At present, the government-led home care service presents four modes: government sponsorship and hierarchical linkage; Government-led, intermed
At present, the government-led home care service presents four modes: government sponsorship and hierarchical linkage; Government-led, intermediary operation; Government funding, institutional sponsorship; Government procurement and market operation.
Government sponsorship, hierarchical linkage
1 mode
This model is mainly a top-down pension service model implemented by governments, streets and communities at all levels by means of administrative coercion. The main funds come from financial support at all levels, and some funds are raised by administrative organizations at all levels or social welfare undertakings.
Managers at all levels not only hold certain positions in the corresponding administrative institutions, but also take charge of the different work of the community home-based care service departments, and establish three-level management institutions of the district government, sub-district offices and community neighborhood committees to provide a variety of care services for the elderly at home within their jurisdiction.
2 cases
Qingdao implemented home care service earlier, and it is also one of the few cities in China that explored the integration of urban and rural home care service. 20 12 Qingdao has fully realized the home-based aged care service and formulated the Opinions on Accelerating the Development of the Aged Care Service Industry. Through the integration of care resources, the community has established a service center, and established a platform for the elderly, such as a medical room, a leisure and entertainment room, and a course room. Provide or assist in providing "one-stop" services such as housekeeping, food assistance, medical assistance, rehabilitation assistance, spiritual comfort, day care, leisure and entertainment. It is designed for the elderly aged 60 and above who need life care.
Home care for the aged and community care for the aged are inseparable. The essential purpose of community support for the aged is to serve for the aged at home, which is a necessary condition to realize the aged at home.
This model needs to integrate the surrounding living services, medical and health services, cultural and entertainment facilities and other resources, establish a home-based care service center, and the community provides a platform for the elderly to communicate with each other, thus providing a better home-based care environment for the elderly.
3 reference
Mode advantage: it is easier for leaders and competent departments at all levels to attach importance to the aged care service from top to bottom through administrative means, and persistently promote the implementation of community home-based aged care services, so that all policies can be implemented faster and more effectively, and it is easier to gain the understanding and trust of the majority of community residents.
There are problems: the government is responsible for management and operation, and there may be problems of high consumption, low efficiency and overstaffing, which will affect the efficiency of service supply; At the same time, it is not conducive to mobilizing more social resources and non-governmental forces to participate in the aged care service, and it is difficult to meet the diversified needs of aged care services, which may hinder the development and popularization of community home-based aged care services.
Government-led, intermediary operation
1 mode
This model is that the government itself does not directly provide services for community residents, but implements home-based care services through public, private or funded private institutions, mainly responsible for the planning, investment, project construction, formulation of operation standards and related laws and regulations, inspection and supervision, performance evaluation and other responsibilities of community care services, such as Haishu District of Ningbo City, Chengguan District of Lanzhou City, Jinhua Community of Zhejiang Province, etc.
2 cases
In order to meet the growing demand for the aged, Haishu District of Ningbo City began to explore socialized ways of providing for the aged, mainly entrusting home-based aged care services to Starlight Association, and providing home-based aged care services through the organization form of the association. The service modes include "going in" and "going out".
"Going in" mainly provides services for the elderly through purchasing services, "volunteer bank" and a team of caregivers; "Going out" refers to providing leisure and nursing places for the elderly through various elderly clubs, communities or street day care centers.
In addition to relying on the Starlight Association for Respect for the Elderly, Haishu District has also established a volunteer recruitment service center to recruit volunteer nurses through the community, and set up a "volunteer bank" and a community volunteer team to provide professional training for nurses and provide services to the elderly.
Home-based care for the aged in Haishu District is a very important exploration of home-based care service mode through government support and giving full play to the role of third-party organizations and volunteers. The mode of home-based care for the aged in Haishu District of Ningbo mainly relies on social subjects to provide home-based care service resources, which is mainly reflected in three aspects:
First of all, non-profit organizations play an important role in the model of home-based care for the elderly. Haishu District entrusts the public welfare project of home care for the aged to the non-profit organization-Haishu District Starlight Senior Association, that is, the socialized home care service center is operated by the District Senior Association (General Association), and the community provides specific services in the service station in the name of the Senior Association.
Secondly, volunteers and volunteer teams play an indispensable role in home care services. In the process of implementing home-based care for the elderly, Haishu District has set up a "volunteer bank" to mobilize community residents to become volunteers and provide services to the elderly who need services as much as possible.
Finally, the community uses government-funded welfare lottery subsidies and social charitable donations to develop home-based care services, effectively alleviating the financial pressure on home-based care services.
3 reference
The advantages of this model are: giving full play to the macro-control function of the government, and fundamentally separating government from enterprise and government affairs; Reducing the administrative operation cost can make the limited resources of the government play a greater role; It is conducive to cultivating and developing non-profit service organizations and institutions, and promoting the professional and industrialized development of home-based aged care services; We can better understand the changes of the needs of the elderly in different communities, adjust and improve the service items in time, and improve the satisfaction of the elderly clients.
