Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Building Long-Term Care Insurance System in China

The objective is to explore the foundation of the elderly long-term care insurance system in China, which is to face the problem resulted from aging of the population. Adopting the contrastive analysis to introduce briefly the long-term care insurance system in German, Japan and America for our learning. Therefore, China＇s long-term care insurance system could not totally indiscriminately imitate the mandatory long-term care insurance system in German and Japan, it also could not copy the business model of nursing insurance system in America. The conclusion is that long-term care insurance system in China should use the experience of developed countries based on the basic national conditions, doing some relative works, such as establishing policies and regulations, strengthening personnel training, and improving the market specification.

Research on the institutional design of the long-term care insurance in Shanghai

Shanghai went into the ranks of the aging society in 1979, as the first area which entered into the aging society in China. Along with the arrival of the ageing, the nursing problems of the old man and disabled elderly become the important factors which affect social development. The establishment of the legal system, System integration to realize resource optimal allocation, Division of multilevel optimization services provide new pattern can make it happen.

Analysis of the necessity of Shanghai＇s long-term care insurance

The aging population of Shanghai is China one of the most serious city, is also one of the cities of the aging problem is prominent. As a result, the city＇s endowment pressure also with aging and aging aggravate gradually increased, especially the old man nursing problems become the main problem in society. Study abroad to establish a long term care insurance comprehensive factors, considering the feasibility of the long-term care insurance in Shanghai, alleviate the pressure of the pension, the construction of a harmonious society.

Performance of Rural Municipalities After the 2015 Reformation of Long-Term Care Insurance in Japan

Worldwide,welfare is trending from a welfare state model to social participation to ensure the sustainability of health care systems.Japan,where the aging rate will reach 40%by 2060,reformed public Long-Term Care Insurance(LTCI)on a large scale in 2015 and started the Comprehensive Service project(CS project),which emphasizes the prevention of long-term care through social participation in the community.Through this project,communities work to develop prevention efforts revolving around the community salon/caféand mutual support,including all daily tasks that previously were the purview of family members.Each municipality has an obligation to promote a CS project through new community development initiatives among community members.The purpose of this study is to investigate the CS projects performed by rural municipalities and to explore the important factors for their success.The authors used a case study methodology and constant comprehensive methodology for analyzing interview data to pull out the elements of successful initiatives.The study shows that the following factors influence success:recognition of demographic risk,recognition of the ineffectiveness of LTCI services,developing a passionate philosophy and strategy as a municipality,developing community members’initiative,and having many assets and full participation in the community.These factors imply that community development is a critical part of any successful CS project.

Research on the development mode of long-term nursing insurance ——taking Qingdao as an example

With the gradual development of society, scientific and technological progress, aging gradually aggravated, has become a hot topic of society. People to old age, self-care ability than in the past, not only suffer from disease, life has become difficult, coupled with the large number of empty nest family, the cost of care is also very high, whether it is to receive home care or professional institutions of care have great difficulties. Therefore, the community should be a large number of people with long-term care needs of the appropriate economic compensation, in this context, long-term care insurance is born. As a leading city in Shandong Province, Qingdao has introduced long-term care insurance and achieved good results. This paper analyzes the practical problems faced by Qingdao, that is, the development background of Qingdao long-term nursing insurance model, obtains the deficiency of Qingdao long-term nursing insurance, and then puts forward the corresponding countermeasures, and then ponders how to choose the long-term nursing insurance model of our country＇s future development.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Long-term care policy simulation of disabled elderly

With the accelerating process of population aging in our country, the physical function of the elderly will decline, the possibility of suffering from acute and chronic diseases will increase, and the occurrence of disability will become more common and normal. The potential demand for elderly care is rapidly increasing. With the growth, the care of the disabled elderly has become increasingly acute. At the same time, due to the intensification of family miniaturization and population migration, the traditional family-based long-term care has been difficult to sustain. How to incorporate long-term care into our social security system as soon as possible has become the focus of the whole society. The thesis through the combination of public policy simulation methods and the research data, the long-term care insurance system implemented at the beginning of 2018 in Shanghai is a policy blueprint. It uses statistical software SPSS, MATLAB, etc. to achieve data collation, analysis and prediction, and at the same time integrates the pilot of the long-term care insurance system. The implementation of policies in cities such as Qingdao and Nantong has been simulated. Finally, on the basis of simulation results, suggestions have been made for the future development of China＇s long-term care insurance system.

日本介护保险制度建设经验对我国的启示

随着失能老年人规模的扩大和传统家庭护理功能的弱化,我国迫切需要建立长期护理保险制度来分散失能风险,满足失能老年人的护理需要。然而对49个试点地区的政策进行分析后发现,我国长期护理保险制度在参保对象、筹资渠道、待遇给付、失能评估标准上均存在不足。日本通过有效设计及运行介护保险制度,满足了大量失能老年人的护理需要,可作为有益借鉴。为此提出以下建议:参保对象应该覆盖全民,包括城乡居民和年轻人;采取多元、独立筹资渠道,强调个人缴费责任;将失智和高风险人群纳入给付范围,树立事前预防保障理念;鼓励多方力量采取全国统一的失能评估量表开展评估工作。

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

中日农村医疗保险制度比较研究

纵向比较分析中日两国农村医疗保险制度的发展历程,从覆盖范围、筹资方式、补偿方式、资金收支情况等方面横向比较中日两国的农村医疗保险制度,探讨中日两国农村医疗保险制度的优缺点,为我国完善新型农村合作医疗制度提供相关建议。

