Family elderly care support policy system: a comprehensive construction for both the supply and demand of family care services

In general, the construction of home care friendly family support policy should be started from three aspects: first, to create a good social environment for family care; The second is to improve the family support policy for the needy; The third is to establish family support policies for family care providers.

(1) Create a good social environment for family elderly care

"The foundation of the world is in the country, and the foundation of the country is at home." The family is the basic cell of society and the first residence for the aged. Home care for the elderly is the common wish of the vast majority of the elderly, and the elderly service provided by the family with "family temperature" such as life care, spiritual comfort, and affection is difficult to replace any other way of providing for the elderly. Therefore, creating a good social environment for family care is an important part of building a home-care friendly family support policy system.

Praise and respect relatives, filial piety and other traditional virtues.  Family and everything, family happiness, respect for the old and love the young, good wife and mother, husband and children, diligent and thrifty, etc., all reflect this concept of the Chinese people." [4] To praise and respect the traditional virtues such as filial piety and filial piety for the elderly, one is to raise the care for the elderly from the moral level to the national policy level, and create a good policy environment for family elderly care. Guide the whole society to positively view the aging society, the elderly and the elderly life, [5] actively carry forward the Chinese traditional virtues and thoughts of gratitude, which are "kindness and filial piety first", "supporting relatives", "respecting relatives" and "sending relatives", and respecting and caring for the elderly; To carry forward the promotion of filial piety for the elderly into the core values of socialist propaganda and education, sublimate it into the social morality of "respecting the elderly" and implement it into professional ethics and personal morality, and build a culture of filial piety for the elderly with national characteristics and characteristics of The Times; We will carry out extensive public education on the national conditions of the aging population, strengthen public education on the preparation for old-age care throughout the life cycle, strengthen cultural education for young people to respect the elderly, love the elderly and help the elderly, and guide people to consciously assume family responsibilities, establish good family customs, and promote harmony between the young and the old.

The second is to carry forward and reform the culture of filial piety, and create a good cultural atmosphere for family pension. On the one hand, the culture of filial piety should be promoted and the family should be encouraged to become the main body of the elderly care, and the culture of filial piety, which was originally the source of the family care for the elderly theory, should be upgraded from a family ethic of "caring for the elderly" to a social ethic of "caring for the elderly", so as to provide cultural support for the supply of socialized elderly care services, promote the coordination of family care for the elderly and socialized elderly care services, and jointly solve the dilemma of home care for the elderly. On the other hand, in combination with the spirit of The Times, the traditional filial piety culture should be creatively consolidated and innovated, the rights and opportunities of the young generation and the old generation in the family should be well coordinated, and the intergenerational relationship should be reasonably adjusted. In the specific handling of intergenerational relations, it is necessary to emphasize that children's "filial piety" and parents' "love" complement each other to achieve proportionate rights and obligations; It emphasizes that children's "filial piety" to their parents should come from love and be fully self-conscious and self-disciplined. It emphasizes on grasping the changes of The Times in the needs of the elderly in modern society, paying attention to keeping the body and mind healthy, and paying attention to letting the elderly obtain spiritual comfort; It emphasizes the balance between the rights and interests of different generations of family members, and focuses on each other at different times to achieve mutual benefit and sharing within the family. [6]

The third is to protect the legitimate rights and interests of the elderly in accordance with the law, and create a good atmosphere for the rule of law for family pension. To commend and respect traditional virtues such as filial piety and filial piety, we must implement the Law on the protection of the rights and interests of the elderly, implement preferential treatment policies for the elderly, implement elderly care services, improve the elderly guardianship system, safeguard the legitimate rights and interests of the elderly, and combat elder abuse in accordance with the law, so that the elderly can share the fruits of reform and development and enjoy their old age in peace and happiness.

We will improve the home environment to accommodate aging. If the traditional virtues such as praising and respecting relatives and filial piety are to create a good "soft environment" for the elderly, then the aging transformation of the home environment is to create a good "hard environment" for them. The suitability of the home environment for aging is of great importance, which is related to the life safety and physical health of the elderly, and has an important impact on better playing the basic role of family pension. From the existing practice at home and abroad, the aging adaptation of home environment has been proved to be an important way to improve the quality of home life of the elderly. Some aging transformation measures, such as installing handrails in the bathroom, non-slip treatment on the indoor floor, and installing emergency callers for the elderly, can provide great convenience for the elderly's home life. At present, the phenomenon of "old people living in old houses" and "housing not suitable for old people" is prominent in China, and it is imperative to transform the home environment of the elderly to adapt to aging. Previously, China only implemented the home environment modification for the elderly, disabled and disabled elderly families who were included in the special poor and registered poor people, and the overall benefit was relatively narrow, and the initiative of family members was not fully mobilized. In recent years, China has issued a number of policy documents on age-appropriate renovation, and the top-level design of age-appropriate renovation of the home environment has gradually become clear. At the same time, various localities have successively introduced detailed programs to accelerate their inclusion in people's livelihood practical projects, and the aging transformation of the home environment is entering the "extensive practice period" from the "pilot exploration period".

