Medical-nursing Combined Community Care Service For The Elderly: The Status Quo,difficulties,and Ways Of Improvements

At present,with the increasing trend of population structure and weakening family caring function,aging boom has become an increasingly serious social problem.Compared with the institution-care,community home-based care costs less with higher economic and social benefits;and compared with the traditional family-care,community home-based care can provide more professiona l and more efficient services for the elderly.Therefore,community home-based care has been defined as the main way of old-age care.Community home-based care holds an important position,and many places have identified the development pattern for aged mode of “9073” or “9064”.However,the development of community service-oriented home care can't satisfy the demand of old people.In the process of providing the community home-based care services,the segmentation of policies,resources and carriers,which especially lead to the segmentation and fracture between medical resources and pension resources barely satisfy the needs of the aged for integrated medical care and pension services within the community.In the existing research,medical-nursing combined as a new research topic,and the relevant study of medical-nursing combined are still less.Moreover,existing few studies mainly focus on the organizational level,and only pay little attention to the research on the medical-nursing combined at the community level.This paper is based on the background,to analyze current situation,problems and countermeasures of developing medical-nursing combined community endowment mode in China.This paper uses the methods of typical case analysis and other specific methods,such as questionnaire survey,observation,and interview,to select city B as a typical case to describe and analyze the current development situation of community care and medical-nursing services for the aged,analyze the obstacles and deep reasons for medical-nursing combined care services,and put forward the future growth path of community care and medical-nursing services for the aged on this basis,including building the system framework and supporting protection mechanisms of medical-nursing combined community endowment services.Qualitative and quantitative research methods are both adopted in the paper,including methods of literature research,field study,questionnaire investigation and statistical analysis of data.In the aspect of method documents review analysis,both domestic and foreign documents have been read to provide theoretical basis and experience for the study.In the aspect of field investigation,we have interviewed the government staffs,community pension agency directors and staffs,community workers,Community health service center staffs,elders and other persons related to the medical-nursing combined community endowment services of C ity B.Through the interview,we try to observe the developing condition of typical medical-nursing combined community endowment services,analyze and summarize the obstacles encountered in the implementation of the medical-nursing combined community endowment services,and make deep analysis on the causes of the problems.Through questionnaire survey and statistical analysis,this paper further reflects the current situation of supply and demand for medical-nursing combined community endowment services of the elderly in City B.The study found that,medical-nursing combined community endowment services in china encountered the obstacles from the system,resources,management and cognitive level.At the institutional level,the development of medical-nursing combined community endowment services mainly faces lacking of top-level system design,obstacles to policy cohesion,and imperfect supporting protection policies and systems.Resource level mainly faces dilemmas in “persons,goods and materials”.At the management level,there are three main obstacles,which including low administrative efficiency caused by multiple governance,rejections from community to preventing occupying the resources,and the imperfection of supervision and assessment systems.At the cognitive level,it mainly refers to the cognitive limitations of staffs in grassroo ts governments,Community workers,the elders,and other subjects.To further analyzing the reasons for obstacles,this study views medical nursing combined community as a system,and uses the structural-functionalist paradigm of Parsons to analyze,which attributes the profound causes for the above dilemma to the reasons that,insufficient capacity of accessing resources,inaccurate target location,lower levels of consolidation,and dysfunctional latency pattern maintenance,and etc.Based on the above analysis,this study further puts forward the development path of medical-nursing combined community endowment services.We inclined to construct the system framework of medical-nursing combined community endowment services from four dimensions,including the idea,policy,operation and institution.At the same time,the supporting protection mechanisms should be established,including the support of legal policy,the guidance of publicity and education,the security of resource investment and the reform of administration institution.Finally,this study summarizes the research conclusions and prospects for future research directions.