Lessons from America’s Home-based Community Care for Seniors

Published in People's Daily
(China) on 08 Aug 2012
by Guangzong Mu (link to originallink to original)
Translated from by Tuo Huang. Edited by .

Edited by Audrey Agot

The global society has gradually come to agreement on community retirement. Building retirement communities has become a trend. Community home-based care for senior citizens in America is exemplary quality elderly nursing, with its offer of good service and premium life, making people feel like wanting to get old quickly.

Recently, [China’s] Standing Committee of the National People’s Congress for the first time has examined the revised draft of Old People’s Rights Protection Act, which reevaluates elderly care and changes the currently law-regulated “family-dependent nursing for the aged” into “home-based care for the aged.”

In terms of building home-based care for the elderly, America has accumulated much experience. Communities feature great elderly nursing functions, which make elderly Americans peaceful at heart and physically comfortable. Because of the life purpose of a healthy regimen, a happy life and good completion for the aged is realized, most elderly American citizens choose community home-based care.

Good lessons can be learned from America’s experience with Home-based Care for Seniors in Communities.

Approaches/Methods to Home-based Care for Seniors

1. The boarding nursery method (“Retirement Family”): Great amenities and services. Facilities include infirmary, library, computer lab, gym, laundry, emergency call system, etc. Services cover dining, room-cleaning, activities and outings.

2. The daycare method (“Senior Nursing Center”): Residence in the center by day and rest at home at night. Daily centers are also equipped with great facilities with start grade services: one-bed, one-room with reading room, health center and activity center. Seniors are not only ensured three healthy meals in the day, but also entitled to readings, socials and making handicrafts, thus living their remaining years in comfort. Other subsidiary services, such as medicine management and special treatments for Alzheimer's disease, are also available upon payment.

3. “Senior Care by Mutual Help” creates partners and pairs among seniors to help each other.

4. On-site service: The U.S. government provides a welfare home-based care program for seniors. Funded by the government, seniors in need are sent home-visiting nurses with healthcare services. Different from nannies, healthcare nurses have received training in nursing knowledge, and are also capable of cooking, cleaning and laundry. Only American citizens with green cards are entitled to enjoy the privileges. Chinese senior immigrants in America generally apply for green cards through their children. Having stayed for enough years to gain American citizenship, the elderly can then enjoy all the privileges for American seniors, including a pension of more than $700 per month and housing insurance, which are all covered by the government.

Recently, aid communities have been developing the fastest. Currently, America has 1,900 Continuing Care Retirement Communities altogether, 82 percent of which are run by nonprofit organizations. Most of them are turned from traditional nursing homes. In for-profit nursing communities, more than 50 percent employ an aid method while less than 10 percent are Continuing Care Retirement Communities.

America’s homecare nursing system gives support to the Home-based Care for Seniors mode. Good-quality, secured senior care should be an “all-four-in-one,” consisting of material guarantees, nursing protection, medical insurance and mental security. A home-care assistant’s job is somewhere between that of a domestic waiter and a professional nurse – they mainly take care of solitary elderly, the disabled and the sick, either at home or residential nursing centers.

In New York City, for instance, each borough has a nursing center that arranges and dispatches homecare assistants. The nursing centers determine the number of days that each assistant serves at his or her patient’s home depending on the elderly’s health conditions and self-help skills. In most scenarios, seniors under good health conditions and capable of helping themselves (usually between the ages of 70 and 80 years old) are attended by a daily homecare assistant who works eight to 12 hours from 8 AM to 6 PM. In the event of any senior getting sick or an emergency occurring, the center will change the number of workdays for assistants. For those under poor health conditions and incapable of helping themselves (usually over 80 years of age), they will be accompanied by assistants all day. Every day, homecare assistants make phone calls from their patient’s home to report their attendance upon arrival. In the meantime, the center’s administrators visit patients, gain feedback from them regarding the assistants’ work performance, heed their suggestions and take advice. Praises and rewards apply to the assistants who have done a good job, while proper critiques, education and fines await those who have done poorly. Homecare assistants’ wages range from $7 to $12 per hour, paid by the nursing center and free for patients.

Also, America has the world’s largest non-profit organization for senior care. Participants pay fees depending on their individual incomes, and the remaining cost is paid for by fiscal subsidies from federal government and social donations. This fully showcases the government’s fulfillment of duties in caring seniors and society’s human care. In general, communities have a tight cooperation with hospitals and specialized health institutions.

The Trend for Community Senior Nursing in China

Aging, solitude and dysfunction are common trends in the elderly population. China’s elderly population above 80-years-old amounts to over 20 million, with the dysfunctional and semi-dysfunctional population being more than 33 million. Demand for community care is increasing every day. In an acquainted community, the elderly can find a sense of security, belonging and love. The significance of community is great for the development of home-based nursing. A home-based nursing community for seniors is the right solution to combat aging for those with few children, solitude and dysfunctionality.

