Research on the Construction Strategies of Community-Based Targeted Elderly Care Service—Based on the Investigation of Elderly Care Services in Y City ()
1. Introduction
Since entering the aging society in 2000, the construction of China’s socialized elderly care service system has made a lot of remarkable achievements, but there are still many problems and deficiencies. The existing supply structure of elderly care service is too extensive to present three major contradictions, namely, the growth of elderly care service demand and the weakening of home-based elderly care service supply, the diversification of elderly care service demand and the lag of public elderly care service supply, and the differentiation of elderly care service demand and the dislocation of social service supply (Li, Guo, & Cai, 2016), hence of the structural imbalance of elderly care service supply and demand (Hu, Wang, & Liu, 2019). Based on the investigation in Y City, it is found that the most prominent realistic dilemma of supply-demand mismatch of elderly care service is the high vacancy rate of institutional nursing beds, the monotonous content and form as well as the low quality and inefficient service level of community-based home care service, and the weakening of traditional family care functions. In the 13th Five-Year Plan for the Development of National Undertakings for the Elderly and the Construction of the Elderly Care Service System, it is clearly proposed to “provide precision, personalized and professional services for the elderly”, which for the first time elevates “precision” to the state strategic height of the elderly care service. To explore the precise elderly care service strategy, effectively connecting the personalized and dynamic elderly care service demand with the multi-subjects service supply, and optimizing the allocation of supply and demand elderly care resources can promote the implementation of the strategic goal of targeted elderly care service, and overcome the mismatch problem between demand and supply under the traditional elderly care service mode.
Because European and American countries entered the aging society earlier, the research on the practice strategy of targeted elderly care started earlier and developed more perfect than domestic ones. The United States provides corresponding services for the elderly with different incomes and self-care conditions (Wang, 2012). Singapore files for the elderly so as to achieve targeted elderly care service. Firstly, community elderly care service institutions are divided into Home Care, Day Care and Stay-in Care from the supply side, and then, corresponding service institutions are selected from the demand side according to the different service needs of the elderly (Xiong, Luo, & Chen, 2021). Japan classifies the elderly according to their nursing insurance, and carries out corresponding care services for the elderly according to the classification (Naruse, Nagata, Taguchi, & Murashima, 2011). Finland is undergoing a long-term and deep degree of aging society. To effectively cope with the impact of the aging population, under the starting point and the center point of the elderly care service demand, by making various of elderly care service policies, optimizing the supplies of service resources, improving the pertinence and effectiveness of service supplies, Finland has built a relatively perfect and targeted elderly care service system (Sui & Cao, 2018), enabling suppliers to provide efficient services timely and accurately.
Due to different national conditions, the domestic researches on targeted elderly care service are obviously lagging behind. The existing relevant literature mainly discuss the implementation strategies of targeted elderly care service from the perspectives of system, market, technology and environment. Xi Heng proposed a layered method of elderly care service to meet the needs of different elderly groups based on the reality of the difference in elderly care needs. The concept of stratified elderly care service here mainly refers to the development of products meeting the elderly care needs, the establishment of an elderly-friendly environment and the provision of care services tailored to the characteristics of the elderly (Xi, 2015). Qing Lianbin pointed out that the government’s purchase of elderly care services should be accurately positioned at two levels: for whom and from whom (Qing, 2015). Li Qiao, Guo Kaikai and other scholars suggested the government strengthen the construction of rural elderly care service system from the state system aspect, carry out supply-side reform of rural elderly care service by adjusting the supply structure of rural elderly care service, and explore the implementation form of targeted elderly care service (Li, Guo, & Cai, 2016). With the development of Internet technology, the academia began to advocate the use of big data of terminal-net-cloud to achieve targeted elderly care through accurate data collection, demand analysis, service supply and collaborative management (Jia, Lan, & Liu, 2019). There are also some other scholars who put forward that, multidimensional rationalities (Du & Kang, 2020) such as technology, value, rules and regulations should be taken into account to solve targeted public service difficulties (Ji & Xu, 2020), like consciousness, technology, system, collaboration which were driven by big data. Elderly people, where they live, what they need and when they need the care service (Zhao, Wang, & Li, 2018) should all be considered to focus on when targeting service objects, service contents, service support (Du & Kang, 2020), so as to explore comprehensive optimization path of targeted elderly care service. From the perspective of environment, the focus is mainly on improving the precision docking of elderly care services by strengthening the construction of smart communities (Wang, 2021).
