居家失能老人长期护理服务需求的人力成本及影响因素研究

Labor cost of long-term nursing service for the community dwelling disabled elderly and its influencing factors

目的调查居家失能老人长期护理服务项目需求的比例、工时、护理员和护士的配置比情况,并探讨其影响因素。方法采取整群抽样的方法,抽取2018年7-12月居家失能老人1456名进行调查。采用一般人口学资料、护理服务项目需求清单调查了1456名居家失能老人,以当地医保局出台的项目频次和平均操作时间计算出所需工时。结果居家失能老人工时的总分为(171.21±31.62)min/(人·d),6个方面工时由高到低依次为营养摄取(64.68±10.65)min/(人·d)、清洁卫生(53.74±8.99)min/(人·d)、排泄(45.44±35.84)min/(人·d)、生命体征观察与护理(5.61±2.03)min/(人·d)、移动、舒适和安全(1.01±5.20)min/(人·d)及药物疗法(0.71±3.99)min/(人·d),前三方面占95.5%。A类护理员工时为(170.56±31.65)min/(人·d),占99.6%;B类专业护士工时为(0.65±0.22)min/(人·d)。重度失能老人在总工时、营养摄取、清洁卫生的工时显著高于轻中度失能老人。老人和A类护理员总体配比为1∶0.474,重度失能老人的护理员配比(1∶0.483)略高于轻中度(1∶0.425),B类专业护士配比在总体和不同失能群体差异不大(均为1∶0.002)。在重度失能老人中疾病数量越多需求工时越多。结论居家失能老人对对清洁卫生项目的需求比列均很高,在营养和排泄的大部分项目需求比例较高。其需求仍然以生活上的“养”为主,以专业操作的“护”为辅。如需满足需求,A类护理员最低配置比接近养老机构的辅助生活区配置,B类护士配置比远低于养老机构的独立生活区配置。今后需结合失能老人轻中重失能比例、考虑病情严重程度将工时调整系数,从而对长期护理保险进行合理的人员规划。

Objective To explore the working hours and influencing factors of the long-term care services for the community dwelling disabled elderly,and the allocation ratio of caregivers and nurses for the elder.Methods A total of 1456 community dwelling disabled elderly was investigated by using the general demographic data and the demand list of nursing service items,and the required working hours were calculated based on the frequency of items and the average operating time issued by the local medical insurance bureau.Results The total score of the disabled elderly at home was(171.21±31.62)min/(person·d),and the working hours of the 6 aspects from high to low were nutrition intake(64.68±10.65)min/(person·d),cleaning and sanitary(53.74±8.99)min/(person·d),excretion(45.44±35.84)min/(person·d),observation and care of vital signs(5.61±2.03)min/(person·d),mobile,comfortable,and safe(1.01±5.20)min/(person·d),and drug therapy(0.71±3.99)min/(person·d),respectively.The first three aspects accounted for 95.5%.The working hours of total aspect,nutrition intake,and cleaning and sanitary among severe disabled elderly were significantly higher than those of the mild and moderate disabled elderly.The working hours of class A nursing assistants was(170.56±31.65)min/(person·d),accounting for 99.6%,while the working hours of class B professional nurses was(0.65±0.22)min/(person·d).The ratio of the elder to class A nursing assistants in total sample was 1∶0.474,and the ratio of severe disabled elderly(1∶0.483)was slightly higher than that of the mild and moderate disabled(1∶0.425).The ratio of the elder to class B professional nurses was not significantly different in the general and different disability groups(both 1∶0.002).Among severely disabled elderly,the greater the number of diseases,the more care hours required.Conclusion The proportion of demand for cleaning and sanitation items for the disabled elderly at home is very high,and the proportion of demand for most items of nutrition and excretion is relatively high.Its demand is still to the life of the"raise"mainly,to the professional operation of"care"as a supplement.To meet the needs,the minimum allocation ratio of class A nursing assistants is close to that of the auxiliary living area of pension institutions,while the allocation ratio of class B professional nurses is much lower than that of the independent living area of pension institutions.In the future,it is necessary to combine the proportion of disabled elderly people with mild,medium,and severe disability,and adjust the working hour coefficient considering the severity of the illness,so as to carry out reasonable personnel planning for long-term care insurance.