ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响

目的探讨ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响。方法将2023年1—6月绵阳市4家县级敬老院的养老护理员作为研究对象,采用便利抽样法抽取其中两家的40名养老护理员作为观察组,另外两家的40名养老护理员作为对照组。对照组采用常规培训模式,观察组则在对照组基础上以ICARE理念为指引实施养老护理员培训。干预前后,对两组失能照护能力、职业精神与态度进行评价。结果干预前,两组失能照护能力、职业精神与态度比较差异无统计学意义。干预后,两组失能照护能力、职业精神与态度比较差异有统计学意义,观察组优于对照组。结论融入ICARE理念的养老护理员培训能提高养老护理员失能照护能力,转变其职业态度,有利于养老护理队伍整体水平提升。

农村老年失能照护筹资侧改革:框架、评估与改进方向

农村老年失能照护是我国养老问题的关键挑战之一,失能照护筹资体系建设是回应我国农村老年失能照护风险的关键内容。我国农村老年失能照护筹资体系包含正式、非正式两类筹资途径,主体包含家庭、村集体/互助组织、社会、政府、市场等,筹资形式分为直接筹资和间接筹资(服务替代)两类。我国农村老年失能照护筹资体系呈现多元发展趋势,一些新型筹资方式涌现,兜底保障筹资较为充分。但是,该体系也面临整体筹资能力不足、来源不畅,以及传统照护筹资边界蜷缩、新型照护筹资发展不足等问题。应更新观念、改进认知,基于农村老年失能照护筹资体系发展现状,将体系性、规范性、有序性、整合性、兜底性、发展性、增能性、引导性作为我国农村老年失能照护筹资体系改革和优化的根本方向。

人口负增长背景下的失能照护保障:逻辑机理与治理路径

人口发展有其内生规律与联动效应,出生率、死亡率的动态演变引起人口规模阶段性或长期性转变,联动年龄结构由扩张走向收缩,推动失能照护的阶梯型发展,其中,人口负增长是经济社会发展到一定阶段,无大量人口迁入、死亡率低位稳定、持续处于更替生育水平以下等因素的综合结果,并通过“环境逻辑、供需逻辑、主体逻辑”三大机理持续影响失能照护保障。我国长寿化与少子化趋势的长期交织,驱动人口负增长这一拐点正式显现,呈现“不可逆的长期性、复杂的内生性、趋势的渐进性、影响的系统性”四大特征,进而从筹资侧的“总体+家庭+保险+财政”与服务侧的“总体+家庭+市场+互助”两大机制对失能照护保障发展提出新的挑战。而相关国际经验、事实判断表明,人口负增长之下我国失能照护保障的发展,在理念层面应做好前瞻设计与系统方案,在制度层面应尽快推动长期护理保险落地,建立政府、家庭、社会多元主体共担机制,以及稳定服务、资金等关键要素保障。

中国市域老年失能照护机构发展及其供需适配性

老年失能照护是人口负增长时代的巨大挑战。文章结合多学科研究方法,刻画了老年失能分级照护机构的空间格局及密度差异,并揭示了其供需适配性的形成机制。研究发现:(1)中国老年失能照护机构数量总体呈现以北京、上海、广州为高值中心的分布格局,且高值区随照护分级的提升而逐渐收缩。(2)老年失能照护机构密度在不同区位、等级和规模的城市类型中有所差异,东部城市、直辖市和超大城市在所有失能分级下的发展优势均十分突出。(3)中国老年失能照护机构供需适配水平的空间分化迹象明显,总体表现为“东部繁荣、西部发展、中部塌陷”,且随着照护分级的提高,适配区向东部地区与省会城市集中。(4)供需适配格局受多种因素的共同影响,社会经济、支付能力和人口结构为空间分异的主导因子,其中人口结构与社会服务、医疗资源与交通条件的因子交互解释力最强。(5)各因素的影响效力存在区域差异,未来中国老年失能照护建设应充分考虑地区失能人口规模及结构特点,提供差别化的资源增补以弥合发展差异、实现社会公平。

孝道与生计:农村失能老人子女照护需求、照护冲突与调适

在人口快速老龄化的背景下,农村的养老照护问题显得十分突出。子女照护是农村失能老人照护的重要方式。农村失能老年人的经济状况和健康状况较差,意味着较大的照护需求和照护压力。子女照护失能老人是孝道的重要体现,大多数农村子女具有较强的照护意愿。在现实中,由于诸多原因,面临着孝道与生计的冲突,主要包括经济冲突、时间冲突、技能冲突、情绪冲突、支援冲突。平衡孝道与生计的总体思路:孝道为基、生计并举、社会支持、福利多元。具体对策:加强子女照护的经济支持,完善照护设施,加强照护技能培训,加强社会支持,发展社会化养老服务,建立长期护理保险制度。

长期护理保险需求与服务水平研究进展

长期护理保险服务建设是有效确保我国失能老人照护需求得以满足的关键举措,也是近年来的研究热点之一。本文以分类视角综述了长期护理保险服务过程中的需求理论、研究思路选择的量性—质性分野、国内外课题研究现状及发展趋势,并总结了相关成果的服务实践开展思路及结论共性,以期推动长期护理保险服务需求领域研究进一步发展。

长护险制度的实践与思考

伴随人口老龄化日益严峻,失能和半失能人员比例增多,失能人员由配偶、子女或亲属照护造成的“一人失能、全家失衡”状况成为家庭、政府和社会面临的共同挑战,建立长期护理保险制度应对人口老龄化的一项重大制度安排。本文在概述样本城市长期护理保险制度设计框架的基础上,重点论述其艰辛探索和实施过程,以及对一些重点和关键难题的破解方法。经过几年发展,其长期护理保险制度拉动了养老服务供给端的劳动力配置需求,带动了养老照护服务产业链的形成,同时也推动公立医院转型、盘活相关中小微企业,形成城市新的经济增长点,增强群众的幸福感和获得感。

Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Quality indicators for the care of older adults with disabilities in longterm care facilities based on Maslow’s hierarchy of needs

Purpose:This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities(LTCFs)based on Maslow’s hierarchy of needs.Methods:The draft of the quality indicators was drawn up based on a literature review and research group discussion.The quality indicators were finalized by two rounds of expert consultation(involving 15 experts)using the Delphi method.The Analytic Hierarchy Process was applied to calculate the indicators’weight.Results:The response rates of the two rounds of consultation were 100%and 93%,and the expert authority coefficients were 0.86 and 0.87.After two rounds of consultation,the expert opinion coordination coefficients of the first-,second-and third-level indicators were 0.42,0.25,and 0.96,respectively(P<0.05),and the variation coefficient was0.25.The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level,19 second-level,and 107 third-level indicators.Conclusion:The quality indicators for the care of older adults with disabilities in LTCFs are reliable,scientific,comprehensive,and practical and specify the content of person-centered care needs.This can provide a reference for evaluating and improving care quality in LTCFs.