In the process of localization of social work, the important role of social work for the elderly in participating in social care services has gradually attracted public attention. On the one hand, social organizations, typically on the basis of social workers, are new professional forces that indirectly deliver institutional elderly care services; on the other hand, social work organizations that undertake community-based home care services for the elderly purchased by local government directly meet the needs of personalized elderly care services (Yan & Li, 2020). Social work stations located in towns and streets, which are different from administrative departments and third-party social organizations, can be regarded as grass-roots comprehensive professional service platforms in nature. At the level of social work practice, providing community-based home care services for the elderly is one of the four basic work projects of social work stations, which plays the role of elderly care hub platform in practice. Compared with community self-sustaining non-profit organizations, social work stations uphold the professional social work concepts and have professional working skills advantages. Compared with third-party autonomous social organizations, social work stations located in towns and streets, play the role of governance hub, integrating official resources, social resources and public resources (Yan, 2021), and can fully demonstrate the organic integration effect of “autonomy” and “co-governance” in grassroots governance of “one core and multiple parties” (Ma, 2021).
The above theoretical and practical research accumulation of “targeted elderly care service” provides good reference and inspiration for subsequent research, but there is still some space for expansion and in-depth. From the existing literature, most studies focus on exploring the practice path of targeted elderly care from the perspective of system, market, technology and environment. Social work, which has obvious professional advantages and humanistic care concept advantages in promoting the realization of targeted elderly care service, has not yet been attached importance to by the research community. In particular, the role as integration and practice platform of town and street-based social work stations in carrying out targeted elderly care service has not attracted the academic communities’ attention. Secondly, existing studies mostly focus on the composition and participation mechanism of multiple providers of elderly care resources, while the integration effect of multiple providers of targeted elderly care services is obviously weak. Thirdly, most studies focus on how to improve the precision results of supply and demand of elderly care services, but lack consideration of the local situation and dynamic process when implementing the precision of elderly care.
This study will firstly build a theoretical analysis framework of community-based targeted elderly care service by referring to the concept of Finland’s targeted elderly care service system, describe the imbalance situation of elderly care supply and demand in Y City, and will then analyze the feasibility and practical mechanism of community-based targeted elderly care service mode on top of the special practical experience in N community, J Street, Y City. Hopefully this paper will make a slight advancement in the practical strategies research of social work participating in community-based targeted elderly care service.
2. Theoretical Perspective and Survey Spot
2.1. Theoretical Perspective: Community-Based Targeted Elderly Care Service
2.1.1. The Connotation and Analytical Dimensions of Targeted Elderly Care
The word “Targeted” originated from Taylor’s targeted management concept (Zhang, Wei, & Liu, 2022), and is widely used in China’s social governance fields such as “targeted poverty alleviation”. With the rapid changes of society, the needs of the elderly in China are increasingly diversified and show the characteristics of classified care needs and motivation differences, and there are obvious cascade changes among the needs of the elderly (Hou, 2019). In light of this, the concept of “targeted” has been gradually introduced into elderly care research. Some scholars believe that targeted elderly care service is a system that contains four aspects: accurate identification of elderly care service needs, accurate supply of elderly care service resources, accurate management and accurate support of elderly care supply-demand process (Sui & Cao, 2018). Some other scholars believe that targeted elderly care service is a new elderly care mode that accurately identifies and connects the elderly care needs of different elderly groups and provide them with differentiated elderly care service supply (Zhao, Wang, & Li, 2018; Wang & Zhu, 2016). From the essence of “targeted”, the concept of targeted elderly care service includes the connotation of specialized, diversified and personalized elderly care service (He & Zhou, 2018). From the perspective of the internal structure and mechanism of targeted elderly care, its essence is actually to clarify the issues of “whom to be provided services”, “who provides services”, “what services to be provided”, “how to provide services” and “who supports services” (Du & Kang, 2020).
