The living status of disabled elderly women
In terms of health status, in this study, it was found that the disabled elder women suffer from various degrees of chronic diseases, such as hypertension, diabetes, tracheitis, cerebral thrombosis (most likely to cause paralysis), etc. these diseases have a long course, difficult recovery and many complications. The disabled elder women are deeply troubled by these diseases, which seriously affect their normal life, Therefore, the health status of the vast majority of disabled elder women is worrying. Among them, the more common obstacles are ‘inconvenience in walking’, ‘unconsciousness’, ‘slow reaction’ and ‘inability to do heavy work’. Some elderly people who can't take care of themselves are bedridden for many years and need to be taken care of by others for eating, dressing and going to the toilet.
The disabled elder women have less income, more dependent on children with respect to economic support: the family and personal income of the elderly is an important indicator to measure the quality of care for the elderly. In cities, pension is the main source of income for many elderly people. Apart from the little increase of pension, there is generally no other fixed new income. For most unemployed elder women, their financial support mainly comes from the support of their children and the welfare pension with a small amount each month. The support of children is the first source of income for most disabled old people. In this study, five out of nine disabled women have pensions ranging from 900 yuan/month to 3000 yuan/month, while the other four are totally provided by their children and relatives. In this study, the disabled elder women need injections, medicine and hospitalization all the year round, so the family expenses are large. The lack of financial and material resources in the family care resources for the disabled elder women is mainly reflected in the family's economic ability, housing conditions and related service facilities.
(Participant): I come from the countryside to live with my son in the city. I'm old that I don't have much money. My son and daughter usually pay for my daily living. Now I'm in poor health. I still need to be taken care of, and I have no source of income. I do not want to go hospital to get the medicine, you have to pay a lot of money for medicine, health check-up and having an X-ray. Children give me money, but I do not want to get money from them, they do not earn much money, also have to pay the mortgage…. (sighing)
In this study, the participants have higher demands for spiritual life, and their needs are difficult to be met. The most prominent feeling of the disabled elderly is the emptiness and boredom of life, which is mainly manifested in the lack of emotion and the lack of entertainment life. Among them, the widowed elder women are more likely to feel lonely than the elderly whose spouses are still alive. Among the participants, there are two widows. They lack the spiritual support, and their children are busy with work. Most of the time they are alone at home, afraid to go out for physical reasons, and lack of communication. In addition, with the increase of age, the scope of activities is limited, social activities are gradually reduced, coupled with physical inconvenience, the time to go out is reduced. Although they want to participate in diverse cultural and recreational activities, it is difficult for them due to physical reasons, and their social circle is shrinking.
(Participant): My husband passed away two years ago. He could take care of me previously. He talked with me together, and the child was at ease. Now that he's gone, I'm not in good health, and the child is not often at home. I'm too lonely by myself. What else can I do after watching TV and reading newspapers. Previously I could chat with my husband, now I understand that the husband and children are different. Sometimes the lack of a common language made it very difficult to intercommunicate with my children.
There are problems about lack of human resources, lack of professional care knowledge in in terms of caregivers. In this study, most disabled elder women were provided with daily care by their children, while less elderly people lived in nursing homes and asked nannies to take care of them. Currently, eighty percent of the disabled elderly are cared for by their children or relatives when they are ill or in poor health (Li, 2018). Due to the implementation of the family planning policy, China's family size has become smaller and smaller in recent decades, and the family structure of ‘421’ or ‘422’ has gradually emerged. A couple has to support four elderly people. As family members go out to school and work, many children simply do not have enough time to accompany their parents. Some old people's children settle in other places and leave them in their hometown; Some old people's children are busy with work, and having their own families, and have no spare time and energy to take care of them. The caregivers of the disabled elderly are generally their spouses and their children, and some of them are in poor health. Taking care of the disabled elderly is a great burden to the caregivers, which is both physical and mental fatigue. In this study, it was found that the general caregivers only took care of the elderly in the aspects of food, clothing and daily life, lacked professional nursing and rehabilitation knowledge, and did not master professional nursing skills. Due to the limitations of various conditions, the caregivers were not able to do enough.
