Elderly's Home Care Services In Shanghai Metropolitan

BackgroundAs the world comes to an aging era,elderly's health has become one of the hottest issues.The main health problem which elderly are facing is low self-management caused by the senility of the body function and chronic diseases. Long term care is the best way to slove the problem.Home care is an important long term care form in China which refers to the service basing on community given by governments or social organizations to elderly aging in place.It includes living care,domestic service,rehabilitation care and spiritual comfort.It is considered by the government as the basic socialized care for reasons that 1) it is cost-effective,2) it is favored by the elderly,3) it is recommended by a lot of countries in the world.Shanghai is the first city in China stepping into aging society and also has the country's highest aging rate which is 20.8%at the end of 2007.With these characteristics and its flourishing ecomomy,Shanghai is one of the pioneers in China's home care developing.The three inner metropolitan districts - Jing'an,Luwan and Huangpu have the city's highest aging and old aging rate.Besides,existing caring institutions in these areas can not meet the growing demand because of the expensive housing pricing, elderly will be forced to choose between going suburb's institution or "aging in place" when they need caring.All those make home care more important in this area.AimThis study aims at describing home care's current status in Shanghai Metropolitan,analyzing the relationship between its supply and demand,figuring out the problems existing and their solutions,and discussing its implications to policy making.MethodsThree study methods were used in the research process,which are:1.Literature review.Literature about demographic statistics,policies and laws were collected to learn the aging status and home care policies and laws.2.Questionnaire survey.248 elderly aged 60 and above of three inner metropolitan districts in Shanghai(Huangpu,Luwan and Jing'an) were surveyed about their demographic,socio-economic,health,and self-management status and demand for home care basing on a typical sampling method.3.Key informant interview.Officials of Shanghai Civil Affairs Bureau,home care service direction centers and home care stations,gerontologists and some elderly were interviewed to explore policy-making background,exsisting problems of home care and their solutions.ResultsShanghai has built its home care system which is conducted by the government and operated by non-profit organizations since 2000.In financing,the government covers the organization and operation expenses for home care service direction centers and home care stations.In organization,home care workers consisting of laid off workers and rural migrants provide the service,home care stations are responsible for the service organization and home care service direction centers for management and supervision.In rembuirsment,part of the care recivers is subsidied by the government while the other part self-paid.There are 18 home care stations with 2,935 home care workers serving 21,252 elderly in metropolitan area.Elderly's home care demand rate is 25.8%which is relatively high in China.Whether elderly need home care or not is positively correlated with their financial,chronic disease and self-management status while negatively correlated with the service price.The supply is unable to meet the demand in a long period.For example,in 2015,there will be 309,000 elderly who have the demand but can not get the service.Besides,there are still other problems exsisting in the metropolitan home care system.Low service level,care providing segregated by different administrative divisions,no connection with other health care systems and some district governments' financing responsibility executing uncompletely.To solve these problems,the government can establish long term care insurance,encourage the private sectors' particatipation in the health care providing,organize the mutual care between generations,set up professional standards for home care workers and home care station charging standard basing on the care providing level and quality,build up referral system among elderly's health care organizations and institute specific financial account for home care financing.C onclusionShanghai has established the home care sytem which has contributed a lot to elderly's health maintanence.However,more things need to be done to fulfill the elderly's need better.The government should keep on leading the conducting role in the process.Additionally,it should induce new service providers and search for new cooperation partners to improve the service.