The existing researches on targeted elderly care service are mainly carried out under the framework of targeted identification, targeted supply, targeted management and targeted support. Among them, targeted identification of elderly care service demand mainly refers to identifying the differentiated characteristics of elderly care demand by using of diversified identification methods and by subdividing the diversified demand of different elderly groups according to certain standards. Although the classification standards vary, the needs of the elderly can be basically divided into survival needs, emotional needs, development needs, sense of value needs, sense of belonging needs and some other aspects (Mu, 2005). The specific ways of demand identification mainly include technological governance (Lei & Ran, 2018), participation of social organizations (Li & Zhang, 2019), and training of evaluator for evaluating the elderly ability (Zhang, 2020). Targeted supply mainly focuses on the subjects, contents and methods of supply (Chen & Gu, 2018). Targeted management emphasizes on the supervision and assessment of the multi providers of elderly care services (Yi, 2019). Targeted support mainly involves external supports such as policy, funds, law, culture and technology (Du & Kang, 2020).
The above four-dimensional analysis framework provides an important theoretical reference for the following study of targeted elderly care. However, targeting is not only just a goal but also a dynamic process of targeted elderly care service. From the perspective of dynamic process, on top of the existing elements analysis of targeted elderly care and under the perspective of social work ecosystem theory, targeted elderly care can be regarded as an ecosystem consisting of elderly care demand, elderly care supply and the interaction between them. Therefore, this study will analyze the practice of targeted elderly care from the perspective of the 3 aspects of the ecosystem which includes targeted identification, targeted allocation and targeted integration.
2.1.2. Community-Based Targeted Elderly Care
Community, as the basic unit where the contemporary elderly live, is the direct field that the practice of targeted elderly care takes place. In the community field, theoretically, the diversified needs of the elderly and the multi providers of the elderly care service are accurately identified and classified at first. Then, the elderly care service resources are accurately dispatched according to the professional, diversified, personalized needs of the elderly. Finally, after matching the supply and demand of targeted elderly care service, targeted and dynamic integration in the process of elderly care service is implemented. In the process of practice, social work stations play the main role of integration, fully exert its social work expertise, value and integration functions, explore and utilize community welfare governance resources and big data resources of smart elderly care service platform and achieve a balance mode of supply and demand of elderly care service that combines humanity and rationality from targeted identification of elderly care needs, targeted allocation of elderly care resources, to targeted integration of elderly care process (see Figure 1). In fact, the relationship between targeted elderly care service mode and community field is mutually constructed. On the one hand, targeted elderly care practice operates in the community field, and its operation process will inevitably have an important impact on the implementation of elderly care welfare policy, the development of elderly care industry, and the development of elderly care culture in the community field; on the other hand, the development of community-based elderly care ecosystem will further promote the practice of targeted elderly care. Therefore, the community-based targeted elderly care service mode is not only committed to
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Remark: This figure is drawn with reference to Xiong, L., Luo, J., & Chen, Y. T. (2021). Study on the Construction of the “Community Plus” Assistance Mode Targeted at the Elderly Group in China Who Have Lost Their Only Child. Journal of Xiangtan University (Philosophy and Social Sciences), Vol. 45, No. 4, 85-91.
Figure 1. Social work participating in community-based targeted elderly care service.
solving the elderly individuals care problems in the community field, but also to promoting the sustainable development of whole community elderly care.
2.2. Introduction on Survey Spot
This study mainly adopts qualitative research method based on the investigation of supply and demand situation under the general elderly care modes in Y City, and is going to explore the possible path to achieve targeted elderly care in the community field from the three analytical dimensions of targeted identification, targeted allocation and targeted integration.
At present, there are about 200,000 elderly people over 60 years old and 30,000 elderly people over 80 years old in Y City, and the total number of disabled people is about 20,000. There are 14 nursing institutions (registered), with nearly 9000 nursing beds. A total of 338 urban and rural community-based home care centers and 139 community-based home care service stations have been built in Y City, covering all areas with home care services. In terms of spatial distribution, the distribution of elderly care service resources in Y City is reasonable. Almost every town or street has at least one elderly care institution, and every community has a home care service center. From June to August 2021, this study took Y City as the survey site, and investigated 2 private-owned public-assisted elderly care institutions, 3 public-owned private-operated elderly care institutions, 3 community-based home care service centers and 3 communities. The reasons for selecting the above survey objects are mainly based on the following two considerations: first, in general, Y City takes the leading position in the exploration of socialized elderly care services in Z Province with rich practical experiences and has certain typicality; second, during the interview with the person in charge of Y City’s Elderly Care Service Guidance Center, the author obtained a statistical summary table of Y City’s institutional and community-based home care service centers. Based on different types of services, the author selected institutions/community-based home care centers/communities located in different regions as survey objects randomly.
