Beijing is studying the paid nursing policy for children who care for the elderly at home, and management measures will be introduced this year. According to reports, the paid care for children who care for the elderly at home is mainly aimed at the disabled and demented elderly who have difficulties. It is estimated that there are about 600 thousand people. Yesterday, the Fourth Session of the 14th Municipal People's Congress held its second plenary meeting, and the listed people's government made a written report on the implementation of the Regulations on Home Care Services in Beijing. At the same time, this conference held the second press conference, which introduced in detail the current development of the old-age care in this city. Medical expenses incurred in designated medical institutions in Hebei can be reimbursed according to Beijing's policy of supporting the elderly in different places. At present, Beijing-Tianjin-Hebei is systematically docking.
□ Status quo
The total number of old-age service teams is insufficient
In order to meet the social service demand of home-based care for the aged, the Regulations of Beijing Municipality on Home-based Care for the Aged came into effect on May 1 last year. In the process of implementing home-based care for the aged, there are still some problems and deficiencies in this city.
For example, there is a shortage of old-age service facilities in Beijing at present. Urban six districts10.6 million old residential areas have a serious shortage of old-age service places. The transformation of barrier-free facilities for the elderly has not yet been carried out, and there is no policy of using idle state-owned assets and facilities to carry out home-based care services. The established street and township old-age care centers are not operating well, their service functions are not suitable, and the home-based old-age care projects provided are limited.
In addition, the total number of old-age service teams is insufficient. Nearly 3 million elderly people in the city need corresponding aged care service talents, but the total amount is seriously insufficient, and there is a big gap in aged care service talents, especially the professional nursing talents serving nearly 600,000 disabled and semi-disabled elderly people are basically blank.
initiative
How to alleviate the shortage of manpower?
Push the paid care policy for children this year.
In the old-age care center, short-term custody service, which is often called respiratory service, is promoted for the elderly who have been bedridden at home for a long time to provide support for such families. This year, we will explore the implementation of paid care policy for children who take care of the elderly at home.
According to the report, Beijing will study the paid care policy for children who take care of the elderly at home. In this way, the government will "hire" children to take care of the elderly at home in the future, which can not only make up for the shortage of nursing staff for the aged, but also meet the emotional needs of the disabled elderly.
Li Hongbing, deputy director of the Civil Affairs Bureau of Nanjing, said that Nanjing has made similar explorations in caring for the children of the elderly at home. "How to design the supervision system and how to ensure that the corresponding care is effective and concise at home is what we are doing now." .
"The relevant management measures will be introduced this year and will be tried out later." Li Hongbing said. The main content of the "Measures" is to consider supervision, how to ensure that these children subsidized and paid by the government can really go home to take care of the elderly in need, and truly guarantee the problem of providing for the elderly. These monitoring measures must be done. At present, relevant measures are being studied, and specific plans will be introduced during the year, and suitable districts will be selected for pilot and further promotion.
Liu Weilin, deputy secretary-general of the Municipal People's Congress, said that exploring children's "paid" care for their parents is not to encourage the concept that "parents should give money to their children first", but that the government gives some subsidies to children who take care of the elderly at home, which does not conflict with the tradition of filial piety. In the future, Beijing will introduce detailed rules in its exploration. This is not confusing children's filial duty, but two different things. If there are elderly people at home, children will take care of them voluntarily. Government subsidies are equivalent to government purchases of services. Subsidies are not necessarily many, but mainly play an encouraging role.
According to reports, the paid care for children who care for the elderly at home is mainly aimed at the disabled and demented elderly who have difficulties. It is estimated that there are about 600 thousand people.
How to solve the high cost?
Medical expenses for family beds will be included in medical insurance.
The "Report" proposes that Beijing is prepared to refine the medical expenses incurred by family beds and include the items that meet the requirements into the scope of medical insurance reimbursement. At the same time, adjust the nursing expenses and medical rehabilitation projects within the scope of reimbursement of basic medical insurance in this city to improve the level of reimbursement.
