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Speech On the research status and the research conclusions Distinguished experts, teachers: Good morning!I am Zhang Cuicui from Department of Public Administration ,Nanjing College for Population Program Management, currently leads the practice of 2011 college students in Jiangsu province innovation training project of senior home group moderator.I`m honored today to share our group`s harvest with you.Our task is to investigate city community home-based care services model`s present situation, problems and sustainable development investigation and study, for this task we conducted a year-long survey research and social practice.Following I will represent our task group to report our investigation Research background information the degree of aging and the problems In 2011 the State Council iued the“ China aging development” Twelfth Five-Year Plan “ which points out,” Twelfth Five-Year Plan“ period, with the first arrival of the peak growing elderly population, the population aging proce will be accelerated further, the problem of aging population is becoming more and more serious, the aging proce and the nuclear family, empty nest is accompanied, and economy in the period of social transition contradiction interweaves, social security and pension service demand will increase quickly.In 2011April, IMF(International Monetary Fund)published to countries and regions in the world per capita GDP newest data shows that though our country`s GDP maintains moderately faster growth rate in gro, but the per capita GDP is only $4382, far behind the United States, Australia, Holland, Britain and Japan and other countries., accompanied by the state and pension fund run behind one's expenses, our country population advance rapidly aging problem is serious and people aged more than 65 years taking the proportion of the total population has increased from 7% to14%, most developed countries with more than 45 years time, China only 27years to complete the course, which belongs to the aging speed of the soon, the pension problem and economic development is not harmonious problem severity among countries.In spite of the great achievements China's social security work has labored, b there is still a big problem, facing a lot of difficulties.Social work preure, the basic old-age insurance fund gap is huge, pension expenditure, medical insurance expenditure expands, which also caused the proportion of retirees and workers, social security” consumers“ and” producer“ ratio change, increase on-the-job worker contribution burden.Large senior groups` nursing, medical, social services and other aspects of the demand for social security will bring enormous preure.In addition, the medical insurance system faces serious challenges, after 20years of medical insurance system reform in our country, the town has initially established the basic framework of overall medical insurance.However, medical insurance coverage is low, the medical service price confusion, the low proportion of government investment is the fact that hasn`t changed.Social welfare coverage grows, which has layed increasingly heavy preure on the system, lack of effective interface between, the grim situation can`t be ignore.Family support for the senior has been considered to be the eastern traditional pension mode, with filial culture as the core of the supporting and respecting the old and has been praised as is the traditional virtues of the Chinese nation.Admittedly, in the natural economy of providing for oneself, as well as in our present from the family support to social transition stage, Xiao Yin culture and family endowment has played an important role.However, with the development of economy, especially the industrialized, city is changed, family that provides for the senior is bound by the impact, and the modernization of production are aociated with the establishment of a social security system.The aging of society serious, the city`s accelerating changing speed and the increasing of floating population, not only brings the senior social security cost increase in the number, also caused the traditional family size and the change of family structure, family structure was gradually dismantled, family pension mode is lack of power, but the traditional culture and to win support among the people, nursing homes and other nursing institutions, seniors preferred for the familiar person and environment, more inclined to accept social services at home.In this case, whether the pension institutions or family, the traditional mode has to be broken.The above four points, is summed up to show our country`s per capita GDP is insufficient, the social security system is not all-round, strength and insufficient coverage of pension mode transition, case, do not become ”senile“ state preparation, into the” old“ state, the situation and the battlefield found bullet enough, pocket on the examination room found the book didn't read is the same reason.The current old-age home mode, the international community has become a widely respected pension system.Our country`s home-based care services research started in the nineteen eighties.The development of old-age service is the inevitable result of the trend of population aging, aging population old-age service is a social cause, which needs government, community, non-profit organization and other multivariate main body`s participation and construction, has gradually been the extensive consensus of social all circles, in recent years with the pension demand increase, government to improve the people's livelihood and promoting social harmony requirements, home-based care services to get the attention of social all circles and carry out, but the old-age population expansion, to China's old-age security brought hitherto unknown challenge, urgent need for home-based care services to carry out further research practice and innovation, maintaining its sustainable development.Two methods of investigation Research mainly includes two aspects, one is the Jiangsu provincial city, Nanjing, and other cities” home-based care services“ for the senior were obtained through a survey questionnaire, reliable data;two is the in-depth study of street, government and other