With the deepening of aging and the evolution of aging trend，Disabled and dementia The size of the elderly continues to grow，How to deal with the growing long -term care challenges of the elderly，Become a challenging public health topic。"Healthy China 2030" Planning Outline clearly proposed，To promote healthy aging、Maintaining the health cycle health，Promote the development of long -term care services for the elderly at home，Establish a multi -level long -term nursing guarantee system。Rooted in the traditional pension tradition of my country、Based on the current pension pattern，Establishing the needs of the elderly for the elderly、Take care of the interests of the provider、Long -term nursing insurance system that maintains family function integrity，It has important practical significance。

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With the deepening of the aging process of population，The scale of disabled elderly people continues to expand，Long -term care burden worsen。At the same time，Modern development has led to continuous reduction of family scale，The family -based long -term care system is facing huge challenges。

On the one hand，The aging process in my country is accelerated，A large number of disabled elderly people are facing care of care。As of the end of 2022，About 190 million elderly people in my country have chronic diseases，Among them, about 44 million elderly people are in disability、Semi -disabled energy status，The latter accounts for 15.7%of the total population of the elderly，That is about 6 elderly people，There is a life who cannot take care of yourself。With age，The proportion of disability also continues to rise，Among the population of 80 and above，Disable、Semi -disabled person accounts for more than 40%，It requires different degrees of medical and long -term care services。Bet365 lotto review Disabled，Family imbalance，Nursing problem of disabled elderly people has become an urgent social problem。

On the other hand，Insufficient social security for long -term care，Family caregivers face outstanding dilemma。Data display，In a developed country，More than 95%of the elderly at home accepts care services provided by families and communities。In our country，Family members are the main forces to provide long -term care，Only 2%of the elderly get market care。But，Guardian disabled elderly is a difficult "long -term project"，Not only must you invest huge costs，You need to devote a lot of time and energy。According to a survey by the Institute of Elderly, Renmin University of China，The average daily care time of family caregivers is about 15.7 hours，far higher than ordinary workers' daily working hours。For the elderly at home, the elderly，The proportion of the spouse as the main caregiver is nearly 50%，For a spouse who is also the same elderly，The difficulty of care can be imagined。Long -term、Ultra -loaded care burden may lead to a negative evaluation of the caregivers for themselves and life，Make it body、Psychological、Disagreement in social adaptation，At the same time, leading to unemployment and economic pressure、A variety of realistic dilemma such as husband and wife conflict and reduction of interpersonal communication。During the modernization of Chinese -style modernization，With the continuous change of the family structure，The challenges faced by family caregivers for disabled elderly people are constantly intensified，The construction of a long -term care insurance system and social service system that needs to promote family friendship urgently。

　The current long -term care insurance policy is insufficient to support family caregivers

Challenges brought about the problems of disability and care for the elderly，The "Thirteenth Five -Year Plan" plan proposes "Exploring and Establishing Long -term Nursing Insurance System"。my country has launched a pilot at the Bet365 app download national level since 2016，Exploring many places has established a long -term nursing insurance system with characteristics。Where，The form and standard of treatment payment are important content of long -term care insurance，It also directly affects the performance of the long -term care function of the family。Current，Payment policies in pilot areas are diversified、Fragmentation characteristics，Not yet forming a mature mode，Especially insufficient support for home care and family caregivers、Policy guidance is different。

First，Some pilot areas implement a single service payment method，Family caregivers and other informal caregivers have not been included in the treatment of benefits。In some areas，Disabled elderly people who enjoy the treatment at home can only choose service payment。For example，Jinan City stipulates that home disabled elderly people can enjoy on -site care provided by designated medical institutions or concentrated in community day care，The highest payment time daily is 4 hours，The highest payment time of the month is 15 hours。Compared with the daily care needs of the elderly for nearly 16 hours，Family caregivers still need to pay a lot of care for labor，But I can't get subsidy support。The original intention of taking service payment is to cultivate long -term care service markets，However, to a certain extent, the functional maintenance of the subject of the family，It also ignored the care of the burden of relative care。

