio of ordinary elderly care service personnel is 3:1, the national shortage of elderly care talents is more than 10 million." At the bi-weekly consultation forum of the National Committee of the Chinese People's Political Consultative Conference in October 2016, Su Hua, a member of the National Committee of the Chinese People's Political Consultative Conference, used a set of figures to show the urgency of strengthening the construction of professional personnel for elderly care services in China.

The lack of long-term care beds and the unreasonable pre-approval of elderly care institutions have also become the bottleneck for social forces to actively participate in the elderly care service industry.

The "Notice" proposes to break the bottleneck of the development of the elderly care service industry as soon as possible, stimulate the market vitality and the potential of private capital, promote social forces to gradually become the main body of the development of the elderly care service industry, and cultivate and build a number of branded, chain and large-scale elderly care service enterprises and social organizations. The move is said to open a new window for social forces to participate in the elderly care service industry.

According to the relevant provisions of the Notice, the government will have "release" and "management" of elderly care service enterprises and social organizations in the future. "Release" is to simplify the procedures of administrative examination and approval, real estate registration and other matters; "Management" refers to the handling of administrative illegal cases of elderly care institutions in strict accordance with legal authority and procedures, the information on administrative penalties made by elderly care service enterprises shall be publicized according to law, and a social evaluation mechanism shall be established.

According to the requirements of The State Council's "on fully opening up the elderly care service market to improve the quality of elderly care services", in 2020, the proportion of long-term care beds should reach more than 30%, and encourage the development of community nursing homes to meet the nearby care needs of disabled and mentally disabled elderly people.

Behind the gap in service teams and facilities for the elderly is the lack of funds. At present, the average disposable pension for the elderly in our country is generally between 1800-2000 yuan, and the cost of care for the handicapped and dementia is about 3500 yuan, according to Tang Wenxiang, member of the national Expert Committee on pension service Industry of the Ministry of Civil Affairs and chairman of Hunan Puqin Aging Industry Development Co., LTD. There is a difference between 1500 and 1700 yuan.

A trial of a long-term care insurance system was carried out to break the bottleneck of pension funds

In order to explore the establishment of a social insurance system that can raise funds through social mutual assistance and provide funds or service guarantees for basic living care and medical care closely related to basic living for disabled and mentally disabled elderly people, the Ministry of Human Resources and Social Security issued the Guiding Opinions on carrying out the Pilot Long-term Care Insurance System last year, and 15 cities including Shanghai, Guangzhou and Qingdao were included in the first batch of pilot cities.

Pilot projects have been launched in many places. In July 2016, Beijing Haidian District introduced the local measures of "home care disability care mutual insurance", of which the disability service standards, around the "eating, dressing, sleeping, toilet" 4 content, by a professional third-party agency will be the elderly disability degree to do four levels of division, corresponding to enjoy 900 to 1900 yuan of services.

Shanghai announced that from January 2017 in Xuhui, Putuo, Jinshan three districts to carry out the pilot, 60 years old and above enjoy the employee pension insurance retirees or residents pension insurance personnel, can voluntarily apply for the elderly care needs assessment. After the assessment of nursing needs of grade 2 to 6, the designated nursing service agencies can provide corresponding nursing services and reimburse nursing expenses according to regulations. During the pilot period, individuals and units will not pay for the time being, and the required funds will be transferred from the balance funds of medical insurance; After the city's pilot, long-term care insurance will be funded in accordance with the basic principles of the social insurance system.

In both the Beijing and Shanghai pilot schemes, an assessment of the disability or care needs of the elderly is mentioned. "There are people who are able to get out of bed and move around on their own, and there are people who may have lost the ability to move around freely and need 24-hour care. Chu Fuling, director of the China Social Security Research Center, suggested that the national unification of disability rating and nursing service rating standards should be realized as soon as possible.

"Long-term care insurance is mainly for disabled and semi-disabled people, but these elderly people are diverse and need different levels of care." Du Peng, director of the Organization Department of Renmin University of China and director of the Institute of Gerontology, believes that in order to implement the insurance, it is also necessary to subdivide the insurance and carry out targeted services and support projects.

In addition, Tang Wenxiang pointed out that the current pilot is to consider taking money from the financial and medical insurance, and then pay part of the individual to form a new insurance, such a practice may lead to excessive medical care, aggravate the tension of medical resources, overdraft the possibility of medical insurance funds. It is suggested that the pilot direction should be further diversified from the perspective of assisting some necessary medical care on the basis of basic life care.

From the experience of Japan, Germany and other countries, long-term care insurance exists as an independent social insurance, and generally establishes a payment mechanism jointly borne by the government, employers and individuals. For example, in Japan, where the aging population has reached 26%, long-term care insurance is funded equally by the government and individuals.