institutions in home-based care services in primary practice, investigation of various measures of the concrete implementation situation, understanding in the actual operation proce initiatives, including the old-age home status, satisfaction, group differences, the difficulties encountered and the sustainability of the investigation.The investigation into the questionnaires and interviews of two parts, Questionnaire survey in Nanjing Xuanwu District, Jiangning District, Qinhuai District, area within the city limits of the object of investigation for the Nanjing household registered 201for the senior, the aging distribution is from 60 to 92 years old.Interviews as long as in Jiangsu province Nanjing City, Suzhou City, Wuxi City, Changzhou City, Zhenjiang city service system for the aged in the workers were surveyed, respondents specifically responsible for home-based care services of community workers, participation in home-based care services by nursing staff, each city is in charge of the administrative staff in nursing work.In the survey, we extracted the Nanjing Xuanwu District” Suo Jincun10000 to help“ as a home-based care services of typical model analysis.A questionnaire was developed by the project team members in a large number of interviews, reading a lot of literature on the basis of prepared by natural information, questionnaire, on home care social understanding of the situation, the elderly mental health situation in three parts.The questionnaire used a single topic and MCQs, structured and unstructured combined form, contains a total of 30 projects.Main outcome measures in the following three aspects of different gender, age, cultural degree, family members of senior people's mental state, the future pension concern degree of correlation coefficient.The senior overall mental status index shows the different natural conditions in case selection difference test result.The current situation of old-age home services, service content, service satisfaction of the elderly.On the questionnaire survey to the data using the SPSS17.0version of the software, using descriptive statistics, mean, correlation analysis, statistical testing of statistical data and proceing.Through the interview the interview data were summarized the collation and analysis.Three results 3.2.1basic situation analysis Relevant experts, scholars, the senior group can be divided according to age,60-69 for younger elderly,70-79in the age old man, aged 80 years and above for the elderly.The younger elderly67 people, accounting for29.8% of the total number of surveyed, age of85 elderly people, accounting for42.3% of the total number of surveyed, aged49, accounting for24.4% of the total were investigated;the marriage, married elderly people140 people, accounting for69.7% of the total number of being investigated, the widowed old people 57 people, occupy the by the investigation of the total 28.4%, unmarried1 elderly people, accounting for0.5% of the total separation were investigated,3 elderly people, accounting for1.5% of the total were investigated;the cultural degree, illiterate29 people, accounts for14.4% of the total number of surveyed, primary school culture 34, accounting for16.9% of the total number of surveyed, culture of junior high school50 people, occupy investigation total 24.9%, high school59 people, accounting for29.4% of the total number of survey, undergraduate culture 29, accounting for14.4% of the total number of survey.3.2.2cultural characteristics Present investigation shows the primary school and the education of the elderly accounted for31.3% of the total number of elderly, junior high school education accounted for24.9% of the total number of elderly people, high school education accounted for29.4% of the total number of elderly people, bachelor degree accounted for14.4% of the total number of elderly people.Different gender old cultural degree is also different, in which the primary school and the education of male elderly accounted for all the male elderly18.9%, while the primary school and the following cultural degree of elderly female accounted for all of the women surveyed elderly total 44%, younger elderly, primary school and education in the elderly accounted for28.3% of the total number of young people, in the in advanced age, primary school and education in the elderly accounted for35.5% of the total number of old age, but in the very elderly, primary school and the education accounted for36.7% of total other elderly.Investigation shows, at present in the elderly because of the influence of historical conditions, cultural degree is not high.Elderly female cultural level substantially lower than men's, so in home-based care services content and mode improvement should pay more attention to this.But at the research institute surveyed senior intellectuals in the oldest old is very high, with the paage of time, the proportion of senior intellectuals will be higher, and the older age groups cultural level will be higher, also means that the old man on the nursing service mode quality requirements are higher, which requires the old-age home nursing mode in operation in addition to providing material, medical and physical care, but also pay attention to the mental care and spiritual consolation.3.2.3family structure Survey of the family patterns, a living alone in the elderly accounted for13.4% of the total number of parents surveyed, living alone accounted for37.3% of the total number of people surveyed, and their children, grandchildren living together accounted for46.3% of the total number of people surveyed, other family structure accounts for3% of the total number of survey.In the survey sample of 57elderly widowed, in which 21old people still choose a person living alone accounted for36.8% of the total, widowed elders;one spouse for elderly parents living alone140 people,84 elderly people, occupy53.6% of the total number of spouses of elderly, children, and grandchildren live in the elderly is 56 people, occupy the a total of 40% spouses of elderly.In the older age groups, the elderly living alone accounted for22.4% of the total number of the oldest old in age, low, elderly parents living alone in the family mode respectively, middle aged elderly low total 58.8% and 49.2%.The