In the future, to promote the renovation of the home environment suitable for aging, it is necessary to focus on the residential environment, public space, inner space, construction equipment and facilities, start from the physiological, psychological and behavioral characteristics of the elderly, take different life scenes as traction, target at different types of elderly people and their differentiated daily life needs, in accordance with the principle of "basic guarantee" and "voluntary choice". Based on professional experience, the professional team determines the specific renovation matters, provides the corresponding design options for the elderly, proposes a more practical, targeted and personalized aging renovation plan for the home environment, avoids "one size fits all", and truly creates a comfortable, safe and suitable home for the elderly.

(2) Improve family support policies for those in need of family care for the elderly

In practice, family care for the needy - the family support policy expected by the elderly at home mainly includes three aspects: economic support, service support, and technical support:

Financial support. When the elderly live at home, they need a stable source of economic support, whether they get basic living security or accept socialized elderly care services. At present, with the full coverage of the basic old-age insurance system for urban and rural residents, the elderly can receive a monthly pension of varying amounts in addition to their own savings and other sources of income. However, due to the large size of the elderly population aged 80 and above and the high proportion of elderly women, China not only needs to consider the issue of extending the pension payment time, but also needs to consider how to better protect the basic life of these elderly groups, and implement economic support for the elderly from the institutional level to ensure that their living standards will not be reduced. To reduce the burden of family pension. [7]

To be specific, a collaborative mechanism between old-age security and social assistance should be established to provide reliable old-age security for the elderly, especially low-income elderly groups. First, we will develop a multi-tiered and multi-pillar pension insurance system. [8] Learn from international experience, establish a three-pillar model consisting of national basic annuity, occupational annuity and personal savings pension insurance, and gradually increase the proportion of the second pillar. Specifically, it is to break the current situation that the basic pension insurance system is separate, and carry out the national basic pension reform for the pension insurance system of government organs and public institutions, the basic pension insurance system of enterprise employees and the basic pension insurance system of urban and rural residents. Relying on national tax contributions, we will establish a national basic annuity that covers all citizens, guarantees the basic and has a unified level across the country, implement pay-as-you-go, and realize the unification and coordination of various basic pension insurance systems in basic pensions, reflecting inclusive fairness and limited government liability. On this basis, establish a multi-level structure of the pension insurance system, implement the occupational annuity system for several different groups of people, and vigorously develop the personal savings pension insurance. In the path of realization, individual accounts and pooling accounts in the current basic endowment insurance system can be completely separated, and the pooling account can be developed into a pay-as-you-go national basic annuity, with funds mainly coming from enterprises (units) to pay taxes and implement national pooling; The personal accounts will be transformed into occupational annuity accounts, and the universal implementation of occupational annuity system will be promoted. Second, according to the situation of aging population, the necessary parameters of the pension insurance should be reformed, and a moderate level of pension replacement rate should be designed and maintained to provide adequate economic security for the elderly. To adapt to the incentive flexible retirement policy, it is necessary to embed a treatment adjustment mechanism in the basic pension scheme, and deduct part of the pension for those who retire before the delayed statutory retirement age (except for those who can retire early according to the law), and increase part of the pension for those who delay retirement. Third, establish a minimum pension system and other low-income elderly income protection mechanism, improve the old age allowance system, increase the pension benefits of low-income retirees and elderly people, and effectively reduce the risk of poverty among the elderly. The fourth is to establish a long-term care insurance system as soon as possible to provide a reliable source of funds for the elderly at home to receive socialized professional care services, so as to avoid the elderly from being unable to enjoy necessary care services due to the low level of pension. Fifth, establish a social assistance system for the elderly to provide living subsidies and nursing subsidies for low-income, disabled and semi-disabled elderly groups, and provide a practical and effective safety net for their basic living security.

Service support. For the elderly who choose home care, in addition to providing economic support, we should also provide life care, housekeeping services, health maintenance, psychological support and other services in combination with the actual needs of the elderly. Generally speaking, as the elderly age, the need for daily life care is increasing. However, some empty-nest, left-behind, elderly and disabled elderly people in urban and rural areas generally lack daily life care, and their attention to production is far more than their attention to their own food, clothing, housing and transportation. With regard to life care and support, on the one hand, residents' (village) people's committees should give full play to their advantages of being rooted in the front line and familiar with the situation, and do a good job of information search, regular visits, key help, and urging their children to fulfill their maintenance obligations, especially the timely detection and dynamic grasp of empty nests, left-behind, elderly, and disabled elderly people. On the other hand, by linking social organizations, social workers, volunteers and other resources to actively participate through policy guarantees, financial support, improved services, incentives and commendations, the establishment of urban and rural empty-nest, left-behind, elderly, disabled elderly home community visit system, improve regular visit measures, and provide some life care services for the elderly at home. At the same time, for the elderly with the ability to take care of themselves, they also need to rely on medical service institutions, elderly care service institutions, professional nursing service institutions to carry out skills training to improve their self-care ability.

