Not long ago, Zhang Zhenghong, a newspaper delivery worker in Harbin, used her care and love to save the 88-year-old man whose life was in danger in time. While being touched by her heart-warming story of her enthusiasm to save people, people are also eager to improve the community home care service mechanism as soon as possible.
It is difficult to innovate the home care service model
Affected by the new crown epidemic, since the beginning of this year, most community day care and social pension institutions have been closed. The reporter recently visited several service centers for the elderly in Harbin, and they are preparing to resume operation services in accordance with the requirements of epidemic prevention and control of relevant units.
A community pension service center in Qunli New District, Harbin City, where elderly residents exercise in a spacious and bright activity room.
Harbin Shouzhiyuan Nangang District Elderly Assistance Service Center is the largest and most functional community elderly care center in Nangang District, which is provided by the Harbin Municipal Government for public housing free of charge, and is built and operated by Shouzhiyuan Pension Service Management Co., Ltd. On October 28, accompanied by the staff, the reporter visited the convenience canteen, comprehensive activity room, auxiliary bathroom, free clinic room, day care room, zoning layout, complete functions. At this time, an old man sneaked in, and he looked forward to opening the business as soon as possible every day. In the past, he ate three meals a day, played ball, chess, sang, danced with his old friends, and was happy every day. Since the center was put into use in September 2018, with the community care center as the center and social organizations, social workers and volunteers as the important service force, it has radiated the surrounding elderly and residents, created a "15-minute pension convenience life circle", and led the innovation of the home care service model in the community of Harbin.
However, in the 9 districts of Harbin City, 141 street offices, and 780 communities, there are only 19 community elderly care centers with comprehensive functions, and only 15 home care service stations with comprehensive functions. In accordance with the requirements of the state and the province, by 2022, at least one community pension service institution with comprehensive functions will be built in each street, and the coverage rate of community day care institutions will reach more than 90%. It is still difficult for Harbin City to complete the task of meeting the standards.
In recent years, Harbin has been committed to building a trinity, integrated development of the old-age service system of "home-based, community-based, institutional supplementation, and medical and nursing care combination", but at present, the development of community home-based old-age care services is far from enough.
The head of the institution is trapped by the "difficulty"
"It's too hard!" This is a sentence that Wang Bin, chairman of the Sangyu Old Service Center in Xiangfang District, repeatedly said when talking with reporters. Affected by the epidemic, the "off-site pension" government purchase service project declared by the center this year failed to be approved, and the funds of the service center were also facing difficulties. He applied to the relevant departments for a community free site to build a day care center, which has not yet landed. Friends repeatedly advised him to give up this public welfare undertaking and switch to other businesses. He is also often shaken, but when he thinks of those "big brothers" and "big sisters" who have relied on him for many years, looking for him when he is sick, looking for him when there is a problem with water and electricity at home, and even talking to him about emotional unhappiness, he really can't bear to give up on them.
The reporter has interviewed the heads of several institutions specializing in community and home care services, and none of them are not trapped by "difficulty".
A difficulty is that the relevant policies and regulations of the old-age service system are not matched. In recent years, Harbin has issued nearly 50 relevant pension policy documents. Wang Bin said that the introduction of the policy is encouraging, but it is difficult to implement it at the grassroots level. In 2017, Harbin issued the "Guiding Opinions on the Construction and Operation of Community Service Facilities for the Elderly in Harbin", requiring communities to provide free space as day care centers and old-age service stations, and governments at all levels should give corresponding financial subsidies. For the priority use of idle assets to develop the pension service industry, planning, land, fire and other departments have their own regulations, which are incompatible with each other. In terms of the integration of medical and nursing care, affected by the current industry management system, medical insurance settlement system and fiscal policies, the relevant work cannot be effectively connected, which affects the in-depth development of medical and nursing care integration.
