美国长期照护服务体系对中国的启示

摘要

本文综述了美国长期照护服务体系的服务机构、服务方式和服务提供者及其角色.美国长期照护服务机构可提供长期入住照护、短期入住照护、成人日间照护及居家照护服务,服务方式逐渐从机构服务向居家与社区服务转变.长期照护服务由正式照料者和非正式照料者共同提供,正式照料者提供有偿服务,非正式家庭照料者以女儿(29.3%)和配偶(21.2%)为主,随着居家和社区服务可用性增加,家庭照料者与有偿的正式照料者分担长期照护的可能性更大.美国长期照护服务体系结构完善,准入机制严格且系统,强调服务质量和效果评价,且重视老年人个人意愿,尊重其服务偏好和选择权利.基于美国的经验,我国在探索长期照护服务体系时,应以居家和社区照护为主,充分发挥社区卫生服务机构、社会和家庭的力量,注重服务机构和内容的多样化,建立完善和详细的服务使用评估标准,强调服务质量的有效性评价,体现人性化.%This paper summarizes the kinds of long term care facilities, service delivery organization, service model, service role and experience of long-term service system in the United States. It provides referral implications for China to explore and establish its own long-term care service system. . There is a variety of long-term care services such as short and long-term stay, adult day care, and home care services, with a gradual change from institutional services to home and community ones. Long-term care services are provided by paid both formal and mostly unpaid informal caregivers. Informal family caregivers are most frequently daughters (29. 3%), followed by spouses with (21. 2%). With the increased availability of the family and community-based services, the family caregivers are more likely to share long term care services with the paid formal ones. The United States has a well-structured long-term care service system whose access mechanism is rigorous and systematic, emphasizing the evaluation of service quality and effectiveness. Moreover, the U. S. long term care service system pays more attention on elders' wishes, respecting their preferences and rights of choice on the services. Based on the experience of the United States, China should primarily focuses on establishing a family and community-based long term care service system with a variety of service delivery facilities, give a full play to the community health facilities, social partners, and families. The Chi-nese government should not only give a focus to the service institutions and content diversification, but should as well establish a sound and detailed assessment and evaluation standard system to access the services and assure the effec-tiveness of service quality with a humanized concern.