Six major aspects of elderly health services

my country's current health service system for the elderly covers six core dimensions: preventive care, medical diagnosis and treatment, long-term care, rehabilitation promotion, psychological counseling, and social participation. This is not an empty theoretical classification in the academic world. It is a practical framework honed from millions of elderly service cases after more than ten years of grassroots pilot iterations. I have been on the front line of community care for the elderly in Shenzhen for 4 years. I have participated in no less than a hundred policy trainings and practical reviews of various sizes, and I have the deepest feelings about this.

Don’t tell me, many people’s first impression of elderly health services is “free physical examinations”. This is indeed the most well-known content of the preventive health sector. Last week, I followed the community family doctor to visit Uncle Zhang from Lianhua North Village for quarterly follow-up. He was squatting in the garden of the community teaching a few old guys how to play Baduanjin. When he saw us coming from a distance, he waved at us and said that his blood pressure has been very stable in the past six months, and his old chronic bronchitis, which he coughed every day before, is much better. This time last year, he was so frightened that he couldn't sleep all night because of the pulmonary nodules detected in his physical examination. Later, we followed up with health guidance for half a year, stopped smoking, and developed the habit of exercising every day. Now his whole state has completely changed. Regarding the allocation of preventive health care resources, there have been different voices in the industry: One group believes that resources for free screening and health education should be directed towards the elderly and disabled elderly people over 75 years old. After all, their health risks are higher. ； The other group believes that the health concept of young people aged 60-70 has just taken shape, and early intervention can reduce medical insurance expenditures in the next ten years. The current implementation policies in various places basically give consideration to both sides. All people over 65 years old have free physical examinations once a year, patients with chronic diseases such as hypertension and diabetes are followed up quarterly, and disabled elderly people are evaluated monthly.

Many family members panic when an elderly person is uncomfortable and insist on running to a tertiary hospital. Even if they bother for a long time, the elderly also suffer. This is actually because they do not understand the medical diagnosis and treatment section of the elderly health service. The current medical diagnosis and treatment for the elderly follows a hierarchical diagnosis and treatment route. Family doctors in community health service centers have a clear understanding of the medical history of the elderly who have signed contracts. Common diseases and chronic diseases can be adjusted and prescribed, and prescriptions can be obtained at home. If there is a need for referral, family doctors can also help connect with the green referral channels of higher-level hospitals, saving a lot of trouble. A family member complained to me before, saying that before he took his old father to a tertiary hospital to see a doctor for high blood pressure, and had to wait in line for 3 hours and 5 minutes to see the doctor. Now he goes directly to the contracted family doctor in the community, and we can chat for 20 minutes each time. The precautions for diet and exercise are clearly explained, and the elderly's compliance has become much higher.

Of course, not all elderly people's problems can be solved by "treatment." We previously took care of an Aunt Li who was hemiplegic after a stroke. Her family members insisted on being hospitalized in a tertiary hospital at first, saying "it must be cured no matter how much money is spent." However, the doctor has long said that the golden period of recovery has passed, and the core need in the follow-up is to maintain the quality of life. This is the service scope of the long-term care sector. Different from the "cure" goal of medical care, long-term care is aimed at disabled and demented elderly people. It covers everything from daily feeding, dressing, and bathing to professional care such as pressure ulcer care and urinary catheter replacement. The most discussed area in the industry right now is the implementation of long-term care insurance. Some people advocate that the national disability assessment standards be unified to ensure fairness. ； Some people also feel that the economic levels of various regions vary greatly, and the reimbursement ratio and service content must be left to local adjustments. The current actual situation is that the country has issued guidance standards, and each locality has refined and implemented them. For example, severely disabled elderly people in Shanghai can be reimbursed for up to nearly 3,000 yuan in care expenses per month. The reimbursement ratio in many central and western cities is around 50%, which is also in line with the actual local development situation.

When talking about Aunt Li, we have to mention rehabilitation promotion. Many people’s understanding of rehabilitation is still limited to “rubbing arms and legs”, but in fact it is much more than that. The rehabilitation therapist we arranged for Aunt Li comes to her home three times a week. In addition to passive limb training, she also provides specialized swallowing function exercises. After persisting for half a year, Aunt Li can now pick up a spoon to eat by herself, and can also walk two steps with a walker. Her family never thought that she could recover to this level before. In addition to physical rehabilitation, there are also cognitive training for patients with early Alzheimer's disease and respiratory function training for patients with COPD, which all fall into the category of rehabilitation promotion. However, there is indeed a huge shortage of professional geriatric rehabilitation practitioners, especially in the field of cognitive rehabilitation. Many second- and third-tier cities cannot find relevant professionals at all. This is also a core shortcoming that elderly health services must make up for in the future.

Physical needs are easy to meet, but invisible emotional problems are the "invisible health killer" for many elderly people. This is also the meaning of the existence of the psychological counseling section. Aunt Wang in our community used to stay at home every day after her husband left. She didn't even bother to touch her favorite braised pork. Her children thought it was because her personality had changed as she got older. Later, when our social worker came to investigate, we discovered that it was an early manifestation of geriatric depression. After that, we came to chat with her twice a week, and took her to participate in the handicraft class at the inn. Now she is the monitor of the handicraft merchant. She leads a dozen old sisters to make sachets and handicrafts every day. She is so busy that she often has no time to answer the phone from her children. Regarding the staffing of psychological counseling, there are also different opinions in the industry: some people think that it must be done professionally by certified psychological counselors. ； Some people also think that community social workers who deal with the elderly every day understand the thoughts of the elderly better and have no sense of distance. Now our implementation method is that general emotional counseling is completed by social workers. If serious psychological problems are found, they will be referred to professional mental health medical institutions. In practice, the effect will be better, and the elderly will not have the resistance of "I want to see a psychiatrist."

Finally, there is another point that many people are not aware of. Health in the elderly is not just about being “free from illness and pain”. Being able to integrate into society and find self-worth is also an important part of health. This is the core of the social participation sector. Our post station now has a "Silver Age Volunteer Team", which are young healthy elderly people aged 60-70. They usually help deliver meals and pick up express delivery to elderly people living alone. During holidays, they also organize trips to tell stories about the past to children in the community. The annual physical examination indicators of these elderly people are generally better than those of the same age group who stay at home every day, and their blood pressure and blood sugar are more stable. Of course, some people think that asking the elderly to volunteer is "torturing the elderly." Our principle has always been that it is completely voluntary, and those who don't want to volunteer will never be forced to do so as they feel comfortable. After all, the core of elderly health is to make the elderly feel happy and motivated.

In fact, after all, these six dimensions are not clear-cut rules. Many services are overlapping. When following up with the elderly, they can not only monitor blood pressure and blood sugar, but also ask if they have been bothered recently. They can also remind him whether he wants to come to the station next week if there are activities. Classification is just to clarify the work boundaries for our service providers, not to set limits on the needs of the elderly. In the final analysis, services that allow the elderly to live comfortably and decently are good elderly health services.