In the process of investigation, observation and semi-structured interview were used to collect and sort out data. The contents of participatory observation mainly include the construction of hardware and software facilities related to the elderly in institutions and communities, the staffing situation and the mental situation of the elderly. Semi-structured interview subjects are consisted of the person in charge of the nursing guidance center in Y City, the persons in charge of the nursing institutions, the elderly people living in the institutions, the persons in charge of the community-based home care service centers, the elderly people in the community and the chairmen of the community associations for the elderly. The contents of semi-structured interview mainly include occupancy situation, operation situation and main service contents of institutions, comments and evaluation from elderly people who live in the institutions, overall situation of elderly people in the community, elderly care service contents and utilization situation, etc. The survey specially focused on the community elderly care experience of N community, J Street, Y City.
3. Imbalance between Supply and Demand: The Situation of Elderly Care Service in Y City
3.1. Institutional Care Is the Passive Choice of Some Special Elderly People, Such as Disabled and Mentally Disabled
This study randomly selected 2 private-owned public-assisted and 3 public-owned private-operated elderly care institutions in Y City as the research objects. It is known that, among 200,000 elderly population in Y City, the total number of elderly people who chose for institutional care is only about 3600. Private-owned public-assisted institutions run in a market-oriented mode, with nursing beds allocated according to demand, hence of a higher occupancy rate. In contrast, public-owned private-operated institutions adopt semi-market operation mode. The government comprehensively organizes the size of the institutions, Y City Investment and Construction Group bids for building construction, and private enterprises bid for independent operation. The utilization rate of nursing beds is 12.2% - 82.8%, and accordingly the vacancy rate of nursing beds is 17.2% - 87.8% (see Table 1).
However, there is some homogeneity in the service types and the characteristics of the elderly residents for both of the above institutions. In terms of service types, the current elderly care institutions in Y City basically have three major service types: first, long-term institutional care services; the second is to provide door-to-door home care services, such as bath aid, haircut, housekeeping, food delivery for those villages or communities that did not have a dining room for the elderly and other services; third, full time or day care services for the disabled. It is not difficult to find that the services provided by different institutions of different natures are somewhat homogenous, and it is difficult to meet the differentiated needs of the elderly of different types.
In addition, although there is a slight difference in the proportion of elderly residents in the two types of institutions, they are mainly in semi-nursing or full-nursing needs, such as advanced age, dementia and disabled, accounting for
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Table 1. Utilization of nursing beds in elderly care institutions in Y City in 2020.
about 70% - 90%. The elderly residents who are able to take care of themselves are mainly the orphans and widows living under the standard poverty line, accounting for about 10%-30%.Apart from that, institutional care is not an option for any other elderly with potential care needs.
3.2. Traditional Family Care for the Elderly Is Still the Foundation, but Its Function Is Weakening
This study randomly selected 3 communities in Y City to investigate the general situation of traditional family care for elderly. Although the traditional family care is still the preferred way for the elderly, in the modern society with atomized family structure and accelerating pace of life, the practical pressure of family care is increasing year by year. Firstly, the economic support function is weakening. Prices are rising, the cost of living is increasing, children’s education investment makes families face huge economic pressure, and the expected feeding function from filial generations is less reflected. On the contrary, most healthy elderly people who can take care of themselves still support their filial generations, including but not limited to financial support, daily housework and grandchild care. A study has pointed out that 34.7% of the elderly in China will provide economic support for their children, 65% of the elderly provide daily life assistance for their children, and 5.9% of the elderly in urban and rural areas think their children or grandchildren are “NEET” (Bai, 2021). The second is the weakening of daily care function. The self-care or semi-self-care elderly with chronic diseases usually become a burden to ordinary families, including financial burden, care burden, psychological burden, etc. For the dementia, disabled and advanced age elderly, a small number of families with good economic conditions will hire a nursing staff to serve at home, while most ordinary families and families with difficulties will choose to send them to elderly care institutions. Third, the function of spiritual consolation is weakening. On the one hand, this is due to the pressure of their children’s life; on the other hand, it also dues to the decline of traditional filial piety, the younger generation who are tired of family sustaining, have no consciousness, or spare time or ability to take care of the psychological and spiritual needs of the elderly.
