失能老人配偶照料者心理健康及其影响因素研究

利用2015年中国健康与养老追踪调查数据发现,失能老人的配偶照料者心理健康水平显著低于其他家庭的老年人.回归分析证实,被照料者的失能程度作为照料活动的主要压力源,对照料者的心理健康水平有显著影响,但这种影响受到个人资源和社会支持的调节,该影响对女性、受教育程度较低、健康状况较差以及没有其他人帮助照料老伴、不与子女同住、不参与社交活动的照料者更为明显.因此,倡议关注失能老人家庭照料者的心理健康,在社区开展照料者支持服务,以期失能老人家庭照料的可持续发展.     

建构完善的老年人社会照料制度

传统家庭结构变化是中国社会转型的重要特征之一。随着人口老龄化的不断加快,家庭结构变化导致传统家庭养老功能衰减,社会照料服务在老年人权益保障中的地位和功能日益凸现。尤其是面对高龄老人、失能老人、空巢老人不断增多的人口形势,迫切需要推进单一的传统"家庭养老"方式向"家庭养老"与"社会养老"结合方式转变。借鉴东亚国家和地区的经验,在现有地方立法和相关政策的基础上,通过修改现行老年人权益保障法,建构完善的老年人社会照料制度,具有重大现实和战略意义。完善和发展老年人社会照料制度,需要通过立法固化"居家照料为基础、社区照料为依托、机构照料为辅助"的社会照料模式,系统地构建老年人社会照料服务体系;需要加强社会照料职业教育和培训,促进社会照料服务职业化建设;尤其需要突出社会照料服务中的政府责任,包括促进和监管职责;并且需要鼓励和支持老年人社会照料志愿服务事业的发展。     

构筑家庭照料者社会支持体系

在拥有家庭养老传统的中国社会,以成年子女为主的家庭成员一直是老年长期照料的主要力量。尽管家庭照料模式正在受到人口老龄化、城市化进程和家庭结构转变等社会现象的剧烈冲击,但家庭依然是老年人的主要照料来源,为国家节省了大量长期照料开支。与此同时,家庭成员在照料老年人的过程中也面临着极大的挑战,     

城市失能老人家庭照料的困境及应对——以北京牛街为例

在我国,家庭一直以来承担着老年人长期照料主要角色,但伴随着人口老龄化、高龄化、家庭小型化等趋势,以及家庭照料功能弱化、社区和机构在针对失能老人服务上的缺位,使得家庭内非正式照料显得势单力薄.而十年之内,独生子女一代父母将陆续进入老年期,届时老年人照料问题必然给家庭、社会、经济带来挑战.     

城市失能老年人照料资源分布及照料满意度的实证研究——以北京市西城区为例

失能老年人是一个对长期照护服务需求更高的群体。目前城市失能老年人的照料满意度较高,但仍存在提升的空间。在中国加快建立社会化养老服务体系,构建老年人长期照护制度和支持性服务体系的过程中,城市失能老年人的照料资源仍然主要来源于家庭,对社会化的照护服务使用较少且满意度较低。城市失能老年人的健康状况、丧失自理能力持续的时间、照料存在的问题以及照料提供者对其照料满意度影响显著。提升城市失能老年人的照料满意度和生活质量,需要发挥政府和全社会的共同力量,大力弘扬孝亲敬老的传统美德,促进家庭和谐健康发展,实施家庭照护支持政策和项目,建立居家、社区、养护机构联动工作机制,培育专业照护人力资源,汲取国外先进经验。     

美国：老年人家庭照料者支持项目（NFCSP）

家庭是为老年人提供长期照料的主要渠道,家庭照料不仅能节省大量的机构照料成本,也有利于老年人的身心健康。但家庭照料者在照顾老人时,需要付出巨大的情感、身体和经济代价。研究表明,美国22％的照料者同时照顾2个老人,8％同时照顾3个或更多老人。美国有近一半的照料者已经超过50岁,他们自己也将成为老年人,健康也更容易受到损害,三分之一的照料者认为他们的健康变得越来越差。     

城市居家养老生活照料体系研究

建立居家养老生活照料体系,解决现阶段居家养老老人照料问题,必须走政府、社区、家庭和个人相结合之路,即老年人个人自助、家庭支助、社会化服务相结合。具体来说,必须发挥老年人自身作用,积极自养;继续鼓励和支持家庭照料;进一步加快发展老年社会化服务事业,积极发展社区服务。在我国居家养老生活照料体系中,国家居主导地位,它提出社会整体性老年照料体系的构想,制定居家养老服务的法规政策,确立居家养老服务的整体发展规划,做好居家养老服务的经费预算、综合协调和有关监管工作。社区为体系发挥功能的基本载体,要建立健全功能齐全的社区服务网络。家庭为体系的基石,它在养老体系中的核心地位应该予以保持和加强。老年人个人是照料体系的主角,要大力提倡自信、自强、自助、互助,充分发挥老年人个体的主观能动作用。     