illiterate culture level in elderly people, a people living and you live alone in family life in the elderly of illiteracy education in the elderly a total of 41.3%, in the primary school education in elderly people, a people living and you live alone in family life in the elderly accounted for the primary school education of the elderly is 44.1% of the total, in the junior middle school education level in elderly people, a people living and you live alone in family life in the elderly accounted for the junior middle school education level in the elderly a total of 48%, in the high school education for the elderly, a people living and you live alone in family life in the elderly accounted for the high school education of the elderly is 54.2% of the total, the bachelor degree in elderly people, a people living and you live alone in family life patterns in the elderly accounted for the bachelor degree in the elderly is 55.2% of the total, according to the correlation analysis, age and pattern of family life has statistically aociated(> 0.05), the correlation coefficient is 0.345, marital status and the pattern of family life has statistically aociated(> 0.01), the correlation coefficient is 0.433.Investigation shows, at present more and more senior people may fear that the children's life preure is too large or relationship of proceing factors such as the reluctant and children live together.The higher level of education of the elderly is reluctant and children and other family members living together, contrary to the lower level of education, the elderly where the family structure, family life relation is complex.The elderly family structure appeared diverse, is no longer before the traditional family pattern, but appeared alone, empty nest and other forms.At the same time, because of the increasingly intense competition in society, the lives of their children and work preure, the old man is a joint family living in the trend of weakening, but rather and spouses living alone, and even some old man in a widowed after still alone.The 3.2.4 health status(1)the old man 's physical health Investigation shows, at present, the senior’s physical condition is satisfied, the senior whose physical health status is poor have worries, and should therefore provide more medical services.(2)the mental health of the elderly For the senior`s health status investigation and analysis we used a mood, a perfect score of 60, high scores that emotional states good mood, happy, positive, optimistic mood;encountered life events, emotional without obvious fluctuation, self adjustment, stable;life satisfaction and happine of higher.Scores indicated low emotional state is poor, unhappy, emotionally negative, peimistic, prone to anxiety, depreion, often to worry about the future;encountered life events, emotional volatility, not good at self adjustment, poor stability;life satisfaction and happine of the lower.By the investigation of elderly scored an average of 39.30, in a state of health.Gender differences in the elderly mental health status, female elderly mental health status in elderly male, but the difference was not obvious.With different cultural level of the elderly mental health different status, the bachelor degree in the elderly mental health status is not average, because of the high degree of the elderly for the home-based care services requirements are relatively high, but the old man 's overall educational level is not high, there will be lonely and communication.In social participation, active participation in community organization of the mental health of the elderly and other elderly compared with statistically significant difference, difference coefficient of 0.02.” Active aging “ is the first goal in 1996 in the” health and ageing Manifesto“ in put forward ” target“, the report in2002after from 21 countries of 29 delegates discued revision submitted after the second seion of the United Nations World Aembly on aging, accepted by the general aembly and written into as a political declaration on twenty-first Century, the aging of the population policy framework put forward formally.Since 2002, the second seion of the United Nations World aging conference will be” active aging“ as a response to the twenty-first Century population aging ”policy framework“ was formally put forward,” independence, participation, care, self realization, dignity“ has gradually become the world recognized the old work basic principle, to” acknowledge that people in the aging proce, they are in all aspects of life, enjoy the opportunity equality rights“ as the starting point.Among them, based on” the potential for the elderly is the future development of a strong foundation“ on the elders' social participation, is promoted to the ”older people's basic rights“ and” old people should enjoy the full life “ height, in two aspects of theory and practice is paid close attention to extensively, emphasize” from work in retired elderly and those sick or disabled people, their families, friends and relatives can still be, communities and nations are active contributors".Positive aging stre the aged social participation, with the elderly culture degree unceasing enhancement, the old man 's psychological demand will increase continuously, so home pension pension model should pay attention to the elderly in the community participation, rich people 's spiritual life, is the elderly in nursing proce can feel self realization and self involved values.3.2.5social support Investigation shows, in all the surveyed people in difficulties, only rely on their own accounts for42.8% of the total number of elderly people.Rarely ask for help the elderly accounted for15.9% of the total number of elderly, sometimes ask for help the elderly accounted for13.9% of the total number of old people, often ask for help the elderly accounted for27.4% of the total number of elderly.In different cultural degree, the ability of elderly seeking social support had significant difference, in the independent sample variance analysis, cultural level and difficulties are encountered in the practice has a coefficient of 0.02significant differences.In different cultural degree, difficulty feel helple ratio is with culture and raise the level of falling.In the face