(Participants): My husband and I are both over seventy years old, we usually have no problems with food and clothing, but once we are ill and hospitalized, my husband cannot take care of me. Our children are all busy, they only come back to see us once a few months. It's not easy for us to live in big cities, and we don't want to drag them down. But we are worried that we don't know who to look for when something happens in our two old people's home.
The needs of disabled elderly women for community care
The care needs of the disabled elder women generally include basic daily life care (such as eating, going to the toilet, bathing, shopping, etc.), physiological treatment and rehabilitation (such as rehabilitation, medical care, provision of assistive devices, etc.), spiritual comfort, social communication, hospice care and aftercare (Gao J, Raven J, Tang S. 2007).
In this study, six of the nine families needed home-based care services, and the most needed services in life care are door-to-door meal delivery and door-to-door laundry. The elderly whose children are in other places show the demand for door-to-door meal delivery, laundry, cleaning and other aspects. However, when asked whether it is door-to-door service or centralized service, most of the elderly and caregivers prefer door-to-door service. ‘It's better to provide on-site service. It's safe to eat at home. I'm not in good health and it's troublesome to go upstairs and downstairs. It's great to be able to deliver it to my home’. It can be seen that due to the physical condition of the disabled elderly, the demand for domestic services is relatively high.
In terms of the needs for medical care, the participants all suffered from diseases of different sizes. They needed medical services and hoped to see a doctor nearby. In particular, they hoped to enjoy family sickbed services. An old woman interviewed said, ‘I'm not in good health. The hospital is far away. It's very tired to go back and forth. It's likely to get sick. It would be ideal if I could go to the community or even get medical treatment at home’. When talking about the most needed items in various community care services, the participants believed that what they needed most was that they hoped the government could increase the investment in medical assistance and provide cheap and high-quality medical services, ‘Now I dare not get sick. I have to spend money for my whole life, from thousands to tens of thousands. I have to take medicine every day, and I have to pay a lot of money. I have no pension and I can't get reimbursement. If only the government could give us some solutions’.
Spiritual comfort was in huge need among disabled elder women, all participants raised that spiritual care services are needed, especially the pairing care from young people, and that weekly on-site communication was the most appropriate way of care. At the same time, some old people also said that they like to participate in recreational activities, including watching Beijing Drama, and there was a great demand for similar activities suitable for the elderly in the community. The pursuit of life among disabled elderly is not limited to eating and drinking enough, and they have obvious demand for spiritual comfort services.
There was a need for emergency rescue, some participants whose children are away from home mentioned that they need to install emergency call devices, so they can get help in time in case of accidents, ‘I'm all alone at home. What can I do if something happens? It's very convenient to have an emergency call system. When I press it, at least someone can help me, so I can rest assured’ (participant). With the increase of age, the physical function of the elderly is also declining, which is prone to emergencies. Therefore, the demand for emergency rescue equipment is obvious.
Current situation of community care services for disabled elder women
The main components of the three communities in community care are: home care service centre, day care centre, community health service centre and volunteers. Through the communication with community workers and on-the-spot community observation, it is found that the four main suppliers are in the process of continuous development and improvement, and inevitably there are some problems.
About home care service center, in recent years, through selection, bidding and other ways, communities have introduced social elderly care services, household services, medical and health services, culture, catering and other institutions with high service quality, good reputation and strong strength into local services. As designated units to undertake home-based elderly care services and government purchase services, some communities operate in accordance with the market mechanism and enjoy the supportive policies for the development of elderly care services. Several home-based care service centres are basically informal employment organizations. They operate according to the market-oriented mode and focus on the basic living needs of the elderly. They mainly provide meal, cleaning, bathing, medical, mobility and emergency services for the elderly in the community. At the same time, they also take into account the various needs of the elderly, providing cultural entertainment, learning, chatting, consulting, and other services. According to the service content and the economic situation of the elderly, the fees are charged according to different standards. Preferential services should be provided for the elderly in urban families with minimum living allowance, and low compensation fees should be charged; The elderly with stable income and better economic situation can be charged according to the market price. The centres mainly provide services for the elderly in the community through door-to-door services. According to the needs of the elderly's families and themselves, the home care service centre regularly provides housekeeping services for the elderly, such as meal delivery, cleaning and laundry. The scale of each community centre is not large. One community home care service center in this study covers an area of only more than 80 square metres, but it undertakes the door-to-door services for dozens of elderly people in the whole community. In the process of observation, it was found that the hygiene condition of the catering departments in three centers was not good, and the food pattern was few, and the catering department in one center did not obtain the hygiene license. In order to reduce the cost of service, one community only employs two staff members, who are usually tired.
