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Promises and pitfalls of integrating home-based health services into Shanghai's elder-care system

Published online by Cambridge University Press:  28 August 2018

Yan-Yan Chen ,
Honglin Chen Open the ORCID record for Honglin Chen [Opens in a new window]  and
Priscilla Song
Yan-Yan Chen
Affiliation:
Department of Social Work, Fudan University, Shanghai, China
Honglin Chen*
Affiliation:
Department of Social Work, Fudan University, Shanghai, China
Priscilla Song
Affiliation:
Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong, China
*
*Corresponding author. Email: chl@fudan.edu.cn
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Abstract

Faced with the dramatic pace of population ageing, the Shanghai municipal government launched a pilot programme in 2013 designed to address this and to strengthen ageing-in-place arrangements by providing basic in-home medical services for residents above the age of 80. Yet after a two-year trial run, the ‘Home-Based Medical Care Scheme for the Oldest-Old’ (HBMCSOO) policy remained significantly under-utilised despite the increasing demand for medical services. Our multi-disciplinary research team of social workers and anthropologists identified two key factors impeding the implementation of home-based medical care services: (a) the distortion of policy implementation and (b) the inadequate professionalisation of community-based elder-care workers. Based on our evaluation of the pilot programme, the Shanghai municipal government made several practical adjustments to improve the subsequent city-wide policy implemented in 2016. While these changes mostly focused on minor adjustments to improve in-home medical services for the oldest-old, they represent an encouraging first step towards our call for a holistic integrated care system whose design and delivery takes into account local political and social contexts, including existing institutional infrastructure and cultural expectations about care-giving responsibilities. The challenges of implementing Shanghai's HBMCSOO policy ultimately provide instructive lessons on best practices for integrating medical and social services in order to improve ageing-in-place measures in diverse local settings around the world.

Keywords

oldest-oldageing in placehome health aideintegrated care modelsocial workanthropology
Type
Article
Information
Ageing & Society , Volume 40 , Issue 3 , March 2020 , pp. 480 - 500
Copyright
Copyright © Cambridge University Press 2018