3.3. The Demand of Community-Based Home Care Is Large, but the Service Content and Form Are Too Simple
This study randomly selected 3 community-based home care service centers in Y City for investigation (see Table 2). They are basically funded by the municipal civil affair department, subdistrict offices and community economic cooperatives with a certain proportion of their respective subsidies, operated by community Party branch and the community committee or association for the elderly. After investigation and comparison, it is found that the following problems are very common in the community-based home care service in Y City: first, the service content is very simple. In some poorer communities, only meals are served only to the advanced age people. Another example, the community accommodation service
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Table 2. Basic situation of home care services in Y City.
is very popular in a couple of special communities, while the elderly in other ordinary communities are not able to enjoy this service. Secondly, communities with better conditions fill the empty leisure time of the elderly with the help of elderly associations, cultural halls, community self-organizations and other platforms. But the programs, activities always repeat with no new idea. People’s deeper spiritual needs, such as spiritual comfort and meaning of life, are not answered. Over time, the participation rate is declining, resulting in vacancy of the cultural auditorium after a short hot moment. In addition, the external social service contents are also encountering the boring and repeating problems provided by multi-subjects. Take foot washing and hair cutting services for example, there were social work agencies, voluntary service organizations, elderly care institutions and household companies offering the same services in the same community in the same month, resulting in a big waste of resources and bad social impact. Although the current community-based home care mode offers such simple service contents, it is still welcomed by the overwhelming majority of the elderly in the community, and the happiness of the elderly is significantly improved.
Through the above analysis, we can find that different elderly care modes in Y City have their own advantages, but at the same time, they also have operational difficulties respectively: although institutional care mode is a passive choice for special elderly groups, such as disabled and dementia elderly, it does bear the nursing function together with medical institutions; the traditional family care mode is still the active choice of the vast majority of the elderly, but its functions in economic support, daily care, spiritual comfort, emotional interaction and other aspects are weakening; community-based home care mode has gradually gained social recognition, but the service contents and forms are very simple, the coordination of multiple suppliers is difficult, and there are wastes of repeated care resources. In light of these, the community-based targeted elderly care service mode proposed in this study may be a new attempt to explore the organic operation of the social elderly care service system based on home, supported by community, supplemented by institutions and combined with medical care.
4. Community Oriented: The Realization Path of Targeted Elderly Care with Social Work Participation
At present, the practice of community-based elderly care in China is actively exploring innovative governance modes. The joint governance of multiple providers of elderly care services, such as the government, social organizations and the market, has the support of mature welfare governance theory and the realistic basis for the diversified and personalized needs of the post-modern society (Jiang, 2017). This also provides a theoretical and practical basis for the construction of the community-based targeted elderly care service mode.
4.1. Feasibility Analysis of Community-Based Targeted Elderly Care Service Mode
The realization of targeted elderly care service is actually a social governance system project. Multi-participants and multi-departments cooperative governance is increasingly regarded as the best way to deal with the challenges of post-modern society and stimulate social innovation (Grudinschi, Kaljunen, & Hokkanen, 2013), of which resources integration is the most critical step. Based on the elderly care needs, relying on social work stations in towns and streets as integration hubs, this study proposes to build a community-based targeted elderly care service mode with social work participation from the three analytical dimensions of targeted service demand, targeted service supply and targeted supply-demand dynamic process.