The second difficulty is that there is a serious shortage of social capital entering the field of pension. According to the relevant person in charge of Shouzhiyuan Pension Service Company, the number and scale of social organizations participating in home and community pension services in Harbin City have a large gap with the demand for pension service markets, and most of them are concentrated in urban areas. In rural areas, limited by the income level of the elderly and other conditions, it is more difficult to connect the supply and demand of old-age services, which has widened the gap between urban and rural old-age services. As an economically underdeveloped area, the development of the pension industry is just in its infancy, and it needs the government to guide it in terms of policy subsidy funds. For enterprises and social organizations that have entered the pension market, there are temporary operational difficulties and need the government to lend a helping hand.
The three difficulties are that the talent team for the elderly care service is extremely scarce. Although it is difficult to find employment at present, the number of elderly care service practitioners is seriously insufficient, the level of specialization is low, the level of income and treatment is low, and the loss of personnel is serious. It is understood that the nursing staff of the nursing institutions work intensively, the time is long, the salary is low, and some pension institutions do not purchase social security for the nursing staff. According to the person in charge of a public pension institution, the medical staff in the hospital will leave after an average of 1 to 2 years. At present, the care centers and stations of Shouzhiyuan Management Company are gradually resuming operation services. In order to retain personnel, the company has been ensuring the payment of personnel salaries for more than 9 months, and the pressure on operating funds is relatively large.
Cracking the problem of home care must be strengthened
Jiang Ou, a researcher at the Institute of Sociology of the Harbin Academy of Social Sciences, has devoted himself to the study of social pension problems for 20 years. She believes that at present, the construction of community old-age service facilities in our province is mostly insufficient and subject to multiple factors. First of all, the target task of the construction of community old-age service facilities is not included in the government performance appraisal for supervision, which is not a "hard indicator", which is naturally not enough attention; secondly, the government financial support is not in place. The policy of our province stipulates that only certain construction subsidies will be given to new community old-age service facilities, and there will be no subsidy support for follow-up operations. Shenyang, which is also the capital city of the province, gives the construction subsidy of up to 600,000 yuan for the construction of the home care service center, the maximum subsidy for the construction of the old service station is 100,000 yuan, and the operation subsidy for the home care service center is given 50,000 to 130,000 yuan per year according to the assessment level, and the operation subsidy for the old service station is 20,000 to 40,000 yuan; then most of the streets have not implemented the "Guiding Opinions on the Construction of Home Care Service Housing in Urban and Rural Communities in Heilongjiang Province", and there are no old service facilities in the built residential communities or the existing facilities do not meet the standards. As a result, there is a serious shortage of old-age service housing in old residential areas. Some communities lack support for the social organizations that operate them, and do not realize that social organizations are helping the government to undertake social pension service work.
Jiang Ou suggested that while encouraging social forces to participate in community old-age services, government departments should guide enterprises with state-owned enterprise backgrounds to participate in the construction and operation of community old-age service facilities, and under the premise of ensuring that the project does not change to the use of old services, by allowing enterprises to undertake government construction projects or allocate land for old-age service facilities for enterprises free of charge, the profit funds or savings will be used to subsidize the construction of community old-age service facilities.
At present, the elderly population over 60 years old in Harbin has reached 2.0969 million people, 96% of the elderly choose to stay at home for the elderly, the elderly prefer is still the home care model of the elderly, and this pension method will last for a long time, and it is urgent for the community to provide professional and diversified old-age services. "Fushou Pavilion" was created with the support of relevant provincial and municipal departments, with health examination services, community pension, home care, day care center as the platform, culture, green health, and characteristic expert TCM outpatient services as the supporting community pension complex, all over the province in many urban areas. Wang Long, chairman of the company, called on the government to formulate a targeted industrial layout plan around the key areas of the elderly, based on demand, driven by projects, created by the government, guaranteed by policies, guided by a number of key projects with strong driving force, cultivated a number of brand-name service products, and improved the ability to serve the old.
Source: Heilongjiang Daily reporter Yang Guihua Su Qiang text/photo
Editor-in-charge: Xiao Jinbiao
Review: Chen Changxin
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