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References

Baltes, PB and Smith, J (2003) New frontiers in the future of aging: from successful aging of the young old to the dilemmas of the fourth age. Gerontology 49, 123–135.CrossRefGoogle Scholar
Beswick, AD, Rees, K, Dieppe, P, Ayis, S, Gooberman-Hill, R, Horwood, J and Ebrahim, S (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. The Lancet 371, 725–735.CrossRefGoogle ScholarPubMed
Borrell-Carrio, F, Suchman, A and Epstein, R (2004) The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Annals of Family Medicine 2, 576–582.CrossRefGoogle ScholarPubMed
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.CrossRefGoogle Scholar
Cameron, A, Lart, R, Bostock, L and Coomber, C (2014) Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health and Social Care in the Community 22, 225–233.CrossRefGoogle ScholarPubMed
Chen, HL (2015) The Pursuit of Optimal Ageing in China. Beijing: Chinese Science and Literature Press. (In Chinese)Google Scholar
China Daily (2014) China's top ten cities for salaries. China Daily, March 28. Available at http://www.chinadaily.com.cn/business/2014-03/28/content_17383764.htm.Google Scholar
Communist Party of China, Shanghai Committee (2014) Opinions on Further Innovating Social Governance and Strengthening Grassroots Construction. Available at http://www.sh.xinhuanet.com/zhuanti2015/no1/. (In Chinese)Google Scholar
Coulourides, KA, Wilber, K and Mosqueda, L (2016) Moving toward implementation of person-centered care for older adults in community-based medical and social service settings: ‘You only get things done when working in concert with clients’. Journal of the American Geriatrics Society 64, e8–e14.CrossRefGoogle Scholar
Engel, G (1977) The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.CrossRefGoogle ScholarPubMed
Evashwick, CJ (2005) The Continuum of Long-term Care, 3rd Edn. New York, NY: Thomson Delmar Learning.Google Scholar
Fei, X (2013) Xiangtu Zhongguo [Earthbound China], Reprint Edn. Beijing: Zhonghua Shuju Publishing Company. (In Chinese)Google Scholar
Feng, Q, Zhen, Z, Gu, D, Wu, B, Duncan, PW and Purser, JL (2013) Trends in ADL and IADL disability in community-dwelling older adults in Shanghai, China, 1998–2008. Journals of Gerontology: Psychological Sciences and Social Sciences 68B, 476–485.CrossRefGoogle Scholar
Glanz, K, Rimer, BK and Viswanath, K (eds) (2008) Health Behavior and Health Education: Theory, Research, and Practice. Chichester, UK: John Wiley & Sons.Google Scholar
Glendinning, C (2003) Breaking down barriers: integrating health and care services for older people in England. Health Policy 65, 139–151.CrossRefGoogle ScholarPubMed
Glendinning, C, Coleman, A and Rummery, K (2002) Partnerships, performance and primary care: developing integrated services for older people in England. Ageing & Society 22, 185–208.CrossRefGoogle Scholar
Grabowski, DC (2012) Care coordination for dually eligible Medicare–Medicaid beneficiaries under the Affordable Care Act. Journal of Aging & Social Policy 24, 221–232.CrossRefGoogle ScholarPubMed
Greenfield, EA (2015) Support from neighbors and aging in place: can NORC programs make a difference? The Gerontologist 56, 651–659.CrossRefGoogle Scholar
Greenfield, EA, Scharlach, AE, Lehning, AJ, Davitt, JK and Graham, CL (2013) A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages. The Gerontologist 53, 928–938.CrossRefGoogle ScholarPubMed
Guo, X (2016) Community based, family based and prevention first: innovative elderly health service model. Paper presented at the International Conference on Health Social Work for Elders, July 21–22, Shanghai.Google Scholar
Hong, X, Wongtonggkam, N, Ward, PR, Xiaio, S, Wang, S, Peng, Q and Wang, C (2017) Association of demographic, lifestyle factors and serum biomarkers with hypertension in elderly Chinese people. Ageing & Society 37, 661–674.CrossRefGoogle Scholar
Hu, B and Ma, S (2018) Receipt of informal care in the Chinese older population. Ageing & Society 38, 766–793.CrossRefGoogle Scholar
Jones, PS, Winslow, BW, Lee, JW, Burns, M and Zhang, XE (2011) Development of a caregiver empowerment model to promote positive outcomes. Journal of Family Nursing 17, 11–28.CrossRefGoogle ScholarPubMed
Kleinman, A (1980) Patients and Healers in the Context of Culture. An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry. Berkeley, CA: University of California Press.Google Scholar
Kodner, DL (2006) Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons. Health & Social Care in the Community 14, 384–390.CrossRefGoogle ScholarPubMed
Lehning, AJ (2012) City governments and aging in place: community design, transportation and housing innovation adoption. The Gerontologist 52, 345–356.CrossRefGoogle ScholarPubMed
Lei, P, Feng, Z and Wu, Z (2016) The availability and affordability of long-term care for disabled older people in China: the issues related to inequalities in social security benefits. Archives of Gerontology and Geriatrics 67, 21–27.CrossRefGoogle ScholarPubMed
Office of the State Council (2015) Guiding Opinions on Promoting the Integration of Health Care and Elderly Services. Available at http://www.gov.cn/zhengce/content/2015-11/20/content_10328.htm. (In Chinese)Google Scholar
Ouwens, M, Wollersheim, H, Hermens, R, Hulscher, M and Grol, R (2005) Integrated care programmes for chronically ill patients: a review of systematic reviews. International Journal for Quality in Health Care 17, 141–146.CrossRefGoogle ScholarPubMed
Scharlach, AE and Lehning, AJ (2013) Ageing-friendly communities and social inclusion in the United States of America. Ageing & Society 33, 110–136.CrossRefGoogle Scholar
Shanghai Bureau of Statistics (2018) Shanghai Statistical Yearbook 2017. Available at http://www.stats-sh.gov.cn/html/sjfb/201801/1001529.html. (In Chinese)Google Scholar
Shanghai Municipal Government (2018) Policy Interpretation of the Unified Needs Assessment and Service Management Methods for Shanghai Elders Care. Available at http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw41893/nw42233/u21aw1284271.html. (In Chinese)Google Scholar
Shanghai Municipal Government Office (2016) Circular on Comprehensively Promoting the Construction of the Unified Needs Assessment System for Elder Care. Available at http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw51019.html. (In Chinese)Google Scholar
Shanghai Municipal Government Bureau of Human Resources and Social Security (2014) Explanation for Shanghai Basic Medical Insurance Policy for Urban Residents in 2015. Available at http://www.12333sh.gov.cn/201412333/xxgk/zcjd/201410/t20141016_1190663.shtml. (In Chinese)Google Scholar
Shanghai Municipal Government Development Research Center (2016) Shanghai Elder Service Development Report (White Paper). Shanghai: Shanghai Central Press. (In Chinese)Google Scholar
Shanghai Municipal Government Office of the Social Construction Committee (2016) Promotion of Home-based Medical Care Program for the Oldest-old in Shanghai: The Care Workers Providing In-home Service with Certificates. Available at http://gov.eastday.com/shjs/node4/node33/u1ai100851.html. (In Chinese)Google Scholar
Shao, D (2014) An analysis of the health pension model integrated with medical, pension and nursing: taking Sheshan town as a case. Zhejiang Social Science 6, 87–92. (In Chinese)Google Scholar
Taylor, GW and Ussher, JM (2001) Making sense of S&M: a discourse analytic account. Sexualities 4, 293–314.CrossRefGoogle Scholar
Wang, C (2012) The origin, evolution, and contemporary descendent of Chinese filial piety culture. Study and Practice 22, 5–8. (In Chinese)Google Scholar
Wang, Y and Tan, X (2014) Research progress of medical social work in China: based on the statistical analysis of CNKI (2004~2013). Social Work 2, 137–143. (In Chinese)Google Scholar
Wiles, JL, Leibing, A, Guberman, N, Reeve, J and Allen, RE (2012) The meaning of ‘aging in place’ to older people. The Gerontologist 52, 357–366.CrossRefGoogle Scholar
World Health Organization (2007) Global Age-friendly Cities Project. Available at www.who.int./ageing/age_friendly_cities_network.Google Scholar
Xinhua News Agency (2013) Shanghai's Minimum Wage Rose to 1620 Yuan: The Twentieth Consecutive Increase. Available at http://finance.people.com.cn/money/n/2013/0330/c218900-20972808.html. (In Chinese)Google Scholar
Xu, Q and Chow, JC (2011) Exploring the community-based service delivery model: elderly care in China. International Social Work 54, 374–387.Google Scholar
Yang, T (2016) Policy options for long-term care in China. China Social Science 11, 87–110.Google Scholar
Yip, W and Hsiao, WC (2008) The Chinese health system at a crossroads. Health Affairs 27, 460–468.CrossRefGoogle Scholar
Zhou, J and Walker, A (2016) The need for community care among older people in China. Ageing & Society 36, 1312–1332.CrossRefGoogle Scholar