of difficulties on our own, where illiteracy, primary school, junior middle school education level in the elderly the ratio is over 50%, in high school and undergraduate education in the elderly in a very low percentage of only40.7% and13.3% respectively.At the same time, social support and age also correlation exists, the older only depend on own proportion is low, because as the old age increasing, the elderly need help is on the increase, in younger elderly, often ask for help the elderly accounted for the proportion of the total number of younger elderly17.9%, middle aged elderly often ask for help the elderly accounted for the proportion of the total number of age old man in32.9%, the elderly often ask for help the elderly accounted for the proportion of the total number of 30.6% elderly patients.Investigation shows, at present the senior`s seeking social support ability is not ideal, the lower level of education of the elderly social support seeking ability is low.Along with the old age increasing, the elderly need help is on the increase, in the old 60-69years old for this help the demand is not great, but the old man in the 70years old on social aistance demand suddenly enlarged, will be extended to80 years.Cultural level and the elderly to seek social support have significant correlation, the findings of previous research, women have an average life expectancy larger than the male, and female cultural level was significantly lower in men, so women in older age groups need more social attention, at the same time in the future nursing work, nursing career will be faced with more responsibility and more challenge.The old man entered the young old and senile stage social aistance demand also increases, which requires the service should have key, capture main contradiction.3.2.6on home care knowledge Investigation discovery, the elderly on home care is not to understand very much, although home retirement pension mode in our country has been running for more than 10 years, the old man on home care does not understand, which know old-age home number is 75 people only, for all 37.3% surveys in the elderly.Younger elderly living conditions and health status so that it does not pay much attention to their pension problem;in age of elderly living state and their own health condition to begin to consider their own problems, also begin to pay close attention to the various nursing mode choice, thus to better understanding of the elderly old-age home;in most cases, lo of widowed can or a disability, their status is complex, and their social contact, receivers of information capacity is relatively low.Thus, the old-age home publicity work should also strengthen further, considering on home care propaganda way should take into account all age in different situations, to select a suitable information propaganda way.3.2.7 on home-based care services needs of the project On old-age home service project survey, elderly on medical service needs in a substantial increase, for guiding service demand decrease instead.For example, Ankang, old age demand le, because Ankang has been unable to meet the demand of elderly people, cannot provide substantial help.In the younger elderly in only 44.8% of the elderly think there should be a nursing home, this shows that more than half of the elderly in the preference for home care, elderly people over the age of 80on home care needs and rising demand, but is not particularly high, worried that home care can not meet the demand and service.Old table accept degree low, especially the elderly acceptance, because as the old age increases, the elderly body status differences, and elderly patients with chronic disease prevalence rate is high, the old man in the diet on the difference will be bigger and bigger, therefore on the old dining table this service should be further analyzed and adjusted, for example, increased nutrient division.Domestic services and home care needs very high, should be present in the provision of services to expand supply.3.2.8home-based care services satisfaction Investigation discovery, at present the younger elderly to home-based care services satisfaction and satisfactory accounts for28.8% of the total number of survey on satisfaction, home-based care services for general accounted for35.8% of the total number of being investigated, to the satisfaction of home-based care services for le satisfied and diatisfied accounted for35.3% of the total number of survey.In the primary school and the education for the elderly, le satisfied and diatisfied with the proportion of 31.9%, in the junior middle school education level among the elderly, not very satisfied and diatisfied with the proportion of 38%, in the high school education for the elderly, le satisfied and diatisfied with the proportion of 32.2%, undergraduate and above the degree of the elderly, not very satisfied and diatisfied with the ratio of 44.8%.The old man on home care satisfaction varied with age differences in young, elderly, to home-based care services was not satisfied and diatisfied with the proportion of 49.2%, in the age of home-based care services for the elderly, not very satisfied and diatisfied with the proportion of 25.9%, in the very elderly, home-based care services not to very satisfied and diatisfied with the ratio of 32.6%.The senior`s home-based care services satisfaction is low, the old-age home service quality also need to be further improved.The higher level of education of the elderly to the home-based care services satisfaction is low, younger elderly on home care is not very understanding, the spirit of the high demand, and at present home care psychiatric care lack, therefore satisfaction compared with other age groups are low.The oldest old on home care satisfaction is low, mainly because of the elderly on home care have special needs, while the services can not fully meet the needs of the elderly.The old man of home-based care services satisfaction is low, home for the aged in the operation proce, should be aimed at different age stage of the needs of the elderly, while improving the quality of home-based care services, with highly educated elderly population continues to increase, the elderly on old-age home more and more high quality