All the communities in this study have established small-scale day care centres for the elderly based on community home-based care service centres for the elderly, providing activities, day service, lunch and other services for the elderly in the community. Generally, the elders call it "nurseries". For families with busy work, the elderly will be sent to day care centres after their children go to work during the day, and comprehensive services will be provided by community service personnel. In addition to providing basic living care, television, computers, books, magazines and other recreational facilities are also placed in the community for the elderly to have fun. Living in the centre, for the elder women, they can have the opportunity to communicate with other elderly people and reduce loneliness; Compared with the caregivers, it can reduce their care pressure and make them work at ease. What is more distinctive is that one community has set up a simple family sickbed in the day care centre, and a few service personnel provide simple medical care services for the elderly, so as to facilitate the examination and treatment of the elderly. There are three day care centers with small scale and the sanitary condition is average. Although the service facilities are set up, some are not provided for the elderly yet.
Community health service centre can provide convenient and nearby basic medical and health services for the elderly, which is a suitable way of medical and health services for the elderly. At present, according to the requirements of relevant policies, community health service centres of different scales have been set up in all neighbourhoods, which provide small-scale elderly health care, health consultation and other services for the elderly. Some community centres also set up health records for the elderly, so as to fully understand the physical condition of the elderly in the community. The outpatient service of the community service centre in line with the basic medical insurance items are included in the scope of medical insurance payment to ensure the basic medical services for the elderly. Through the observation, it is found that the medical equipment of the health service centres in the three communities was relatively simple, the types of drugs were not complete, the staff were not professional, and the service attitude was not good. According to the response of community residents, one community health service centre was often closed, the price of medicine in the centre was higher than that of ordinary pharmacies, and some drugs are overdue.
Some communities have also organized and developed the teams of volunteers who were enthusiastic about community public welfare undertakings and could provide voluntary services through voluntary registration, oath commitment and other operation modes, providing more systematic and professional personalized services for the disabled elder women according to the specific situation of their families. In each community, volunteers consisted of few university students, relatives and friends of the elderly, other social caring people and other volunteers. They used their spare time to chat with the elderly in the community, to provide relief and spiritual comfort services for the elderly. They also played an important role in the community care of the elderly. In this study, it is also found that the organization and management of volunteers were relatively loose, and they were often enthusiastic at the beginning, and then basically never appeared. The service lacked continuity, and individual volunteers had the psychology of just coping with the task and did not seriously serve the elderly.
Current situation of community care services supply
The three communities in this study did not achieve the full coverage of the service project plan. Although most of the communities listed a full range of services, they did not provide all the services as required. This would inevitably lead to the result that some disabled elder women cannot get the services they expect.
One problem was the awesome differences in supply between different service items. For example, the three communities all provided door-to-door cleaning, door-to-door meal delivery and other services, while very few communities provided spiritual comfort, rehabilitation and other services. The supply of different projects was quite different, showing an unbalanced state. The quality of some service items needs to be improved. In this study, some families were not satisfied with only door-to-door cleaning, and some of the staff were slack. The quality and specialization of other service items also needed to be improved.
Problems of community care for urban disabled elder women
In recent years, communities have opened up new service channels for the elderly according to the actual situation of various communities. For example, a ‘mutual aid group for the elderly’ was set up to guide the healthy elderly to serve the frail elderly on a voluntary basis; The community service agencies provide high-quality and relatively inexpensive services for the disabled elder women through home-based services. At the same time, communities continue to innovate services, such as opening service hotline, providing fast services for disabled elder women and their families, launching ‘good neighbor card’, etc. On the basis of these methods, it can strengthen the contact with disabled elderly families and advocate the whole community to serve the elderly. After years of efforts, the community care has made great progress. However, there are still some problems in terms of basic life care, medical care and spiritual comfort when continuously expanding community service function.