4.1.1. Elderly People in the Community: The Subject of “Targeted Care Demand”
Targeted identification of effective care needs of the elderly is the premise and basis for targeted supply of elderly care services. The starting point and goal of targeted elderly care is to improve care efficiency and the well-being of the elderly. Living in the same cultural background community, the needs of different types of old people are diverse but similar. The efficiency of targeted identification of elderly care needs is usually related to the identification subjects and the identification methods. According to Meyer’s (Meyer, 1983) comprehensive ecological system theoretical framework, the elderly people in the community is a concept containing “system” meaning. The circles system where elderly people live in, including the elderly people themselves, their family, their peer groups, community culture, community environment, which are all important subjects of mining the old people’s real care demands, should be integrated and utilized properly and completely. Personal life experiences, development periods, living spaces, distribution of resources and other communication activities between people and the environment can all be identification objects. As to identification methods, humanism and professionalism in the process of social work participation in demands identification are the dominant factors to improve identification accuracy. Therefore, the identification accuracy of elderly care demands and the accuracy of resources allocation can be improved more effectively by integrating multiple identification subjects, identifing different types of elderly people and their diversified, multi-level and multi-stage care demands via social workers who are professionally trained, adhering to social worker’s humanities value ethics, supplemented by case work, group work, community work and other professional work methods on the basis of community, guided by the care demands of the elderly. All in all, the elderly people in the community are not only the core objects of elderly care services, but also the identification subjects of targeted demands.
4.1.2. The Community for Elderly People: The Field of “Targeted Care Supply”
Community-based home care is still the main choice of most elderly people. Community is one of the key sources of their happiness and sense of belonging. Most elderly people do not want to leave the main environment where their family and social relationships take place. The main reasons lie in that, first of all, the community that the elderly are familiar with can meet their organizational sense of belonging needs, which is also the internal basis for the community-based targeted elderly care practice. On the one hand, the community Party branch and the community committee are the official organizational sense of belonging for the elderly; on the other hand, the elderly people’s family and social relationships are their informal organizational sense of belonging. Secondly, the community membership of the elderly is the guarantee of liberty for the elderly in the community. Community is the field basis of “supply and demand” for carrying out targeted elderly care.
4.1.3. Social Work Stations Located in Towns and Streets: The Hub of “Targeted Integration”
First of all, towns or streets-based social work stations are livelihood projects purchased by government, providing professional social work services for the public. At present, they are mainly undertook by professional social work service agencies which were officially registered in civil affair administration department. They are comprehensive grassroots service platforms administrated, evaluated and supervised by the civil affair administration department. They are also the by-products of professional social work localization in China. According to the author’s survey, the specific service contents of social work stations of Y City are mainly divided into 4 categories, including basic services, research services, empowerment services and governance services. There are total 16 sorts and 69 items, which are carried out in a combination of “order” and “menu” service way. All specific work of social work stations are guided by professional social work theories and practical skills. In essence, the government is buying not just services, but professional services. In this context, social work stations conduct relevant services following the professional theories, knowledge and skills of social work for the elderly in the community under their service areas. The main contents of the field of social work for the elderly include elderly assistance and welfare, elderly family services, medical care services, elderly social adaptation and mental health services, elderly development services, elderly social participation services, etc. The professional work methods of social work such as case work, case management, group work, community work and social advocacy can provide professional support for targeted allocation of elderly care service resources.
As noted above, the government is purchasing professional social work services that go beyond basic services. Social work is a major and profession that serves and helps people and is bound by specific professional values and ethics. The elderly, as a special group, after entering the old age, a series of negative characteristics, such as degenerative changes on various of their physiological functions and psychological cognition, decline of social status, make the elderly service work face great challenges. The professional value and ethics of social work provide the principles to deal with these challenges: humanism, justice, respect, relationship, value, sincerity, trustworthiness, empowerment, advocacy, individuality, development and so on. All in all, social work has strong humanistic care, professional sense of mission, social responsibility, unconditional acceptance of the elderly and their problems, consciousness of respect, sincere care and is easier to get the trust of the elderly (Liao & Li, 2014). All these values and ethics of social work could help to provide professional security for targeted identification care needs.
Last, social work stations have service, empowerment and integration functions. They first offer direct services. One of their main tasks is to provide emotional counseling, spiritual consolation, resources linking and social support network construction for the elderly. The role that social work station plays is positioned as the transformer and provider of government public policies and services, delivering them to the elderly in high quality and high efficiency in accordance with various requirements of different government departments (Yan, 2020). Secondly, they also have cultivation and empowerment function. The empowerment work includes theoretical and practical training for community workers and volunteers, guiding communities and social organizations to explore their own advantages, encouraging and cultivating various community self-organizations, and providing professional supervision for public welfare projects. For example, the social work station of Kanmen Street in Yuhuan city, Zhejiang Province has guided the establishment of literature and art backbone volunteer service team, the health volunteer service team and has also guided Dengta community to create an “embedded” elderly care service project (Zhuang, 2021). Social work stations can not only acknowledge the local community’s human, material and information resources, but also pay attention to excavate the potential advantages of the community, link facilities resources, orderly organize integration, help the service objects within joint efforts via embedding community management system (Chen, 2020). In one word, the profession, value and function advantages of social work stations in towns and streets provide a good internal foundation and external support for the realization of targeted elderly care services.