Second，Although some pilot areas implement a hybrid payment policy，But the family care is still "not friendly"。The payment system in some pilot areas incorporates family caregivers into consideration，Elderly people can choose "Cash Pay"，Provide services with family caregivers and obtain care allowances，But also encountered various problems during the implementation process。A type of "cash payment" form is "Buying Family Service"。Take Jingmen City as an example，Family caregivers are included Bet365 lotto review in the research and training management system，and accept strict multiple supervision，Such as electronic equipment remote supervision、The hosting agencies are sent to visit regularly and at irregularities。other，They also need to upload nursing video simultaneously，The only basis for auditing results as the only basis for settlement care costs。A large number of family caregivers report，This brings additional time cost and heavier psychological burden，Especially for some educational levels low、Elderly caregivers with difficulty in using electronic equipment have caused great obstacles。Another type of "cash payment" form is "family care"。Elderly people can also provide care for their relatives，But the family caregiver does not need to take too much audit task，The results of the audit do not affect the payment of nursing subsidies。but，Family care is usually distributed in the form of small allowances，Payment level is at 240-450 yuan/month，Low level is more like a symbolic encouragement to family caregivers，It is difficult to play a supporting role。other，Although cash payment recognizes the value of informal care to a certain extent，But only obtaining a single and meager cash subsidy can not effectively alleviate the burden on the home caregiver。

Overall，In the existing payment design，Either the family caregiver is not considered at all，Either set mixed payment options at the institutional level，Can't flexibly meet the comprehensive needs of disabled elderly and family caregivers。In fact，Informal home care is always an important part of the long -term care system。If long -term care insurance is established，The efforts of the family caregiver are still unable to be fully affirmed，It is bound to exacerbate family care contradictions，Then affect the construction of multi -level long -term care system。

　　Establish a multi -subject coordinated participationMulti -level long -term care service system

my country has 49 national long -term care insurance system pilots，Pilot work achieves staged results，Bet365 lotto review The economic and affairs burden of disabled persons and families is reduced，Non -pilot areas have also proposed the demand for establishing long -term care insurance。Visible，The establishment of a formal long -term nursing insurance system at the national level is imperative。Future，During the expansion of the pilot and the national promotion stage，need to pay attention to integrating experience。Especially in the guarantee object、Payment system and other aspects to form a unified guidance to adapt to my country's national conditions，Multiple guarantees for the elderly and home caregivers for disabled，to build a family、Multi -level long -term care service system for the coordinated participation of institutions and social diversified subjects。

On the one hand，Guide and cultivate long -term care market，Establish a sound social long -term care service system。True funding guarantee into nursing service support for disabled persons，Support of the long -term care service system，Should do everything possible to expand the supply of long -term care services，"Socialization" in a reasonable burden on family care。On the other hand，Integrate into the family perspective in the design of the long -term care insurance system，Building a family -friendly long -term care insurance system。Institutional care cannot completely replace the role of family caregivers，And family care for institutional care is partially alternative，It is necessary to develop market -oriented social care，Encourage and support family members to provide some care services。

First，Promote the establishment of a mixed payment mode in a timely manner，Improve the diversity of benefits to pay。The long -term care plan of the advanced country，Flexible and diverse mixed payment model is the most popular choice，It is conducive to promoting formal care and informal care.。So，Based on a mixed payment mode，Let the beneficiary target achieve three "self -selection" in treatment enjoyment，Protect the beneficiary object and their family caregivers obtain Bet365 app download The most in line with their own care preferences、The most in line with the actual service solution of the family。First, the elderly at home can choose the institution to serve or care for the family to meet what they need。Second, the beneficiary object can choose a designated service agency or other home care service agencies to provide on -site care，Pay with long -term care insurance。Third, when the time is mature，Explore the allowable beneficiary objects to enjoy two or more payment contents at the same time，And can determine the actual payment according to the actual needs of the family、The ratio of service payment and cash payment。

Second，Rich support content for long -term care insurance，The long protection fund with a certain percentage of the columns provides multi -party protection and system support for family caregivers。1 is to draw on the diversified design of long -term care insurance benefits in Germany，Provide a variety of beneficiary options other than cash subsidies for family caregivers，will assist the care service、Nursing auxiliary device rental and purchase、The service fee of the residence environment is appropriately incorporated into the payment scope of long -term care insurance。Second is to reasonably improve the welfare treatment of family caregivers，Family members who care for the elderly at home，can be distributed for it for it、Provide interest -free loans、Purchase personal accident insurance and pay unemployment insurance for workers for workers，You can also provide them with free nursing training courses and psychological support services。Third is to provide a relatively complete all -weather asthma service for family caregivers，Contains a special person for a few days to come to the door for 24 hours care，or institutional short -term elderly service，It is convenient for family caregivers to temporarily separate from the burden of care to deal with private affairs，At the same time to ensure the care and safety needs of the elderly。Fourth is to explore through smart devices、Smart platform and other information bet365 best casino games technology applications，If a nursing robot、Ping An Bell、Electronic Secretary，The convenience of improving home caregivers at home caregivers。

　　(This article is the National Social Science Fund Key Project "Actively Copy the Study on Family Pension Function System in the National Strategy of Population Aging" (21ASH014) phase -based results)

(Author Unit: Population and Development Research Center of Renmin University of China; Institute