Elderly care does not leave the "home" to open up the "last kilometer" of home-based elderly care services

"Old age care does not leave home" "service distance a bowl of soup"...... According to the survey, 90% of the elderly in China tend to care for the elderly at home, especially the active elderly and the disabled and semi-disabled elderly. In the face of huge inclusive and basic needs, home care services are also facing the embarrassment of lack of people, lack of funds and lack of standards. How to encourage and guide social forces and professional resources to extend and flow to the home? How to build a community home integrated service model and open up the "last mile" of home care services?

Difficulties: There is a big shortage of nursing talents for the elderly

"All the work at home is well done, and the attitude is enthusiastic. But outside of household chores, if you have some physical discomfort, the service staff can't handle it." For three years, Zhang Cuilan (a pseudonym), an 85-year-old living alone in Xiaodian District, Taiyuan, has always had regrets.

Zhang Cuilan's regret is also the reality of home care dilemma. The reporter learned that at present, most of the grass-roots home care services are not highly professional, and still prefer basic domestic service. Nursing staff's low education and professional level are insufficient, and the contradiction is prominent compared with the increasingly urgent demand for the combination of medical care and health care for the elderly.

Gao Huajun, executive director of the China Public Welfare Research Institute at Beijing Normal University, pointed out that disabled and mentally disabled elderly people need more sophisticated and professional long-term care, but neither family nor nannies can get it, which is a major challenge for the elderly.

"The pay is not good and I have to wait on people. I would rather find another job." I heard that the elderly care industry is developing rapidly and there is a shortage of high-quality nursing personnel, and Xiao Zheng, who wanted to engage in elderly care workers, finally gave up because of the gap between actual treatment and psychological expectations. It is understood that the current monthly income of most nurses is about three to four thousand yuan, and some are even lower. This kind of treatment on the market, not very attractive.

Low income, hard working conditions, heavy work content and lack of upward mobility are the main reasons why young people leave and highly educated professionals are reluctant to enter the old-age service circle. According to a report released by the China Institute of Public Welfare at Beijing Normal University, even according to the general standard of 1:3 completely disabled population care ratio, China's shortage of elderly care talents has reached 5 million. This has formed a huge constraint on the improvement of the overall level of home care services.

A senior citizen measures his blood pressure at the Jinyang Home Care Service Center in Caokan village, Luancheng Subdistrict, Luancheng City, Luancheng City, North China's Hebei province, June 2, 2021. Photo by Mu Yu, Xinhua News Agency

In this regard, Chen Yuzhuo, president of the pension Industry Committee of the China Asian Economic Development Association and vice president of the medical and nursing combination Professional Committee of the World Federation of Chinese Medicine Societies, suggested in an interview with the People's Daily Network reporter that the national level should increase subsidies for the training of relevant talents. Guide, promote and motivate from the aspects of vocational education, academic qualification recognition and social recognition.

"For the one-to-one service model of home care, there must be a large number of professionals and service personnel from institutions to families." As the person in charge of the elderly care institution, Ding Shaolei, CEO of Gold Nurse, told the People's Daily Network reporter that from the perspective of supply-side reform, professional service personnel such as nurses should be able to flow freely and invigorate talent resources.

Action is already under way in some places. For example, in the implementation plan for further promoting the development of the combination of medical and nursing care released by Beijing in May this year, a "quantitative" arrangement has been made for the training of elderly service talents: "From 2020 to 2022, at least 10,000 elderly care workers, 500 leaders of elderly service institutions and 500 elderly social workers will be trained every year."

At the same time, we will encourage and support medical personnel to practice in institutions that combine medical and nursing care. Classifying and evaluating the professional title promotion of health professionals engaged in home care for the elderly, emphasizing the evaluation orientation of professional ability and work performance, and weakening the mandatory requirements of papers and scientific research. Medical staff in institutions with integrated medical and nursing care enjoy the same treatment as other medical and health institutions such as professional title evaluation and continuing education for professional and technical personnel.

Medical care services are becoming more and more "home"

The elderly table of Baiziwan Home community retirement service station in Chaoyang is lined up as soon as the meal is ready. In order to solve the problem of "difficult to eat" for the elderly at home, this year, Beijing plans to develop 1,000 pension assistance meals in the retirement station, so that the elderly can eat high-quality and inexpensive "warm heart meals" at their doorstep.