Xu, deputy inspector of the Beijing Municipal Bureau of Human Resources and Social Security, said that in the future, the Municipal Bureau of Human Resources and Social Security will also promote the sharing of resources between community health institutions and old-age care institutions, set up branch medical institutions in old-age care institutions, and set up old-age care centers in community health service institutions to open up a "green channel" for medical insurance.
In view of the fact that the elderly are sick, take too much medicine and have difficulty in moving, in order to further facilitate the elderly to seek medical treatment and take medicine nearby, the Municipal People's Social Security Bureau has further included 224 kinds of drugs such as common diseases, chronic diseases and senile diseases in the reimbursement scope of community medical insurance, so that the number of drugs that can be reimbursed for community medical insurance can reach 1435. Xu said that the elderly in this city seek medical treatment in community health institutions, and the related expenses incurred by using drugs in the medical insurance catalogue can be included in medical insurance reimbursement.
At the same time, the city will further improve the reimbursement policy for family beds and reduce the burden on the elderly. For example, on the basis of including the medical care expenses and physical rehabilitation treatment expenses of the elderly in large hospitals in this city into the scope of medical insurance reimbursement, considering the practical difficulties of caring for the elderly at home, the Municipal Bureau of Human Resources and Social Security issued policies to encourage and support community health institutions to establish family beds for the sick elderly, and to include the medical expenses of family beds into the scope of medical insurance reimbursement. Including family sickbed construction fee, family sickbed examination fee and medical treatment fee, in addition, the reimbursement deductible line is reduced by 50%.
If the elderly set up a family bed within 24 hours after discharge, the medical expenses will be calculated according to the continuous hospitalization, and there is no need to pay the self-pay line. Xu said that this will further reduce the burden of medical expenses for the elderly who are sick at home.
In addition, regarding the expansion of medical care and rehabilitation projects, Xu said that according to the current medical insurance system, the nursing expenses for treatment have all been included in the scope of reimbursement, and most rehabilitation projects are also included in the scope of reimbursement. Xu said that relevant departments are studying the standardization of medical services. In the next step, medical insurance will gradually incorporate rehabilitation projects into reimbursement projects.
How to run less errands when seeing a doctor?
Develop community family doctor service.
The Report proposes to set up geriatric departments in qualified secondary general hospitals to promote the transformation of rehabilitation functions of six medical institutions. Gradually unify the drug catalogue and product specifications of the core hospitals and communities within the medical association, and reduce the drug distribution of the elderly in the community.
Yan Yutian, deputy director of the Municipal Health Planning Commission, introduced that each of the six districts in the city chose a secondary medical institution to transform into a rehabilitation function. At present, the Municipal Health Planning Commission establishes health records for the elderly at home in community health service institutions, provides regular free physical examination services in accordance with relevant regulations, and provides health guidance such as disease prevention, injury prevention, self-help and self-care; Carry out community family doctor services, comprehensively manage common diseases and chronic diseases of the elderly, and provide guidance on medical care, nursing and rehabilitation services; Provide priority treatment and two-way referral services with other medical institutions; Cooperate with community nursing centers as needed to provide contracted medical and health services for the elderly.
In the future, family beds will be established, and the "three priorities" service will be implemented, and the registration fee for general outpatient clinics for the elderly will be exempted. For the elderly who enjoy the minimum living guarantee and living difficulties subsidies for urban and rural residents, the family bed inspection fee is exempted. Provide health management services for the elderly over 65 years old in the jurisdiction every year, including lifestyle and health status assessment, physical examination, auxiliary examination, health guidance, etc.
□ Guarantee
How to solve the problem of going upstairs in the old community?
The government will subsidize the installation of elevators.
The Beijing Municipal Government has proposed that Beijing will launch a pilot project to add elevators to existing multi-storey residential buildings. The pilot will be led by the housing and construction department, starting from the six districts of the city. At present, subsidies have been allocated to the pilot areas. In the next step, Beijing will formulate a series of detailed plans such as applicants, approval procedures, subsidy declaration, ownership of property rights, follow-up operation and maintenance, and demonstrate and evaluate innovative plans such as building small hydraulic external elevators.