Existing problems: it is difficult for intermediary organizations to gain the trust of community residents in the initial stage of operation, and more efforts are needed to open up the working situation; It is difficult for intermediary organizations to shoulder this heavy responsibility under the underdeveloped situation; The government should be clear about its responsibilities, neither let go of intermediary organizations, nor interfere with administrative management and supervision too much.
Funded by the government and sponsored by the organization.
1 mode
This model adopts the way of government funding and community financing, entrusts or subsidizes professional pension institutions to undertake home-based care service stations in the community, and manages and operates them after completion to provide home-based care services for the elderly in the community.
This model does not work well in some places.
2 cases
The Civil Affairs Bureau of Harbin, Heilongjiang Province will introduce professional social organizations and social work agencies to provide "five assistance" home care services for the elderly in Harbin10.8 million community, including meals, baths, medical care, emergency treatment and cleaning.
In terms of food assistance, the community has solved the problem that some elderly people at home are left unattended for lunch; In terms of bath assistance, the community chooses professional old-age care service institutions to provide home bath services for the elderly. After blood pressure monitoring and physical health examination, it is determined that the physical condition of the elderly is suitable for bathing at home, and the staff can help the elderly to bathe; In terms of medical assistance, the community regularly conducts physical examinations for the elderly at home, and provides relevant medical services according to the physical condition of the elderly, as well as health consultation, home medical services and other services; In terms of emergency assistance, such as running water, electricity leakage, forgetting to bring home keys and other emergency matters, the community provides corresponding emergency and problem-solving services; In cleaning, the community can provide domestic cleaning services for the elderly. At the same time, it will also provide special services such as daily care and psychological comfort for the elderly in the community.
The "Five Helps" home care service will provide paid, low compensation and free services for the elderly at home. Among them, the "three noes" are exempted from payment, the low-income and low-income elderly people are partially exempted from payment, and the high-income elderly people are provided with personal tailor-made pension services.
At present, Harbin has selected 42 communities to carry out the pilot service mode of "home-based care for the aged". It is understood that the pilot work of Harbin home care service market is not satisfactory, and the operation effect of some pilot units is not ideal, and some have stopped.
3 reference
Model advantages: the government entrusts professional pension institutions to undertake operations, saving management and operation costs, and also conforming to the professional and standardized development direction of community home care services; The chain operation of professional old-age care institutions can not only quickly improve the professional level of community old-age care services, but also set a demonstration and model for other community home-based old-age care institutions and places, and promote the improvement of the whole home-based old-age care service level.
Existing problems: after the government entrusts, it is easy to ignore and shirk responsibility, and it is difficult for some institutions to support and sustain once they lack government funding; There are some frictions or contradictions between institutions and community managers in professional services; This model is prone to corruption.
Government purchase, market operation
1 mode
In this mode, the government no longer participates in the construction or funding of community home-based care service institutions and facilities, but all or part of it is funded by the government to buy services from non-governmental organizations or enterprises, providing various kinds of care services for specific service targets (such as the elderly with three noes, the elderly with five guarantees, the elderly with martyrs, the elderly living alone in extreme poverty, and the disabled elderly). ), such as Gulou District in Nanjing, Jing 'an District in Shanghai, Lanyin Community in Lanxi City, Jinhua City, etc.
2 cases
As early as the 1980s, Shanghai began to implement the practice of home-based care for the aged, which was mainly purchased by the government. The government encourages communities to set up home-based aged care services, and provides financial subsidies through the government budget, and sets different service standards to provide different aged care services for different types of elderly people.
Shanghai's market is relatively mature, various social organizations and pension institutions are relatively sound, and it has incomparable advantages in market-oriented purchase. By purchasing services through the market, the elderly can enjoy high-level services with little money.
The biggest feature of home care service in Shanghai is to give full play to the advantages of products and services provided by the market, and it is a paradigm to actively seek market-oriented operation.
Conceptually, it pursues the high efficiency of service operation under the principle of emphasizing fairness; In terms of operation, the services provided for the elderly are basically purchased by the market. By signing contracts with market participants, the community allows market participants to provide corresponding services, and gives financial subsidies and tax incentives to participants.
3 reference
Mode advantage: the implementation of old-age care services is carried out by non-governmental organizations, and the government is only responsible for policy support, supplier selection and supervision; It is helpful to the competition among community home-based care service institutions, improve the quality and efficiency of care services, and promote the development and maturity of the care service market.
Existing problems: the government's binding force and influence on service enterprises are limited; Some local governments are prone to the contradiction between the demand for old-age care and the actual supply because they don't understand the service targets and have insufficient capital investment; In order to pursue profits, enterprises often give up or ignore low compensation and free services, thus affecting the provision of services for middle-and low-income elderly people.
The main service modes of community home-based care for the elderly under the leadership of the above government have their own advantages and disadvantages. In the process of developing home-based care for the aged, all localities should adjust measures to local conditions, keep pace with the times, creatively absorb and organize the implementation of various modes of care for the aged.