The present study demonstrates that the elderly have the highest demand for medical and healthcare services, such as regular visits, assistance for referrals, emergency assistance services, and regular physical examination. The availability of professional medical services ranked second as a reason for choosing the location for the provision of care services, possibly related to the majority of the elderly suffering from chronic diseases and poor physical health. In this survey, 90.32% of the elderly suffered chronic diseases, 79.12% had an inability to administer self-care, while almost half of the elderly had a self-rated health status score lower than 60 points. These results are consistent with the study of Han Hu[18] that demonstrates that China has the largest number of elderly people in need of long-term care, with 70% suffering from a chronic disease. Secondly, services in high demand are professional rehabilitation assistance consultation, guidance, and training, etc. As a group with a high incidence of physical dysfunction and disablement, the elderly often require professional rehabilitation training to promote physical recovery, reflected in the survey results, which demonstrated that there was a high demand for rehabilitation guidance services[19, 20]. The elderly's requirement for spiritual and psychological consolation was as high as 81.66%, indicating that the elderly have greater requirements for care services. In addition to traditional financial support, assistance with daily living and other old-age care activities, spiritual problems of the elderly have become increasingly prominent. The elderly not only require physical health, but also have diverse spiritual needs, spiritual and interpersonal communication requirements, cultural entertainment, etc., that reflect their own values[21, 22]. In terms of mental care, elderly care institutions provide the elderly with environmental adaptation, care visits, life companionship, emotional and psychological counseling, and other services to improve their overall quality of life[23].
At present, there are more than 40 million disabled or semi-disabled elderly people in China, and caregivers have constantly increasing demands[24]. There is an urgent need for healthcare professionals with knowledge of medicine, psychology, physiology, sociology, etc[25]. In the present survey, it was found that 78.3% of medical staff in healthcare institutions have training needs, and 72.77% require increased training content. Previous studies have also shown that the current training cannot meet the growing multi-level and diversified needs of health and care services for the elderly[26, 27]. It is also difficult to provide high-quality nursing, medical rehabilitation, spiritual comfort, and other services, so it is necessary to increase the training for comprehensive assessment, rehabilitation and healthcare, chronic management, nutrition for the elderly, humanistic care, etc. In total, 83.6% of nursing staff for the elderly have participated in on-the-job training, but only 53.4% thought that the content was helpful for work, and only 38.9% were very satisfied with the training. In addition to the training content, these observations may also be related to the methods and arrangements for training. Both professional medical staff and nursing staff suggest that more practical training should be provided. Such training can improve the effectiveness of learning, strengthen memory, and when combined with normal work routines, improve the quality of clinical nursing[28, 29]. In terms of training arrangements, the most requested frequency of training for caregivers of the elderly was once per quarter, using phased training, the duration of which should be between 30 to 60 minutes. It is clear that the formation of the elderly healthcare talent team is a long process, which should be gradual, not too rapid, and using processes that do not ignore quality.
The level of education of nursing staff in the present survey was generally low, with only 8.6% having a college degree or above, and only 53.5% having work qualification certificates. This may be related to a reduction in the employment threshold caused by the considerable lack of nursing staff for the elderly. According to surveys, more than 10 million care staff are required in China, while the actual number of employees is less than 1 million[30]. In this regard, the government can, through use of policy guidance, attract more high-quality talent to enter the field of elderly healthcare, improve the overall professional level of the industry, and establish and improve vocational qualification certification and training systems. Professional and technical personnel engaged in healthcare should have obtained the relevant healthcare qualifications, while those without those qualifications should instead have the corresponding job training certification. In addition, the financial and social status of the employees should be improved so that occupational attraction is improved. The salaries and benefits of healthcare workers should be linked to their professional skill levels and the duration and difficulty of the work, so that those who are highly skilled earn more, as would those that work hard. On the other hand, colleges and universities are strongly advocated to offer major degree subjects related to elderly healthcare, introduce incentive schemes for healthcare personnel training, attract students to study healthcare of the elderly through reductions in tuition fees, scholarships, employment subsidies, etc., to improve the reserve of talent.