| China is currently confronted with anaging population.In Jiangsu,one of the first provinces entering the aging boom,the problem is particularly prominent.Family caring and institution endowment,although traditional,remain to be two main ways of supporting the elderly.Considering the declining health of the aged and the "empty nest"trend of family structure,however,family caring has been increasingly unable to meet the needs of the elderly.Institution endowment has more services,but it can play merely a supplementary role in aged-caredue tohigh cost,limited availabilityand senior citizens'refusion of nursing homes,etc.Home-based care,evolving from family caring and institution endowment,has been gradually accepted by the elderly as a new way to solve the aging problem.In 2003,Nanjing and Suzhou launched the first-batch demonstration projects of social home-based care services.Thereafter,the other cities of Jiangsu Province have also started their pilot services of home-based care.As compared with the economically developed parts in the south of Jiangsu Province,home care services in the north of this province are developing at a smaller rate.To date,home-based care services in different cities of Jiangsu Province differ in terms of model and mechanism.The present study dividesthe home care services in Jiangsu into two patterns,i.e.the one "organized by social institutions with government support" and the one "sponsored by government with social institutions' participation".The roles and functions of government and social organizations in the two models have some differences.The article discusses three aspects of home-based care based on the surveys conducted in the four cities of Jiangsu Province,Suzhou,Nanjing,Nantong,and Yancheng.Firstly,it introduces the two patterns and their typical practices.Secondly,senior citizens' needs of home-based care services,different needs of different economic development areas and different needs of home-based care patterns are empirically analyized.Finally,from the perspective of home care service satisfaction,the status quo of home care services and the effect of different home care patterns on the home care service satisfaction are assessed.Below are the major findings of this study.1)The empirical results of service needs of elderly people show that currently most senior citizens have great willingness to accept home-based care.The aged in the urban areas have more aspiration of home-based care than those in the rural areas.Elderly people in poorhealth conditions are more willing to choose home care services.The elderly in poorer economic conditions also prefer to choose home-based care.Significance difference is observed among the elderly in different economic development areas in their attitudes towards home care services.Compared to the southern and northern areas in Jiangsu,the elderly in the middle Jiangsu areas report higher willingness.Physical health,economic conditions and attitudes are found to be important factors influencing the selection of home-based care services.Economic levels and publicity for home care services in a certain area affect the needs and choices of older age groups there for home-based care services.2)The empirical analysis of old-age care satisfaction show that degree of old-age satisfaction with home-based care is relatively lower than that with the other two ways of supporting the elderly.Those selecting institution endowment havethe highest satisfaction.Higher satisfaction is found to be with home-based care services in rural areas than in urban areas.The elderly in better health condition are more satisfied with home-based care servicesthan those in poorer health.Meanwhile,the quality of home care services also affect old people's satisfaction,especially in on-call service timeliness,level of professionalism,and service attitude.3)The analysis of old people who have already received home care services show that most of them prefer the "social institution-organized and government-supported"service mode,and that several factors,including age,relationship with their children,health status,economic conditions,ideas about retirement,etc.,have impact on the aged choosing of the mode of home-based care.The analysis of old people's satisfaction with different modes of home-based care indicate that different satisfaction degrees are found between the two modes of home-based care services.The senior citizens have better satisfaction who choose the social institution-organized home-based care.For different home-based care modes,there are different factors affecting the satisfaction degrees.Inthe mode of social institution-organized home-based care,people with poor self-care ability have better satisfaction;while in the mode of government-sponsored care,the elderly in rural areas have better satisfaction than those in the urban areas,and satisfaction of the elderly increases as their health status decline.Home care quality in different modes is an equally important factor that affects the satisfaction degree.Timely service,higher level of specialization,better service attitude,and higher degree of service diversity mean higher satisfaction degree.The above results of this study reveal some policy implications.Based on the demands of the elderly,mode selection of home-based care must be adapted to local conditions.Better economic areas can choose the social institution-organized service mode,while poorer economic areas can give priority to the development of government-sponsored pattern firstly.But with the development of economy and home-based care,social institution-organized service mode would be the final choice.When one area practices home-based care,it must clarify the roles of government and social institutions in service and establish amulti-governing home-based care service system.By encouraging more social institutions to participate in the home-based care system and exerting the function of government itself,we can promote the sustainable development of home-based care,satisfy the diverse needs of the elderly for care service,and improve the living standards of the elderly after retirement.Currently,there is no universal criterion based on which to divide the modes of home-based care.Previous studies are confined to experience in typical areas,without comparing different cases from the perspective ofdemand or satisfaction.This study works out a criterion to divide home-based care into two patterns,which are "social institution-organized and government-supported"service mode and the "government-sponsored social institutions' participation" mode.Typical experience of each mody is introduced.In addition,this study,based on microscopic data,focuses on demand and satisfaction of the elderly.Therefore,the results are more objective and comprehensive than the results of macro-level researches.The results may provide a basis for different areas to select and develop a home-based care service pattern suitable to them. |
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