Zhao Cheng, deputy director of the Municipal Commission of Housing and Urban-Rural Development, said that all projects included in the environmental renovation of old residential areas, the renovation of bungalows and shanty towns are in full swing, and the installation of elevators in old buildings is advancing and making progress in stages. The financial department has now determined the funding plan for the pilot project in six districts of the city, and the installation cost will be borne by the government by 40%.
The problems faced by elevators in old buildings are that the first installation position cannot affect the safety of fire exits and public buildings; Article 2 The elevator design scheme shall ensure the structural safety of the building; Third, it is necessary to raise funds, which can be raised by property units and residents themselves or supported by other social funds; Fourth, it involves the consent of the relevant owners and residents.
In order to ensure the transparent and fair use of relevant funds, the pilot project of installing elevators in the six districts of the city is seeking opinions and will be fully rolled out later.
Is it feasible to provide for the aged in different places?
Two groups of people "reimbursement for medical treatment in Hebei and Beijing"
Referring to the issue of providing for the aged in different places, Li Hongbing said that since last year, as a pilot project, the bid winning group has built a large-scale pension facility in Gaobeidian, Hebei Province, which was capped immediately, so that Beijing's policies can be released from Beijing.
Xu introduced that the Beijing Municipal Bureau of Human Resources and Social Security has signed relevant agreements with the Hebei Provincial Department of Human Resources and Social Security. People who live in Hebei after retirement in Beijing and people who work and live in Hebei in Beijing can be reimbursed according to Beijing's policy as long as they are designated medical institutions. At the same time, Hebei people also have corresponding policy arrangements for medical treatment in Beijing.
However, it is difficult to settle medical treatment in different places at present, because the medical insurance policies in Hebei and Beijing are different. Hebei has a 1 1 overall planning area, and Beijing is a municipal overall planning area with different policies. So when you see a doctor now, you need to pay cash first, and then you will be reimbursed after you return to Beijing. Reimbursement takes a long time, so real-time reimbursement cannot be realized. However, at present, Beijing is connected with the systems in Hebei and Tianjin. "This is a big system reform and improvement, which takes time, but we are also speeding up, and Beijing is ready."
□ Dialogue
Information-based home care model will be promoted in the whole city.
Yesterday afternoon, Li Hongbing, spokesperson of Beijing Civil Affairs Bureau, revealed in an exclusive interview with the reporter of Jinghua Times before attending the deliberation of Haidian delegation that the biggest difficulty in the implementation of home-based care model is to identify the needs of the elderly at different levels. Li Hongbing said that in the future, the information-based home care model will be promoted throughout the city.
First, meet the needs of the disabled elderly.
Jinghua Times: Our existing beds for the aged in Beijing cannot meet the diverse needs of all the elderly. What will we do in the future?
Li Hongbing: First of all, we have to go back to the question of who is suitable to live in an old-age care institution. According to our original point of view, we didn't divide the crowd. Many ordinary people seem to think that they can live in old-age care institutions after retirement. But in fact, people who really want to live in old-age care institutions should be home-based care services, and it is difficult to have services that meet the needs of the elderly. And in the case of high cost of home-based care for the aged, the cost can be reduced in a centralized way, so I choose to stay in an old-age care institution. Therefore, the old-age care institutions must first meet the needs of the disabled elderly. Health of the elderly can choose its own pension mode, either nearby or through other channels. These elderly people can comprehensively consider which way to choose according to their own needs and cost performance.
In addition, in the supply of services, some are the responsibilities that the government should bear, especially in the central cities where the population is very concentrated. All kinds of door-to-door services still rely on one platform to provide door-to-door services. The service platform needs housing, and housing actually accounts for a large proportion of the current home-based pension costs. To this end, the government is also considering that this year, the government will provide facilities for the service platform free of charge or at low compensation, and the platform only needs to be responsible for professional operations and services. When the service cost is reduced, the cost will not be passed on to the elderly.