requirements, and constantly improve the home-based care services model is home pension mode the key to continue.3.2.9 on future pension concerns Investigation discovery, the elderly on future pension is not worried, elderly people in retirement expectations or positive.Different age of the future pension concern degree is different, younger elderly age is light, since the reform and opening up social security is not in place, the pension system is not perfect, the elderly pension anticipation is not clear;in age old man not too worried, because they are physically healthy, in need of care level is relatively low, at stable period, 3.2.10old-age home run status Home-based care services station receives in the elderly with relatively wide sources, a home-based care services station street near the average from7-8street in the elderly.Enjoy the home-based care services are mostly low income above 70 years of age living alone, empty nester.Engaged in home-based care services at all from the local streets, workers pay 9.2yuan per hour, each month must do 26 hours, a monthly income of about 240yuan.Nursing aement procedure is: at the end of nursing work followed by the old man himself in the table of tick, signature, then workers take their examination table to according to maintain seal, at this stage, the neighborhood of the role is to supervise control.In nursing management, at the end of each month, workers to the service station office meeting, summarize the work this month, according to the nursing work and put forward the new requirements for workers, and the elderly communication skills training.At the same time through visits, telephone and carer feedback to understand the old man 's satisfaction and completion of the nursing examination.The provisions of Nanjing until 2015, each community to home-based care services center, but in the face of such a task, the community will face many challenges, community worker's compensation is too low, each worker has to serve 5 to 6 people, and the nurse's busine hours are fixed, the living conditions of older persons is not good, the main economic status led.In recent years the society of home-based care services demand is growing, the living conditions of older persons can not be relevant departments truthfully reaction.At present home pension problems mainly displays in: the government is short of money, some things as a community worker is incapable of action of government of;of old-age home policy can be implemented in low, execute rise facing great difficulties;nursing level, workers are moving, low degree, low income, age 40 so, some even are illiterate, and they will only be home-based care services as part-time;government policy adjustment can not keep up with changes;the service staff and volunteers of origin stenosis, cutting busine hours too little, old people can easily be lonely.The solution to this problem temporarily coping strategies is door-to-door neighbor, community members, the usual care.Home-based care services station was Aging Committee and the office of the dual leadership, in the policy and decision implementation faces dilemma.We suggest that home care policies to take into account the working-cla, improve workers wages, can provide the relevant social welfare, attract more talented people to engage in this important work.3.3conclusion Our country as the aging of the population, in the impact of population aging appears to be taken by surprise, the supporting problem has become the focus and difficulty in solving the people`s livelihood, so the problem of providing for the aged than ever to get more attention and support.This study is mainly directed against the city 's home pension problems, mainly in Nanjing as the cases for investigation and discuion.From the investigation can be found in our country, the city pension faces many problems.In the nursing career development and economic development to match problem also will face enormous challenge, achieve happine endowment is shouldering the heavy preure.Investigation shows, at present in the elderly is not very willing to work with children live together, but were more likely to choose to old two lives, even in the widowed after still alone.In service for the old projects like Ankang, home care, generation of shopping services such as the actual supply far did not reach the level of demand, in this case, the desired pattern is the old aged pension.The old man 's cultural level of gender significant gaps exist, female culture is much lower than the male, the female life expectancy was generally higher in men, which means that in the empty nest elderly in the proportion of women will be far more than the male, investigation discovery, culture level is high in the elderly seek social support obviously ability strong in the low cultural level.So in home-based care services should be more active to provide help, pay more attention to the mental care.The old man the old-age home understanding is not very common, even with the desired to have bigger difference, take the initiative to participate in community activities on old-age home know better, and the future of nursing concern degree is relatively low, which requires the community workers to for the elderly to provide more group activities, rich organization life.In home-based care services mode of operation, with the continuous development of the social old-age home, the home care service team specialized requirements higher, the service content extensive sex requirement more, to service the normative form of more stringent requirements.This requires engaging older workers in geriatric nursing service to actively take the initiative to see current situation, capture main contradiction, overcome difficulty, optimizing service model, old-age home mode for sustainable operation and development.Currently engaged in home care services and community workers have good profeional skills, whether in services or in the management can provide the basic demand, this also because of community workers and service personnel's salary is too low, cannot reflect the post value caused by, so in the pay and service personnel training and aement the mechanism should be further improved, continuously towards positive aging direction.