4.2. The Practical Mechanism of Community-Based Targeted Elderly Care Service Mode
In practice, although Y City has not yet formed the mature experience of targeted elderly care service in a complete sense, the survey found that the practice of elderly care service in N community has got unexpected positive results which have important reference value for the construction of community-based targeted elderly care service mode. N community is an urban community in J Street, Y City resettled from 6 small villages. There are 2286 residents in the community, including 443 people over 60 years old and 189 people over 70 years old. In the transition period of resettlement, the temporary resettlement for the elderly in N community is shown in Table 3. It is found that the elderly people in N center have a higher sense of happiness than those in other centers in Y City. According to investigation, there are three main manifestations: first, the elderly people’s self-rated happiness is high; second, the occupancy rate of N center reached only about 55% at the beginning of its construction in 2020, and it reached 91% at the end of 2021; third, in terms of the elderly care service experience, N community has initially formed an “targeted” ecosystem, whose operation mainly relies on the mechanism of the elderly’s life circles, community organizational sense of belonging and diversified integration effect of social work station.
4.2.1. Life Circles: Multiple Care Needs Targeting
Constructing a community-based ecosystem of targeted demand identification on the basis of life circles of “the elderly in the community”. Targeted identification and evaluation of differentiated care needs of the potential objects are the
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Table 3. The elderly care plan of N community.
basic premises to realize the precision of elderly care services. The target of targeted identification is the care needs of the elderly residents in the local community, and the care needs are often related to the physical health of the elderly, their family members and financial status, formal and informal social support and other factors. Therefore, the objects of targeted identification can be extended from the elderly individuals in the community to the elderly people’s family circle, peer circle, organization circle and other orderly-diversity pattern of life circles. First of all, through daily case visits, door to door home services, social work group activities, community activities and other ways to investigate the communication and interaction between the elderly and their life circles, so as to have a comprehensive and objective understanding of the elderly people’s life experiences, life cycles, living spaces and resources distribution. Then, classify and evaluate the care needs of the elderly under the evaluation criteria of their economic support, medical services, daily care and spiritual consolation according to the priorities of their age, financial status, health status, cultural status, social support and care willingness. Combined with the background of the current era of big data, social workers from social work stations take the community as the service unit and combine the humanized work concept of social work with the digital technology of all kinds of intelligent electronic service platforms to establish electronic files for the elderly and make regular dynamic adjustment.
In the process of the investigation and evaluation of the elderly people’s care needs, the first important thing to ensure is the professional literacy like humanistic concept, communication skills, assessment skills and others that the investigators and evaluators must have. Secondly, fully highlighting the subject status of the elderly and their families, allowing the elderly themselves and their families to participate in the planning process of their care needs, fully reflecting the spirit of self-determination, are the key steps to successfully identify and evaluate the real care needs. Social workers mainly act as helpers and consultants in this process.
4.2.2. Organizational Sense of Belonging: Multiple Care Resources Allocation Targeting
Constructing a community-based targeted care resources supply ecosystem on the basis of organizational sense of belonging to “the community for the elderly”. Social work is always upholding the practice concept of “people-in-context”. And community, as the most direct context of interaction between people and the environment, is an important carrier of social work practice. First of all, social workers embed in the basic living field of the community, explore and integrate the formal and informal resources of the elderly and their community, and evaluate the accessibility of multiple providers of elderly care services, such as the government, elderly care institutions, social organizations, communities and families. The assessment process should also involve the elderly themselves and their families, comprehensively assessing care demands and supplies, and creating a feasible implementation plan of elderly care services. The content of the elderly care plan should include specific service providers, corresponding service content, and respective role boundaries of multiple providers. Secondly, put forward the multi-lateral cooperation among social work stations, community self-governing organizations, official administration departments, social elderly care institutions, and build a community-based targeted elderly care supply ecosystem. According to the results of stratification and classification as well as the allocation plan of care resources, assess the accessibility of elderly care resources in the community context. This way can not only improve the allocation efficiency of care resources, but also maintain the community membership of elderly individuals. It can not only improve the quality of life of the elderly individuals, but also promote the overall development of the community. The social workers act as service deliverers at this time.