The first problem is that the content of community care was relatively single, and the community service facilities needed to be enhanced. In this study, the nursing services provided by various communities were mainly for the elder women to do laundry and cleaning regularly, and some simple daily care. Other services were not well carried out, and the service content was relatively single. With the continuous improvement of the living standards of Chinese residents, the needs of the elderly in all aspects are also increasing. In addition to meeting the daily basic needs, community care failed to provide psychological counseling, medical care services, legal rights protection services and other services for the disabled elder women. Moreover, some services are not suitable for the disabled elderly and cannot meet their special needs. Through observation, it found that the types of service facilities in the three communities were single, some facilities had rusted and aged, most of them were fitness equipment, lack of comprehensive rehabilitation and health care equipment. In addition, the hospital beds in community health service centers were mainly simple family beds, lack of comprehensive medical beds, and the medical equipment was relatively simple.
(Participant): I went to the health service centre for having an intravenous drip. There were only a few simple beds, but there was no other inspection equipment. There was nothing suitable for elderly people with mobility difficulties like us to play in the community centre, and the facilities should be improved
The second problem is that the degree of socialization of community care for the disabled elder women is low, and the source of funds is relatively limited. The provision of welfare facilities and services for the elderly in the surveyed communities is arranged by the state and the collective, while the practice of direct management by the Civil Affairs Department has not fundamentally changed. The community's care for the disabled elderly was still based on traditional social assistance. Limited government financial input led to a relatively large gap between supply and demand. At present, the municipal financial subsidies are relatively small, and the financial capacity of each district is also quite different. In addition, the community's efforts to cultivate non-profit organizations are low, the sources of funds and service providers are relatively single, and the private capital for the development of community care is insufficient. At the same time, it is not enough to develop the service industry for the disabled elderly in various forms of ownership.
(Participants): We also want to provide better services and expand more projects, but we are short of money. Our District's finance is limited, and we directly allocate a certain amount every year. How can that money be enough. Now many projects are supported by the government. There are few other sources of funds. There are many restrictions. It's hard to do grass-roots work.
The third problem is the lack of professional community caregivers, and community medical service network is not complete. In the survey, the situation of community nursing staff was uneven. On the one hand, most community nurses were laid-off female workers, and there was a serious shortage of trained nurses. On the other hand, the overall quality of the management and service personnel of the elderly care institutions and communities was not high, many service personnel were tired to cope with the work and were weary of it, and it was difficult to meet the growing diversified social needs of the elderly, which affected the expansion of community service items and the improvement of service quality. The job satisfaction of disabled elderly family to social service staff was relatively low. Among them, only a few disabled elderly families expressed their willingness to send the elderly to community service centres. In addition, there was a lack of medical resources in the community. There were only grass-roots health institutions founded by the government in the community, and there was a lack of some professional medical service institutions, such as geriatric care centre, family health guidance institution, community rehabilitation centre, etc. Among them, the cooperative relationship between community medical service institutions and regular large hospitals has not been established.
(Participant): It is said that the doctors in the community health centre are all related households, and were not trained well. Last time I had a headache and fever, and I was prescribed medicine without careful examination. I did not want to go again. Excellent doctors are not working in this kind of small community centers.
The fourth problem is that some departments pay less attention to community care and lack of sufficient propaganda. Some departments and communities did not know recognize the importance and urgency of the community service function. In addition, the government's financial funds are relatively tight. As a result, the community care for the disabled elder women was still in a spontaneous and relatively disordered state of development. Due to the low publicity of the government and the community on various care policies and activities, many disabled elderly families do not understand the government's care policies, and very few disabled elderly families actively participate in the community care. As the disabled elderly are generally older, with low level of cultural knowledge and relatively narrow access to information, it is particularly important to publicize the way of providing for the aged.
(Participant): I just heard about this activity in our community, but I didn't know much about it, and I didn't see any publicity and introduction from the community. We only knew about the nursing home. It's quite new. We haven't gone to see it yet.