老年人日常照料的角色介入模型

本文在总结国内外老年人照料研究的基础上,提出老年人日常照料的角色介入模型,其核心是三个规律：即（1）成本命题：一个角色介入老年人日常照料的成本越大,其介入照料的概率就越低;（2）邻近命题：与被照料者的地理和社会邻近度越高,照料角色介入的可能性就越高;（3）责任命题：对被照料者的责任感越高,照料者介入的可能性就越大。由此三个命题所延伸出的六个假设,通过多元正态概率模型对2000年“中国城乡老年人口状况一次性抽样调查”的原始数据进行分析,结果显示,多数假设得到数据的支持。这一研究结果对厘清老年人照料的社会化和家庭照料之间的关系及其理性的公共政策选择,提供了新的视角和理论依据。     

老年人健康状况及家庭照料资源的社会性别分析

对于步入晚年的老年人口而言,身体健康状况和照料资源是关切其生活质量高低的最主要因素.处于不同婚姻状态和居住方式的老年人,其健康状况和可获得的照料资源也截然不同.目前我国正在大力发展的以满足老年人居家养老需求为宗旨的社会服务体系建设,既是对老年妇女在健康状况和照料需求上面临的困境和特殊需求的揭示,更具有非常现实的政策指导意义.本文立足于近年来有关老年人健康以及婚姻、居住状况的分性别调查研究成果,以社会性别为研究视角,对我国老年妇女群体健康医疗和家庭照料资源的享有状况进行了梳理和阐释.     

上海：倾力打造老年人照料需求评估体系

背景上海建立老年人照料需求评估体系,主要基于两方面：首先,快速老龄化形势下老年人照料服务需求日益增长。随着人口老龄化、高龄化、家庭小型化进程的加快,人均预期寿命延长,老年人护理期也随之延长,但同时家庭对老年人的照料功能逐步弱化,社会化照料服务需求不断增长。其次,社会化养老服务的提供总量不足。目前,上海拥有养老床位数5万张,占60岁及以上老年人口的1．9%,社区居家养老服务人数为5．5万名,占60岁及以上老年人口的2．1%,两者相加,社会化养老照料服务的覆盖面仅占老年人口的4%。照料服务需求与供给之间不相匹配,存在差距。     

社会资本:破解“空心化”农村养老困境的现实选择——以H村为例

农村"空心化"已成为中国社会经济发展过程中中西部地区的一种普遍现象,年轻人的流失突显了农村的养老问题。在年轻人回乡事亲孝亲和农村社会化养老服务在短时间内都难以做到的情况下,加强农村社区社会资本建设,以协助老年人解决日常生活中的困难,成为破解"空心化"农村养老困境的现实选择和可行之路。     

The FACES Project: an academic-community partnership to improve end-of-life care for families

This article reports on a research partnership between a community-based hospice and a graduate school of social work. The purpose of the collaboration was to design and test a tool for assessing caregiver strain and resources in families caring for older adults receiving hospice home care services. Eighteen hospice home care social workers interviewed 162 caregivers for the study and provided their own assessment of the tool's clinical utility. Both strengths and challenges of the collaboration are evaluated and implications are discussed for social work practice and research, particularly academic-community research partnerships.     

Continuing to Pay: the Consequences for Family Caregivers of an Older Person's Admission to a Care Home

This paper aims to discuss the reasons why caregiving in the community had ended for a sample of dependent older people, two-thirds of whom had dementia. Comparisons are made between the situation of a spouse caring for a partner and a daughter or son caring for a parent in a separate household. Spouses in the study had often sustained a greater burden before caregiving collapsedthan had daughters or sons. They were less likely, however, to have had support from the home care service. When caregiving in the community ended and the dependent older person entered a care home, family caregivers themselves often had a financial price to pay. Currently spouses have a legalliability to contribute to a partner's care costs. The implementation of this liability depended on individual local authority policies and the views of the individual social worker doing the financial assessment. Because of the UK's means-testing rules, daughters and sons were often penalizedbecause a parent's assets that they might have inherited had to be used to meet the care home costs. Resentment at being disinherited was related to the daughter's or son's family situation. Those with children or grandchildren themselves were far more likely to be angry than those without children.     