In my opinion, China’s community nursing can be divided into three styles: home-based community nursing, apartment-based community nursing and medical community nursing. Most seniors live in traditional communities, receiving care and mental support from families and friends — this falls into the category of home-based community nursing. Apartment-based communities are specially-designed senior apartments, with complete amenities and professional/individualized services catering to healthy self-maintainable seniors. Medical nursing communities are an outcome of the development of a highly-aged society, mostly catering to the senior population that can’t help themselves. These communities provide long-term medical care to meet the last demand of a good life-ending.

Beijing Sun City is currently China’s exemplary senior nursing community, an excellent example of the senior nursing industry, the pioneer of apartment-style and membership-style senior nursing communities, as well as a model base among 300 care and nursing projects promoted by Ministry of Civil Affairs. In 2011, Beijing Sun City was honored as a “Pioneer of a Green Nursing Community for Seniors” for its design concepts in senior friendliness, intelligence and meticulousness. Beijing Sun City’s medical and all-time Continuing Care Retirement Communities takes different strategies towards seniors under different health conditions. Home-based care mostly applies to low-aged and healthy seniors. Rent-based and medical nursing mostly apply to seniors who can partially help themselves and those who cannot at all. The City hospital regularly invites specialized doctors to offer treatment and cares, so the silver-aged apartment residents can enjoy the best 3-star hospital medical services at their home doors. The precondition of getting high-quality services is expensive, so this kind of nursing system only applies to those who are financially well off.

From ancient times to today, here and everywhere, “healthy regimen, happy life and good completion” are a trilogy in the nursing of seniors and also three key pursuits of a senior life. Currently, China has set up goals to build senior-friendly cities and livable elderly communities. More efforts are needed to establish a senior-friendly society with elderly-comfort communities and happy senior life families, with a work-focus on enhancing service functions in senior communities with home-based care and improving resources for these communities. More importantly, China needs to improve senior aide and nursing services, better senior citizens’ living and life qualities and pay great attention to healthcare and mental care capacities in its traditional communities.


全球社会对“社区养老”逐渐达成共识,打造“养老社区”成为趋势。美国的社区居家养老是“品质养老”的典范,其优质服务和品质生活让人产生快点老的感觉

近期全国人大常委会首次审议老年人权益保障法修订草案,草案对养老重新定位,将现行法“老年人养老主要依靠家庭”修改为“老年人养老以居家为基础”。“居家养老”的提出实际上是要实现从传统的家庭照料到现代的社区照料、老年人的生活单位从家庭向社区的转变。居家养老的实质是社区养老。

在居家养老服务体系建设方面,美国积累了丰富的经验。在美国,社区具备了强大的助老功能,使得美国老人能内安其心、外安其身,实现“安养—乐活—善终”的老年生活目标,所以多数美国老人选择社区养老模式。

美国社区居家养老经验可资借鉴

美国的社区居家养老服务有几种做法:

一是全托制的“退休之家”,设施完备,服务周到。设施包括了医务室、图书室、计算机室、健身房、洗衣房、紧急呼叫系统等。服务包括了就餐、打扫房间、组织活动、出行安排等。

二是日托制的“托老中心”,白天在中心活动,晚上回家休息。中心同样设施完备,并提供星级服务。起居室一人一床,一人一房。还有阅览室、保健室、活动室等。老年人除了不用为一日三餐操心外,还可以阅读、交往、制作手工艺品,安度晚年。

三是组织“互助养老”。让老年人结伴认对、互助养老。

四是提供上门服务。美国政府有一个福利性居家养老项目:由政府财政出钱,派家庭保健护士为有需要的老年人提供服务。家庭保健护士不同于保姆,她们不仅仅为老年人做饭、洗衣、打扫卫生,还得有护理知识。但前提是美国公民,有永久绿卡,才能享受这些待遇。移民美国的中国老人,一般是通过儿女申请拿到绿卡。老人居住年满加入美国籍之后,就能享受美国老人们的一切待遇,每月七百多美元、住房保险等都是国家的事情。

美国家庭护理员制度支持了居家养老模式,真正有品质、有保障的养老必须做到物质保障、照料保障、医护保障和精神保障“四位一体”。家庭护理员介于家政服务员与专业护士之间,主要工作就是照顾住在家里或住宅式护理中心的孤独老人、伤残人士、长期病患者等。 例如,在纽约每个区都设有一个护理中心,护理员由该中心管理调配。中心根据老年人的健康状况与自理能力,决定护理员在服务对象家的天数。一般情况下,老年人健康情况尚好,又有自理能力的,每周安排3天,护理员上午8时上班,下午6时下班,每天8至12小时;如果出现急病或意外伤害,护理中心会调整护理员工作的天数;对于健康情况不佳、又没有自理能力的老年人,每天均有护理员陪伴在他们身边。每天护理员到服务对象家上班时,即在那里打电话向护理中心报到,说明已经到达服务对象家。同时护理中心的管理人员还经常到服务对象家了解护理员的表现,并征求服务对象对护理员与护理工作的意见与建议,对于业绩好的护理员及时予以表扬与奖励,对于表现差的护理员给予适当的批评、教育或处罚。护理员一般每小时工资6至12美元,工资由护理中心支付,服务对象不需付钱 。

