| Objective1.This research aims to investigate the health status,long-term care disability level,and care needs level of elderly people in nursing homes in Guangzhou,and explore the rationality and scientificity of the disability level classification method in the "Assessment Criteria for Long-term Care Disability Level(Trial)"(hereinafter referred to as the "Assessment Criteria(Trial)")and the care needs level classification method in the "Comprehensive Assessment Criteria for Elderly Care Needs in Guangzhou".2.This research also aims to use the research method of nursing intensity per minute to measure the nursing time of the elderly,analyze the current situation and influencing factors of nursing time in nursing homes,construct a decision tree model for nursing time,and divide the elderly into different levels of nursing care.This will provide reference for the construction of a hierarchical nursing system for the pilot cities of long-term care insurance.MethodsConvenience sampling was used to select elderly residents and caregivers from a five-star senior care facility in Guangzhou,China,as the subjects of the study from December 2021 to May 2022.General demographic information of the elderly was collected using a survey questionnaire,while the comprehensive physical and mental conditions of the elderly were assessed using the Long-term Care Disability Assessment Scale and Elderly Health Assessment Questionnaire.To evaluate the nursing workload,the Minutes-per-Care Intensity method was used,and the specific nursing services and time spent on each were observed and recorded using the Elderly Direct Care Service Project Workload Measurement Tool over a 24-hour period.Results1.Long-term care disability levels among the elderlyAmong the elderly,the disability level for long-term care is mostly at level 3(severe disability level I),with 166 cases(34.30%),followed by level 4(severe disability level II)with 64 cases(13.22%),level 5(severe disability level III)with 131cases(27.07%),level 2(moderate disability)with 64 cases(13.22%),level 1(mild disability)with 51 cases(10.54%),and level 0(fully able)with 8 cases(1.65%),respectively.2.Health status of the elderlyThe elderly had at least one health problem and up to 19 health problems,with an average of(6.34±2.99)health problems.The average number of geriatric syndromes for the elderly was(2.04±1.24),with the top three being chronic pain in 218 cases(45.04%),multiple medication use(taking five or more medications simultaneously)in187 cases(38.64%),and constipation in 167 cases(34.50%).The average number of diseases suffered by the elderly was(3.31±2.12),with the top three being heart/lung diseases in 336 cases(69.42%),neurological diseases in 282 cases(58.26%),and musculoskeletal diseases in 232 cases(47.93%).There were 90 elderly individuals who required special care,accounting for 18.60% of the total number.3.Grade of care needs for the elderlyThe level of elderly care needs is mostly at level 5,with 194 cases(40.08%),followed by level 4 with 155 cases(32.02%),level 3 with 66 cases(13.64%),level 2with 52 cases(10.74%),level 1 with 10 cases(2.07%),and level 0 with 7 cases(1.45%).4.Nursing service items and nursing time for the elderlyThe average daily care time for elderly individuals was 37.45(19.86,75.62)minutes.Among the basic life care items,the average care time for assisting with showering was the longest at 19.18(10.00,38.33)min/d,followed by bed care at 10.77(0.81,20.59)min/d,assistance with feeding and drinking at 6.04(0.98,21.12)min/d,outdoor activities at 4.02(1.78,7.50)min/d,and excretion care at 3.51(1.89,5.62)min/d.The average utilization rate of basic life care services for elderly individuals was70.15%,and the top five utilization rates were for the following items: installing handrails and bed rails as needed for room safety(94.21%),keeping the bed unit clean(90.08%),sleep care(89.26%),body cleaning with towels,washbasins,and toilets(82.64%),and assistance with mobility(78.10%).The average utilization rate for ondemand basic life care services for elderly individuals was 19.87%,and the top five utilization rates were for the following items: pressure ulcer prevention and care(57.64%),feeding(oral intake)assistance(56.20%),assistance with position changes and back patting(54.96%),incontinence care(51.45%),and care for bloating and constipation(50.41%).5.Analysis on influencing factors of nursing time of the elderlyNursing time was used as the dependent variable to compare the differences of nursing time among different group characteristics.Univariate analysis showed that the nursing time distribution of different levels of activities of daily living,cognitive ability,perception and communication ability,geriatric syndrome and disease conditions was not all the same,which were statistically significant(P < 0.001).The