4.2.3. Multiple Integration: Dynamic Supply-Demand Process Targeting Management
Constructing a community-based targeted management ecosystem relying on the social work stations which are in dual nature of “state-society”. The completion of the connection between supply and demand does not mean that the relationship between the two remains the same permanently. The sustainability of supply and demand matching process is the inherent requirement of targeted management which mainly includes process management and result management. Process management includes the process of targeted demands identification and targeted resources allocation. In both of the above processes, whether the demands identified are accurate, whether the elderly care plan is reasonable, whether the allocation of resources is valid, whether the service practice is in place, whether the care demands and care supplies changed all need daily monitoring and dynamic adjusting. Results management is mainly reflected in the direct results evaluation of targeted elderly care service and the allocation efficiency of elderly care resources. Whether the elderly are satisfied with the care services and whether the happiness and satisfaction of the elderly are really improved are the key factors to the success of the targeted elderly care service mode. At the same time, the allocation efficiency of elderly care resources meeting the benefit maximization is the most ideal result of targeted elderly care. In addition, the cultivation of culture of helping and respecting the elderly, the construction of intelligent elderly care platform, the top-level policy making, and the support of national and social funds are all indispensable steps in targeted elderly care service management. In this process, social workers act as case managers.
From the microcosmic angle of view, the mode of “town and street-based social work station + community” is a process of case management. On the macroscopic perspective, this mode is a systematic process of resources integration and targeted reallocation. In this process, the government is in the leading position, the community plays the role of practice field position, and the town and street-based social work station is in an axis position, playing the role of integration.
5. Conclusions and Discussion
In view of the structural contradiction between supply and demand of socialized elderly care service resources in China at the present stage, the academic and practical circles have put forward solutions for targeted elderly care. However, the research on the practical path of promoting community-based targeted elderly care service is a theoretical and practical difficulty faced by the current socialized elderly care service, which needs to be further promoted. From the perspective of social work, this paper discussed the practice of targeted elderly care in the community field, and proposed a three-dimensional analytical framework of targeted identification of elderly care needs, targeted allocation of elderly care resources, and targeted integration of elderly care supply-demand process on top of the theory of targeted elderly care service system in Finland. It is found that, through exerting the intermediary hub function of town and street-based social work stations and its social work professional advantages, integrating community resources, and combining with smart elderly care digital technology, it is helpful to accurately identify the elderly objects and their care needs, classify their needs into different levels, optimize the allocation of multiple providers of elderly care services either in forms or in contents, and manage the elderly care service process accurately and dynamically. It is also helpful to promote the effective implementation of community-based targeted elderly care services that can overcome the mismatch problem between supply and demand of existing general social elderly care services, and achieve a balance between supply and demand of elderly care resources.
In terms of the practical strategies of targeted elderly care, this study has the following innovations: first, on top of the achievements that the existing researches have made mainly from the perspectives of system, market, technology and environment, a new research perspective of social work with humanistic care is proposed; second, the practice of targeted elderly care is discussed in the community field, and a new view is proposed that the practice of targeted elderly care is an “organic ecological” system based on the community, and its successful operation is affected by factors such as the life circle of the elderly, the organizational sense of belonging to community and the multiple integration of social work stations; third, it proposes a new practical idea of constructing community-based targeted elderly care service mode by utilizing the intermediary hub function of social work stations located in towns and streets. On the one hand, it has certain enlightenment and reference value for the operation managers of social work stations to optimize elderly care service plans and policy makers to optimize elderly care policies; on the other hand, it also plays an important role in improving the quality of elderly care services for elderly individuals.
The main deficiency of this study is that the case analysis method is adopted, and whether the proposed practice mode of community-based targeted elderly care service on the basis of social work stations located in town and street is universal and scientific needs to be further verified.
Fund Project
A project supported by Scientific Research Fund of Zhejiang Provincial Education Department (Project No. Y202147155).