美国还拥有目前世界最大的非营利性质的老年照顾机构“居家养老院”。在美国50个州有5000个社区分支机构,拥有美国最庞大的义工队伍,每天都有80万至120万名义工将100多万份热饭热菜送到行动困难或者无法自己解决膳食问题的老人家中。

全球社会对“社区养老”逐渐达成共识,打造“养老社区”成为趋势。美国的社区居家养老是“品质养老”的典范,其优质服务和品质生活让人产生快点老的感觉。入托老年人根据自己的收入情况交费,差额部分由联邦政府的财政补贴和社会捐赠弥补,从中体现了政府的养老责任和社会的人道关怀。

美国养老社区的四种类型

在美国,养老社区一般分为四类:生活自理型社区、生活协助型社区、特殊护理社区,以及持续护理退休社区。一般地,社区与医院和专业护理机构均有紧密合作。其中,生活自理型社区主要面向年龄在70-80岁之间、生活能够自理的老人。生活协助型社区主要面向80岁以上、没有重大疾病,但生活需要照顾的老人。社区提供包括餐饮、娱乐、保洁、维修、应急、短途交通、定期体检等基础服务,并可通过付费方式享受其他生活辅助服务、以及用药管理及阿尔茨海默病(老年痴呆症或老年失智症)的特殊护理。特殊护理型社区主要面向有慢性疾病的老人、术后恢复期的老人及记忆功能障碍的老人。社区内设有专业护士,提供各种护理和医疗服务。持续护理退休社区面向那些退休不久、当前生活能够自理、但不想由于未来生活自理能力的下降而被迫频繁更换居所的老人。为了实现对入住老人的持续护理服务,此类社区一般是生活自理单元、生活协助单元与特殊护理单元的混合。

以上四种模式,生活协助型社区在过去几年发展最快。目前,全美共有1900处持续护理退休社区(CCRC社区),但82%为非盈利性组织所有,其中,相当一部分是从传统养老院转型而来的。对于盈利性的养老社区运营商来说,生活协助型社区的占比通常在50%以上,而CCRC社区占比一般不到10%。

我国社区养老发展的趋势

老年人口的高龄化、空巢化和失能化是普遍的趋势,我国80岁以上的高龄老人超过2000万,失能、半失能老人约3300多万,对社区照料的需求日益增大。老年人在熟悉的社区环境里能找到安全感、归属感和亲切感。依托社区发展居家养老服务意义重大,是积极应对少子老龄化、老年空巢化、空巢失能化的正确选择。

我认为,我国社区养老模式包括了居家式社区养老、公寓式社区养老和医护型社区养老三种。多数长者的养老模式属于居家式社区养老,生活在传统社区中,养老的照料和情感支持主要来自家人和朋友;公寓式社区养老就是专门的老年公寓,有完备的养老设施和养老服务,可以为完全健康和没有丧失自理能力的老年人提供专业的、个性化的养老服务;护理型社区养老属于高龄社会发展阶段会出现的养老社区,主要针对失能不能自理的老年群体,采取的是长期医养护理模式,满足的是老有善终的最后需求。

北京太阳城是目前我国养老住区的典范,也是养老产业的翘楚,是公寓式、会员制社区养老的先锋,也是民政部推动的爱心护理工程300个基地中的示范基地。2011年,北京太阳城荣获绿色养老住区先锋奖,其老年住区宜老化、智能化、细节化的设计理念得到肯定。北京太阳城医护型全程化(CCRC)养老住区对不同健康状况的老年人采取了不同的养老策略:低龄健康老人大多以居家养老为主,半自理(介助)老人和不能自理(介护)老人以租赁式、医养式的养老方式为主。太阳城医院邀请专家医生定期出诊治疗,使得银龄公寓的老年人在家门口享受三甲医院最好的医疗服务。高品质服务的前提是高收费,所以这种养老模式只适合于经济条件较好的老人。

无论古今中外,“安养-乐活-善终”是养老三步曲,这也是老年生活的三个核心追求。目前,我国已经提出建设老年友好型城市和老年宜居型社区的目标,还应该朝老年友好型社会、老年安养型社区和老年乐活型家庭目标做出努力,提升居家养老的社区支持能力、增加居家养老的社区资源供给是着力点。我国更需要在传统的社区中改善助老养老的功能,提高普通老年人居家养老的生活质量和生命质量,重视社区的医养护理功能和精神赡养功能。
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