从“机构化”到“家庭化”——美国护理院“文化变革运动”的评析与借鉴

From"Institutionalized"to"Homelike":Analysis on"Cultural Change Movement"in the United States

20世纪80年代,美国兴起了一场关于护理院的“文化变革运动”,在其影响下,护理院经历了从“机构化”向“家庭化”发展的演变。“文化变革运动”的“家庭化”理念表现在伦理价值观、机构管理、护理服务、环境设计四个方面,其形成的动因在于:代际间服务需求的变化、政府监管以及护理院的利益驱动。“家庭化”的理念与美国文化相契合,和福利机构“去机构化”发展相互补充,对美国护理院行业发展产生了深远影响,但也在新冠肺炎疫情中暴露出其缺陷。“文化变革运动”中的经验做法对中国失能老年人、残疾人的长期护理实践有着借鉴价值。

In the 1980s,there was a"cultural change movement"of nursing homes which happened in the United States.Under its influence,nursing homes have experienced the evolution from"institutionalized"to"homelike".The concept of"homelike"is summarized in four aspects:ethical values,management,service and environmental design.The motivation behind the development of nursing home from"institutionalized"to"homelike",is including the change of inter-generational demand for care services,government supervision and interest-driven in the market.The concept of"homelike"is compatible with American culture and complementary to"deinstitutionalization",which has an important impact on the development of nursing homes in the United States although its disadvantages are exposed in COVID-19.The experience of the movement brings inspirations for the practice in Chinese long-term care service.