"Here is close to home, seven or eight minutes can be reached, dining, entertainment, health monitoring and other services are available." In case of emergency, make a phone call, the staff can come to the door in three to five minutes." Gaofu (a pseudonym), a 76-year-old old man in Hexi District, Tianjin, has felt the convenience of retirement at home. In Hexi District, home-based care centers like this one, with a radiation radius of 15 minutes and 700 meters on foot, have covered many communities.

From the help meal to the quarter hour elderly care service circle, it can be seen that the connotation of home elderly care services is becoming more and more rich and the content is more and more solid.

Compared with the needs of meals, cultural entertainment and spiritual care, the combination of medical care and nursing has always been the most difficult breakthrough point to improve the quality of home-based elderly care. That, too, is changing. More and more elderly people who are semi-disabled or severely disabled have passed the assessment and obtained the qualification of government-subsidized family nursing beds, and have enjoyed the high-level and standardized care services of the institution at home. Some comprehensive insurance groups with elderly care characteristics make full use of their resource advantages, extend their services to the community and home, and open up green channels by setting up street care stations and other operation methods, docking medical resources to the elderly who need door-to-door service.

Intelligent management system was introduced in Xinhong Street, Minhang District, Shanghai. Lu Shengyu, 91, shows an emergency call device at his home. Photo by Wang Xiang/Xinhua News Agency

In addition, with the vigorous development of new technologies such as the Internet of Things, 5G, cloud computing, and artificial intelligence, home-based elderly care services have also caught the "wisdom express". "Wearing a smart bracelet on my hand, I can not only monitor my sleep, blood pressure, heart rate, blood oxygen and other health indicators at any time, but also two emergency call buttons, in case of emergencies, I can call the community staff at any time." Liu Dama, who lives in Wuchang District, Wuhan, said excitedly.

New technologies such as "one-click call", "Care treasure", "SOS" emergency callers, and infrared body-sensing equipment have been developed and transformed by aging technology, and have gradually become a "good helper" for the elderly at home. From emergency calls to full-time monitoring, the sense of security of home care has increased, and the timeliness and precision of home health care services has also improved.

To be continued: Future development exploration "on the road"

Home care for the elderly has carried out a lot of active and effective exploration in cracking the degree of professionalism, standardization and coverage. However, some issues concerning sustainable operating mechanisms still need to be further promoted.

For example, although the elderly assistance meal is cheap, many elderly people who have the need for food delivery can only "look at the meal and sigh." "It's not that I don't want to facilitate the elderly, it's just that I have the heart to be powerless." It is very difficult to cover the overhead without the cost. In addition to the lack of manpower, if you ask for a special delivery, the cost will be higher." Some people in charge of retirement stations to the People's Daily network reporter bluntly.

In order to crack the "last kilometer" of assisted meals, some areas in Beijing have begun to try the digitalization of assisted meals for the elderly, and the stations participating in the pilot have signed a contract with the delivery platform to screen suppliers such as restaurants that meet the standards within 3 kilometers around the station to provide "take-out" assisted meals for the elderly.

For another example, although the family elderly care beds that are currently being widely built around the country are popular, in order to encourage qualified and qualified institutions and organizations to fully participate in the construction of family elderly care beds, the current family elderly care beds basically rely on financial subsidies.

A relevant government official admitted that relying on financial subsidies is not a long-term solution, because it is a continuous investment, so it is necessary to slowly guide the elderly to consume and buy services. In the future, we can explore the market operation mechanism managed by professional institutions to form a healthy development model and benefit more elderly people.

In addition, many health stations still do not have the conditions to be equipped with full-time staff or to realize the service of doctors, but simply to measure blood pressure and blood sugar, and there is still a big gap between medical resources. There are also problems such as unbalanced distribution of industrial development, large product differences, inconsistent standards, and limited scale promotion.

However, it can be seen that in recent years, professional long-term care services have been provided to participants in the way of purchasing long-term care insurance, which has made up for the "short board" of social security for disabled people.

In order to improve the overall level of home care and solve the needs of more disabled elderly people for long-term care at home, the phased results achieved after the introduction of the long-term care insurance system are being expanded from the pilot. It not only reduces the burden of the family, but also significantly improves the quality of life of the elderly. In the pilot process, some cities have also begun to form diversified financing models such as medical insurance funds, finance, units and individuals, which will benefit more elderly people in the future.

As a basic old-age care model that is in line with China's national conditions and people's feelings, at present, the various paths it explores to expand service supply are based on solving the real pain points of home-based old-age care, and gradually show vitality and efficiency. With the gradual improvement of the supporting mechanism in the next step, the coordination and optimization of all resources, and the continuous participation of more social forces, it is believed that the elderly at home will experience more and more sense of gain and happiness.