Determine the hierarchical needs of the elderly
Jinghua Times: In the process of promoting the home-based care model in Beijing, Chaoyang District has implemented the pilot model of "one-click call for the elderly". Will it be promoted in the whole city in the future?
Li Hongbing: That's for sure. Informatization must be a very important way to solve the model of home-based care for the aged in the future. A great feature of home-based care for the aged is dispersion, dispersion of residence and dispersion of demand, which is a very difficult problem for providers and will also bring high costs. Therefore, only through the way of informationization, the scattered needs are integrated and become different problems. For example, the elderly only need to find someone to clean the glass, without a nanny. At this time, the elderly can meet their own needs through this platform, which is the problem of refinement. Only in this way can we solve the problems of high cost and scattered demand. This promotion method of Chaoyang is also exploring experience at present, but what must be done is to refine the needs of the elderly.
In the process of "refinement", the biggest difficulty is to find out the hierarchical needs of the elderly at home. The really difficult old man is blocked by two doors, one is the door of the home, and only when he enters the home can he understand the difficulties of the old man. The other door is the heart door, and the old man can't express it. We should find out the difficulties. Without clear demand, there will be no good supply. Supply-side reform also needs to adjust these problems. The most important thing is to grasp the demand, so the demand of the elderly who have lost their independence is the most important, which is our key work in the first half of the year.
Jinghua Times reporter Liu Ji
□ Related hot spots
Revitalize the existing idle facilities in urban and rural communities
In terms of the construction of old-age service facilities, the city has issued the Special Plan for Old-age Service Facilities and the Regulations on Barrier-free Design of Residential Areas and other related documents. This year, combined with the function relief of non-capital, the city-wide investigation, collation and information collection will be carried out on the existing idle facilities in urban and rural communities, and relevant supporting policies will be issued to integrate and revitalize existing resources and alleviate the shortage of community home care service facilities.
Special elderly people can get commercial services.
In terms of preferential treatment services for the elderly, on the basis of existing preferential treatment services, the content of preferential treatment services has been expanded to 44 items in six categories. Government services, medical care, business services, etc. , adding the content of providing on-site service for the elderly with special difficulties and mobility difficulties.
Pilot project of comprehensive reform of home-based aged care service
Li Wanjun, director of the Civil Affairs Bureau, said that the top-level design of the home care service system will be strengthened and the implementation of the regulations will be raised to a new level. At the same time, Dongcheng and Haidian will be added as pilot areas for comprehensive reform of home care services, and the construction of post stations will be promoted in Chaoyang and Haidian. Piloting rural old-age care services and combining medical care with nursing care.
In terms of funds, increase the investment of municipal funds in home-based aged care services and give play to its overall leading role in aged care services. Establish a financial investment growth mechanism linked to the growth trend of the elderly population, and clarify the responsibilities and investment requirements of district-level home care services.
In addition, it will be integrated into the resources of the old service information platform to build a business management platform for home care services in the city. Promote the wide application of the card for the aged and the disabled, and build it into a "gold card" for the elderly that integrates social welfare, preferential travel, preferential consumption and convenient service, so as to realize intelligent analysis and accurate management of the service satisfaction of the elderly.
Primary nursing homes will be transformed.
Li Wanjun said that beds in Beijing's old-age care institutions developed rapidly during the Twelfth Five-Year Plan period. At the end of last year, the number of beds for the aged was10.2 million, which was the top level in China, and there was no problem in meeting the needs of old-age care institutions. During the "Thirteenth Five-Year Plan" period, the number of old-age beds will increase. According to the current development speed, the conservative estimate is about 6.5438+0.5 million.
The growth of beds mainly depends on market regulation, and the focus of the government is to continue to support social forces to set up old-age care institutions and improve the functions of established old-age care institutions. For example, how to fully introduce medical care into old-age care institutions, and how suburban old-age care institutions can provide medical services like urban areas. In addition, the government should give special support to the grassroots to transform the existing nursing homes.