Effects of sharing the parental leave on pensioners’ poverty and gender inequality in old age: A simulation in IFSIM

Female old age poverty is affected by family policy reforms which are meant to promote gender equality when young. Using our in house agent based simulation model IFSIM we show that sharing equally the parental leave can increase or reduce poverty among elderly women depending on the macro and behavioural (i.e. labour supply) responses that the reform off-sets. In general, the reform can be good for highly educated women, who will have an incentive to work more full time thanks to their higher earnings, which can compensate any loss in household income due to the man's staying home. For lower educated however, work might not pay as much and a reduction in labour supply might actually ensue (e.g. to reduce childcare costs). This will reduce also their pension rights at retirement. Furthermore, keeping men at home might slow down economic growth, and consequently growth of income pension accounts will be lower. This effect, combined with lower pension contributions (due to reduced labour supply), might result in higher poverty rates for women with lower education, compared to a scenario where the woman takes the whole leave. Other policies, such as more subsidised child care, might be an alternative worth considering to reduce female poverty in old age more evenly across educational levels.     

Caregiving Around the Clock: How Women in Nursing Manage Career and Family Demands

Nursing is considered a woman friendly profession; however, career advancement in nursing, as in other fields, is predicated on masculine models of promotion, making mobility difficult for working mothers. To learn more about how women negotiate caregiving responsibilities at home and at work, focus groups were conducted with 26 ethnically and socioeconomically diverse registered nurses, licensed vocational nurses, and aides. Three themes emerged from these discussions: tension between the value nurses assigned to paid caregiving and societal devaluation of this work; "costs" of paid caring and emotional labor on family life; and the presence of both obstacles to and opportunities for career advancement. Caregiving experiences were shaped by professional status. Implications for women's well being and career advancement are discussed.     

昆明市老年妇女的社会支持系统研究

老年妇女是社会中的弱势群体,她们安享晚年的重要因素是经济供养、生活照料和精神慰藉,而这些资源需要社会支持系统来提供,社会支持系统的强弱直接影响老年妇女的生存质量。本研究采用定性和定量分析的方法,对昆明市10所养老机构和18个社区中的785位老年人进行深度访谈,分析了昆明市老年妇女社会支持系统。研究表明：昆明市老年妇女的社会支持需求广泛、经济供养渠道多样、生活照料功能弱化、精神需求强烈。在此基础上,提出了相应的政策建议。     

Informal care in Sweden: a typology of care and caregivers

This study describes and analyses the types of informal care provided in Sweden and whether it is possible to distinguish different types of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61 per cent. The results showed that there were large differences in the numbers of male and female carers when the data were divided into a typology of care categories based on different caring tasks. Women were much more likely than men to be involved at the 'heavy end' of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely to provide some kind of practical help for a mother or a neighbour/friend. Even though the Swedish welfare state has been described as universal and characterised by an extensive system of benefits and services intended to cover the entire population, the results here indicate that informal care plays an important role and that the gender role patterns are similar to those observed in other types of welfare state. When discussing support systems it is important for social policy to develop programmes that take into account the support needs of both caregivers and care recipients, and not to see their needs in isolation from the social care system as a whole.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

Early intervention and holistic,relationship‐based practice with fathers: evidence from the work of the Family Nurse Partnership

This paper seeks to add to the literature on working with fathers by focusing on early intervention. It draws on research into fathers involved in a home visitation service delivered by the Family Nurse Partnership in England and evaluates the men's experiences of the intervention. The vulnerability of fathers was striking and many were helped to develop their practical skills and confidence in caring for their babies. The intervention was effective because of the quality time that was invested in developing relationships with fathers (as well as mothers), the focus on their strengths as well as areas for improvement and the skilled, therapeutically oriented, holistic approach through which the service was delivered. The ‘early’ nature of the help was crucial to its success because of how it so effectively tapped into the men's redefinition of themselves as caring fathers during pregnancy and following the birth. We argue that there is important learning here for social care and health services in general about how to engage men and promote fathers' capacities to care for their children.     

Discharge procedures for mentally ill people: The prespective of former psychiatric patients on their professional social network

The analysis of the perspective of mentally ill people on their social network is not complete if the professional arena is left out. This article draws on literature about social network and other forms of human interaction to support the social network concept and an idea about how the professional arena has developed and become a vital part of the network. Fifty-three former patients were interviewed to get their perspective on the professional network. Intimate relations with family and friends seemed to be a model even for contacts with professionals. A social psychological analysis of the satisfaction of the long-term mentally ill respondents with relations to home care workers and their dissatisfaction with psychiatric professionals seemed to be connected to the professionals' ability to undertake a caring relationship.