日本介护保险对我国长期护理保险的启示

从较完善的法律、广泛覆盖的社会保险、多元化的筹资模式、科学的介护程序等方面总结日本介护保险的先进经验,并提出长期护理保险和商业长期护理保险共同发展、重视护理保险人才建设、提供多元化服务等相关建议,构建符合中国国情的老年护理保障体系,促进我国长期护理保险的发展。

Correlations between Motor Ability with Gait Speed and Cognitive Functions in Rehabilitation Users

Purpose: To compare and examine motor and cognitive functions in people who require support, and in healthy elders. Method: The variables of age, BMI, educational background, blood pressure, grip strength, knee extension, gait speed, MMSE, and subjective health feeling for 36 rehabilitation users and 22 healthy elders were assessed. We compared and examined motor and cognitive functions in rehabilitation users who need support and healthy elders. Results: The percentage of MMSE scores with 27 points or higher and that of subjective health feeling with 3 points or higher were significantly higher in healthy elders than in rehabilitation users. Systolic and diastolic blood pressure were significantly higher in rehabilitation users than in healthy elders. Gait speed and MMSE scores were significantly higher in healthy elders than rehabilitation users. Conclusion: Gait speed could be used for physical fitness in elders. Gait speed was the best physical fitness measurement for elders. Gait speed of rehabilitation users was strongly related to MMSE scores. Gait speed could be a determinant of MMSE scores.

日本介护保险经办服务管理研究

日本介护保险制度可持续发展的关键是实现了政府指导与市场运营的有效结合,经办各方职责明确,经办机构高度独立,经办程序严谨,管理系统、规范,各方信息共享,运营高效,确保了优质、便捷、可信的长期护理保险服务。针对我国长期护理保险试点中存在的经办服务管理短板,建议借鉴日本介护保险制度的发展经验,理清思路,积极推进委托独立的第三方开展经办业务,明确经办路径;加强长期护理保险经办服务专业化建设,提升经办能力;加快信息化建设步伐,重视利用信息化平台建设推进经办服务的质量及效率的提升。

日本看护援助专业人员对我国养老顾问制度的经验与启示

“介护支援专业人员”是日本的法定职业,“介护”即为“看护”、“支援”意为“援助”,因此中文可译为“看护援助专业人员”,这一职位在介护行业具有重要地位。与我国养老顾问制度相比,二者在促进养老服务的供需对接、整合零散的养老服务资源并为老年人提供建议的功能方面有共通之处,但日本这一制度创始时间更早、发展更为规范和完善,对我国养老顾问制度具有一定的借鉴意义。本文先描述日本介护支援专业人员制度的做法,再分析上海三个行政区养老顾问的焦点小组访谈资料,通过比较介护支援专业人员的实践经验,提出鼓励多元主体参与建设专职养老顾问队伍,完善培训体系,建立准入机制、规范评价标准,落实岗位补贴、赋能晋升评优,深化有温度的人民城市等本土化服务理念的参考建议。

日本介护保险财源建构模式的最新研究及启示

日本是亚洲首个提出建立介护保险制度的国家,在财源建构模式上积累了丰富经验,其通过颁布《介护保险法》,对筹资对象、筹资比例、各级政府筹资功能及权限分配等内容予以规范,明确国家、各级地方政府应尽责任。在筹资机制方面,采取税收与保险混合制度,建立财源多元筹措模式,避免形成严重的国家财政负担。在给付机制方面,面对无可避免的财政挑战和困境,日本介护保险制度将给付对象限缩到介护需求程度较高的高龄者。在财源可持续方面,日本介护保险制度通过移转支付制度使财源建构更具针对性与灵活性,专设财政安定化基金及市町村相互财政安定化事业保证介护保险制度稳定运行。自2016年试点至今,我国长期护理保险制度处于改革和立法的关键时期。日本介护保险制度的财源建构模式,对我国长期护理保险立法提供了有益的参考。

中国养老福利市场化改革的反思——基于与日本护理保险改革为对照的分析

文章采用统计资料分析的方法,以日本护理保险市场化改革为例,探讨中国现阶段是否可以推行养老福利市场化改革,并尝试性地提出关于中国养老福利制度改革的建议:中国养老福利制度应以政府为主体,发挥国家作用;可以适当引入政府购买福利机制;发挥老年群体的积极效用和增加人力资本的投资;加大财政补贴的稳定性和公平性。

日本介护保险制度对浙江省养老事业的启示

由于医疗水平提高等原因,近年来,浙江省的老龄化进程不断加快。随之也暴露出诸多难题,如倒金字塔型的家庭结构带来的新挑战,生活不能自理老人的护理等问题。日本作为世界上老龄化最严重的国家,介护保险制度是一种成熟的社会养老服务体系。针对浙江省人口老龄化现状,结合日本介护保险制度,具体分析在未来人口老龄化危机的大环境下日本成功的养老经验对浙江省养老事业的启示。

日本社会养老机构的设置及发展趋势

日本高龄者照护设施制度体系根据社会经济状况以及人口结构的变动转变而来。照护保险制度设立前,属于依据行政措施入住的时期,可以分为限定接收低收入者的养老院及养老设施时期,以及不论收入多少都应接受照护的特别养护老人院时期。照护保险制度设立后,过渡到契约时期,被认定给付保险的对象进入不同的照护保险设施接受服务。