Research On Current Status And Demands Of Home Based Long Term Care To The Frail Elders In Jinan City

BackgroundSince China entered the aging society in 1999, the aging population has become a trend of the social development. Due to the huge population, the aging of China presents some characteristics such as a large number, a fast rate of growth and getting old before getting rich. This rapid aging not only leads to the huge number of elders, but also presents the aspects of server aging and old aging, accompanied with the rapid growth of the frail elders. Since their self-care abilities are declined because of the physiological or psychological function disability, these frail elders need help in daily life, including medical, nursing, rehabilitating and the other care. China is not so rich to cope with the aging society, and the need of long term care is a huge challenge to the family and the society.According to the experience of developed country and area, the resolution is to develop the long term care insurance and establish a integrated long term care system including home, community, facilities and nursing home. Compared with the expensive cost of the nursing home and the influence of the China’s traditional culture, the elders are more willing to get care at home. The home based long term care will be the most important part of the long term care system. Not same with the family care in the past which is only depended on the family members, home based long term care is a new pattern that including the community, the facilities, the families and the other organizations. Although China has not yet established the long-term care insurance, but in recent years, many area have made some improvements and attempts at home care policies and services. Based on these backgrounds, to investigate the current status and demands of home based long tern care to the frail elders through research is very important to establish and improve the long term care system in China.At present, some scholars have carried out some research on the home care services to the frail elders, but there are some limitations in the content, research view and methods. Most subjects of the research are only elders, short of the research from the view of the family caregivers. There is no research about the influence factors of caregiver’s ability, demands and burden. In the research of demands assessment, the demands for life care and medical care are usually evaluated respectively and also do not assessment the family caregiver’s demands. Since we do not get the whole, assessment, the conclusion is one-sided and can not as a guide to the practice.Based on this, this research will focus on the status and demands assessment of home based long term care to the frail elders in urban area, from the integrated view of frail elders and their family caregivers and provide some guide for improving China’s long-term care system.ObjectivesThe goals of this research is to understand the status and demands assessment of home based long term care to the frail elders in urban area, from the integrated view of frail elders and their family caregivers. Using qualitative and quantitative research methods to analyze the gap between the demands and supplies. Specific aims of the research are:1. To investigate the status of the health, disability and live of the frail elders;2. To investigate the statues of family caregiver’s ability and burden and to analyze the influence factors.3. To determine the content and items of home based long term care services should cover in Jinan City.4. To analyze the demands of the frail elders and their family caregivers. To analyze the influence factors and the gap between the demands and supplies.5. Provide suggestions to the policy makers about improving the long term care systems based on the analyze the status and demands.Study DesignDocument analysis and depth interview were conducted to collect qualitative materials, while questionnaire survey were carried out for quantitative study and experts consultation were used to define the items of the home based long term care. To understand the statues and the problems of the home base care by depth interview. The objects of the depth interview are 29, including the frail elders and their family caregivers, community workers, community health service center workers and the managers of the day care center. To investigate the characteristics of the frail elders and their family caregivers, health and disabilities, demands of care by questionnaire survey. Based on multistage sampling method, get 1058 frail elders and their family members in 19 community in Jinan.22 experts were investigated to determine the items should cover by home based long term care system using Delphi consultation. Statistical analysis methods included descriptive analysis, exploratory factor analysis, logistic regression model, PLS path models and decision tree model, using statistical analysis software of SPSS18.0 and Smatrpls3.0.Outcomes1.The statues of the frail eldersThe average age of frail elders is 78.41 and the ration of widowed is 48.8%. The level of education is low and mainly are primary school. The ration of aged and widowed is higher in the female frail elders. The health status is poor and 85.8% of the frail elders have two or above kinds of chronic illness. The disability of function is server and 49.9%of the frail elders are moderate disabled at BADL,45.2% frail elders are completely disabled at IADL. Logistic regression shows that the marriage, the number of children live in same city, pension, self health, BADL and IADL are influence factors to the living arrangement.2. The statues of the family caregiverThe average age of the caregiver is 59.13, mostly are female and the many of them are frail elder’s wife and daughter. The average care time is 7.84 hours per day and the lasting time is 8.25 on the average. The score index of the caregiver’s ability is 77.9%. In the three dimension, the ability of psychological care is the best and the ability of illness care is the lowest. The caregiver burden is server,57.9% of the them are at moderate degree. PLS path model shows that the frail elder’s health and disability statues, care time, support system, the caregiver’s ability have direct effect on the caregiver burden and there are many indirect effect in the factors.3. The demands of the home based long term care24 items were determined by the Delphi consultation. These items can be divided in three categories as daily care, instructing and supporting, medical services. The frail elders have demands on every category. The highest demands in daily care are housework, delivery food and day care center. In the items of instructing and supporting, the highest need are physical examination and family visiting. In the items of medical care, the highest demands are Intravenous injection, assisted defecation and Subcutaneous/intramuscular injection.4. The factors influence demandsThere are many factors related to the demands of care. Different categories and different items have different impact factors of demands. For example, the decision tree model of delivery foods has three level and 13 nodes,7 leaf nodes corresponding with 7 rules of classification. The impact factors includes whether the caregiver is at work, whether has an aid caregiver, whether is an empty-nest family, the disabled level of frail elders and the age of caregiver. Each need has its own rules of classification, so the whole assessment to the frail elders and their family caregivers are important.Conclusions and Recommendations(1)The health status of the frail elders is poor and the disabled level is high. Most caregivers are the frail elder’s wife and daughter. The care time is long and the burden is server. (2) The caregiver burden is influenced by the elder’s health status, disabled level, the caregiver’s ability, the care time and support system. Each factor has direct and indirect effect on caregiver burden. (3) The frail elders and their family caregivers has many kinds of demands on home care services and these demands are impacted by the characteristics of the elder and caregiver.(4) The supply of the social services is short and can not meet the demands of the elder and caregiver.Suggestion:(1) To develop the standard of evaluation which can give a whole assessment to the frail elders and their family caregivers. (2)Give more social service to the families having frail elders which can shorten the care time and relieve the caregivers burden.(3) Develop policies and rules of giving medical services in home by the community health service center.(4)Improving the manage pattern, establish the long term care service center in the community and give an integrated services.(5)Develop the long term care insurance and improve the long term care service system.Innovations and LimitationsWe conducted a comprehensive and systematic study on the current status and demands of home based long term care to the frail elders, from the integrated view of elders and their family caregivers. The outcome will give some help to the study in the future and give some suggestions to the policy makers about improving long term care system.1. Form the point of research design, we treated the frail elders and their family caregivers as a whole and investigate their status and demands. The analysis of the gap between the demands and supplies is helpful to improving he social service and long term care system.2. From the point of research methods, we used the PLS path model to analyze the impact factors of caregivers burden that can cope with the non normality and collinearity data. Besides this, the decision tree model was used to analyze the home care demands of the frail elders and caregivers, which is a good attempt for the data mining in the future.3. From the point of research content and outcome, this research including the living arrangements, caregiver’s ability, caregiver’s burden, which enlarge the content of home care research. Besides this, the research also revealed the influence of the disabled levels, health status, demographic factors of elders and the characteristics of caregivers on home care demands. The analysis of the direct and indirect effect on caregiver’s burden give new proof to improving the long term care system.The limitations of the research including:1. Only the qualitative analysis was made to the supply of the social service of home based care which can not revealed the problem deeply. We hope to make a quantitative analysis in the future.2.The sample is only from 4 area of Jinan, maybe can not representing the whole problems. We hope to making much investigation in more area and finding the difference between them.