长期护理保险居家护理项目的伦理基础与制度保障

Ethical Foundations and Institutional Safeguards in Long-term Care Insurance Home Care Projects

长期护理保险居家护理项目包括家庭照护类和上门护理类,以孝道文化和尊老敬老文化为伦理基础。各地试点政策均对居家护理项目进行了规定。但家庭照护类项目中参保人家属在确定非正式护理人员和维系家庭照护质量中承受着伦理压力,上门护理类项目中上门护理员在维系护理质量和上门护理市场中承受着伦理压力。制度解决相关伦理问题,应允许参保老年人自由选择现金或服务支付,推进家政行业建设,对家庭照护质量维系提供支持,并建立统一的居家上门护理质量标准和考核制度,建立针对养老服务机构上门护理的惩罚和退出制度。

Long-term care insurance home care programs include family home care and institutional home care,based on a culture of filial piety and the cultural tradition of respecting and assisting the elderly.Pilot policies in various regions have implemented relevant regulations for home care projects.However,in the family home care project,family members of the insured bear ethical pressure in determining unprofessional caregivers and maintaining the quality of family care.In the institutional home care project,caregivers face ethical pressure in maintaining care quality and competing in the home care market.To address relevant ethical issues,the system should allow insured elderly people to freely choose between cash payment and physical payment for services,promote the construction of the domestic care industry,provide support for maintaining the quality of home care,and establish a unified quality standard and assessment system for home care,implement penalties and exit system for home care in elderly care service institutions.