quantile regression analysis was conducted with the statistically significant variables in the univariate analysis as independent variables.The results showed that the ability of daily living was statistically significant between the low decimal point(10%)and the high decimal point(90%)of the nursing time(P < 0.01),and the influence intensity increased with the increase of quantile(for the quantile of 10%～90%,the standard regression coefficient changed from 4.504 to 25.309);Cognitive ability was statistically significant between low decimal point(20%)and high decimal point(80%)of the nursingtime(P < 0.01),and the influence intensity of the middle quantile was higher than that of the low quantile and the high quantile(for 20%-50% quantile,the standard regression coefficient changed from 4.321 to 11.445,for 50%-80% quantile,the standard regression coefficient changed from 11.445 to 8.608).Perception and communication ability only affect nursing time of the elderly at 10% decimal point(P< 0.001).Geriatric syndrome affects nursing time of the elderly only at 40%～50%decimal point(P < 0.05).Disease status had no effect on nursing time of the elderly at any decimal point.6.Analysis of nursing time decision tree model for the elderlyThe average excretory nursing time of the elderly was 3.51(1.89,5.62)min,and the average dietary nursing time was 6.04(0.98,21.12)min,the average mobile nursing time was 5.46(1.92,9.65)min,and the average cleaning care time was19.18(10.00,38.33)min.The explanatory power of decision tree model of excretion nursing time,diet nursing time,mobile nursing time and cleaning nursing time were 9.52%,32.25%,13.24%,19.54%,respectively.A total of 17 indicators were included in the nursing time decision tree model,including 3 first-level indicators and14 second-level indicators.The second-level indicators that were not included were go up and down stairs,bathing,and personal orientation.7.Analysis of the nursing classification for the elderlyThe standard nursing time of the elderly was the sum of the excretion nursing time,the diet nursing time,the mobile nursing time and the body cleaning nursing,which was6.37～91.87min/d.In the study,the nursing classification of the elderly was divided into4～6 nursing grades with 15 minutes as the interval between groups.The grade with the most nursing time in each nursing classification model was defined as the benefit qualification level of long care insurance,thus the number of recipients in the three nursing classification models accounted for 44.63%,33.06% and 25.83%,respectively,and the overall prediction accuracy of each model was 48.56%,40.37% and 34.23%,respectively.Conclusion1.The score ranges for the different dimensions of disability levels in the "Evaluation Criteria(Trial)" are inconsistent,leading to imprecise level assessments.The combination method for long-term care disability levels has not been verified by data modeling.The subjective nature of the assessment items for elderly health status in the "Guangzhou Elderly Care Needs Assessment Specification" suggests that relevant government departments should refine the assessment indicators and improve the classification method for long-term care disability levels.It is recommended to develop a composite evaluation tool for long-term care insurance that is suitable for China’s national conditions.2.The nursing services that are most commonly utilized by the elderly are in the areas of excretory care,dietary care,mobility care,and personal hygiene care.The utilization rate for psychological comfort and rehabilitation care is lower,and the coverage of care needs is relatively limited.Factors that influence elderly care time include daily living activities,cognitive ability,sensory perception and communication ability,and geriatric syndrome,which show different trends at different percentiles.The required nursing time is not proportional to the degree of disability.3.This study constructed a nursing time decision tree model based on disability assessment indicators,which clearly and intuitively shows the order of the effects of various factors on nursing time.The elderly care level is divided into 4-6 levels based on the value orientation of long-term care insurance policies,which avoids the shortcomings of fixed grouping tools that cannot be adjusted or expanded.This can provide a basis for pilot cities of long-term care insurance to adjust the proportion of beneficiaries in real-time based on local funding levels and insured population.The logical relationship rules between nursing time and disability assessment standards in the decision tree model can lay the foundation for the establishment of a large-scale database and the development of a window-based evaluation system for computer software in the next step. |
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