With the increase of age, the ability of the elderly to do necessary housework such as daily cleaning, tidying up, washing and cooking is decreasing day by day. Accordingly, the demand for social housekeeping services is also increasing day by day. In terms of domestic service support, the community should be used as a platform to integrate various service resources in the region, provide affordable domestic service for ordinary elderly people at home, and provide obligatory or low-paid cleaning, meal assistance and other services for urban and rural empty nest, left-behind, elderly and disabled elderly people.

Health maintenance support is also one of the core contents of family support for the elderly, its purpose is to improve the quality of life of the elderly, reduce the diseases caused by aging, and enable chronic diseases to be treated and rehabilitated, in order to extend the time of social participation of the elderly. According to the different health status of the elderly, the emphasis of health maintenance support is also different: for the healthy elderly, the emphasis is on providing health promotion, disease prevention and other aspects of service support; For the elderly with chronic diseases, the community should establish health records, focusing on the provision of chronic disease management services support; For the elderly who are recovering from illness and need home rehabilitation, door-to-door rehabilitation services should be provided; For elderly people with partial functional disabilities who need long-term care at home, the focus is on providing long-term rehabilitation and medical care services.

Some empty nest, left-behind, elderly, disabled elderly people, due to the lack of family affection, monotonous communication, poor culture, etc., resulting in loneliness, loss, anxiety, psychological pressure. At the same time, the marriage problem of the elderly has also begun to appear, and some rural left-behind elderly people will even appear pessimistic and suicidal feelings. Therefore, family support for the aged should also include psychological support. In terms of psychological support, it relies on community and administrative village medical service institutions or other professional social organizations to carry out targeted psychological counseling and treatment services for the elderly at home, relieve their psychological pressure, and improve their physical and mental health.

Technical support. In the family support for the elderly, the support from the technical aspect is an important content. Scientific and technological innovation has great potential: with the help of nursing care, living assistance, functional compensation and other aspects of the elderly assistive technology products, to provide intelligent technology compensation for the functional degradation of the elderly, assist and replace human care, and enhance the social participation of the elderly group with technological innovation; With the help of mobile Internet, big data, wearable, cloud computing and other new generation of information technology, we provide high-tech intelligent old-age care technology equipment for the elderly at home, such as smart wristbands, one-button pager, fall detection, first aid rope, vital signs monitoring, etc., and connect them with medical centers and children's mobile phones to provide comprehensive technical support for the elderly at home. Develop information health services for the elderly led by active health technology (such as intelligent integrated management of chronic diseases, remote intelligent combination of medical care, etc.), build a continuous health maintenance and intervention system based on evidence-based medicine, and serve the disease prevention, functional improvement and healthy life extension of the elderly at home.

It should be pointed out that while promoting the deep integration of digital technology and elderly care services and empowering home-based elderly care, it is also necessary to consider how to help the elderly fill the "digital divide", cross the "digital trap", and create a digital ecology that is friendly to the elderly. On the one hand, it is necessary to take the needs of the elderly as the starting point and the experience of the elderly as the starting point, strengthen technological innovation, develop more intelligent products and services for the elderly, and promote the effective promotion and application of smart technology. At the same time, more "age-appropriate" transformation is carried out when product technology is iterated and upgraded, which not only pursues the "advanced nature of technology" but also does not forget the "friendliness of operation", and integrates intelligent technology into the daily life of home care for the elderly and constantly optimizes the details. On the other hand, the application platform is encouraged to create a special module for the elderly mobile phone, and some fraud information and virus software are blocked out by setting filtering, reminding and other functions. Guide mobile phone manufacturers to launch a family guardian model, so that family members can remotely delete junk messages, end fraudulent payments, etc.

(3) Establish family support policies for family care providers

Due to the high cost of socialized elderly care services and the uneven distribution between urban and rural areas, not all elderly people have access to institutional care, and the family is still the most important place to care for the elderly in China. In fact, family members are also the best caregivers for the elderly. Based on the nurturing responsibility and gratitude mentality, family members can provide the most meticulous long-term care for the elderly. However, due to the characteristics of long-term care for the elderly, such as long time, high pressure, high difficulty, and many demands, if family members engage in this work independently for a long time without necessary external support, it is easy to lead to problems such as excessive mental pressure, excessive health load, and economic inability of family caregivers. Therefore, family caregivers themselves also need "care" and support from the society in order to facilitate the capacity building and sustainable development of family elderly care, including: