失能失智老人长期照护动态评估及政策选择

Long-term care is an essential element of public service system when human society enters the aging society. With the rapid increase of aging and old-age population, elders with functional disability or cognitive impairment also increase in China. Long-term care for the elderly with disability has become an important social and public issue in China. This study aims to provide new theories, new ideas and methods for future policies of long-term care system in China by clarifying the basic attribute and theoretical framework of long-term care for elders with functional disability or cognitive impairment based on the theories of public services. This study will measure the category/level of functional disability or cognitive impairment of elders and establish dynamic precise long-term care service standards by using measures such as ADLs and MoCA. This study will also analyze the dynamic hierarchical classification requirements and trends of long-term care by establishing a healthy life table and Cox proportional hazards model for the elderly with functional diability or cognitive impairment. It will set up dynamic financing and payment standards for long-term care workforce by calculating the total cost of the workforce using big data of demography and economics. This study will construct dynamic evaluating index system for long-term care service delivery system by using Structure-Process-Outcome (SPO), and further demonstrate the dynamic regulatory mechanism for long-term care by establishing multilevel structure equation models and a latent variable growth curve model, and predict and simulate long-term care policies for different social and economic development level with the mainstream public policy simulation methods.

长期照护是人类进入老龄社会的基本公共服务制度。随着我国人口快速老龄化和高龄化，失能失智老人大量增加，失能失智老人长期照护已成为我国重要的社会公共问题。本研究基于公共服务等理论，厘清失能失智老人长期照护的基本属性及理论架构，运用ADLs、 MoCA等动态评定老人失能失智类别/等级并设立长期照护动态精准服务标准，编制失能失智老人健康生命表并构建Cox比例风险模型分析失能失智老人长期照护动态分级分类需求及变化趋势，借助人口学、经济学等大数据测算失能失智老人长期照护人力总成本并设立长期照护动态筹资和偿付标准，构建失能失智老人长期照护动态服务提供体系的结构-过程-结果评价指标体系，通过多层次结构方程模型、潜变量增长曲线模型等进一步论证长期照护动态监管机制，借助主流公共政策仿真方法对不同社会经济发展水平下失能失智老人长期照护相关政策进行预测和仿真，旨在为我国长期照护政策规划提供新理论、新思路和新方法。

长期照护是人类进入老龄社会的基本公共服务制度。随着我国人口快速老龄化和高龄化，失能失智老人数量快速增加，失能失智老人长期照护已成为我国重要的社会公共问题。本研究厘清了失能失智老人长期照护的基本属性及理论架构，梳理了我国长期照护体系构建及改革探索历程，剖析了典型发达国家（日本、德国、英国、美国等）长期照护体系构建与改革的政策实践，动态预测了我国2025-2040年失能人口数量和老年失能人口照护费用，评估了我国典型地区的机构、社区、居家等形式的长期照护机构的服务内容、服务等级、分级标准、服务人员及服务成本等情况，深入分析我国失能失智老人长期照护存在的问题以及面临的政策瓶颈、改革进展、发展挑战，结合社区老年居民的长期照护服务需求调查和医养结合机构入住老人满意度调查等实证研究结果，提出了我国失能失智老人长期照护服务体系动态评估及政策选择设想，为优化我国多层次失能失智老人长期照护体系提供了创新思路，为相关部门统筹布局与科学谋划失能失智老人长期照护改革提供了新理论、新思路和新方法。