Satisfaction of Elderly Residents in “Embedded” Nursing Homes
and Its Influencing Factors Analysis
—— A Case Study of Shanghai
Wen Haihong, Wang Yihuan
1
, Wang Yihuan
2
(1. Xi’an Jiaotong University, School of Public Policy and Management, Shaanxi Xi’an 710049; 2. Renmin University of China, School of Public Administration, Beijing 100872) Abstract: “Embedded” nursing homes, as an emerging elderly care service model, fully combine the dual advantages of community-based home care services and institutional care services, compensating for the shortcomings of both, and should become one of the important models for social forces to engage in elderly care services. Utilizing survey data from Shanghai, based on the SERVPERF model, this study analyzes the satisfaction of elderly residents in “embedded” nursing homes and its influencing factors. The research finds that more than half of the elderly express dissatisfaction with the services provided by “embedded” nursing homes. The main factors affecting satisfaction with “embedded” nursing services include policy support, informatization facilities in nursing homes, the richness of service content, the professional level of service personnel, the degree of disability of the elderly, educational level, and pension level. Therefore, to promote the vigorous development of “embedded” nursing homes and the supply-side reform of elderly care services, the study provides recommendations for improving policies for “embedded” nursing services and establishing a collaborative mechanism between communities and “embedded” nursing homes.Keywords: “Embedded” nursing homes; elderly care service satisfaction; SERVPERF model; supply-side reform of elderly care services; community-based home care services 1. IntroductionChina will enter a deeply aging society around 2025, with more and more elderly people beginning to receive pensions and enter their later years of life
[1]
. The report of the 19th National Congress of the Communist Party of China clearly states the need to “fully establish a multi-level social security system that covers all people, coordinates urban and rural areas, clarifies rights and responsibilities, ensures moderate protection, and is sustainable.” Therefore, at this stage, it is necessary to fully mobilize the market entities, social forces, and even families and individuals to rationally and orderly promote the multi-level development of elderly care services
[2]
. Currently, the development of community-based home care services in China has achieved certain results, but there are still issues such as an immature home care service system, weak infrastructure, and lagging talent development, which to some extent affect the participation and satisfaction of the elderly
[3]
. At the same time, due to limited resources, high costs, and traditional concepts of elderly care, there is a serious mismatch between the number of beds in nursing institutions and actual demand, leading to a significant waste of idle beds
[4]
, urgently requiring innovation in the combination of elderly care service models. Therefore, the “embedded” elderly care model has emerged, which not only integrates the advantages of community-based home care services and institutional care services but also overcomes their limitations.Shanghai is one of the first cities in China to enter aging and has the highest degree of aging, taking the lead in exploring the “embedded” elderly care model. In February 2017, the Shanghai Municipal “Two Sessions” proposal pointed out the need to promote the “embedded” community elderly care model, improve the vocational training system for elderly care workers, and focus on pilot projects for community-based embedded, multifunctional, and comprehensive elderly care service institutions, achieving certain results and providing experience for the nationwide promotion of the “embedded” community elderly care model. In April 2017, the Ministry of Civil Affairs and the Ministry of Finance issued a notice on the first batch of central financial support for home and community elderly care service reform pilot work, indicating the need to coordinate and integrate a batch of idle social resources for home and community elderly care services, focusing on increasing the establishment of “embedded” home and community elderly care service facilities and institutions. Therefore, to meet the diverse elderly care service needs of community elderly people, it is necessary to establish and improve a multi-level and multi-pillar elderly care service system. In the future, provinces and cities should actively explore the “embedded” elderly care model based on their actual conditions, which has important practical significance.2. Research StatusThe concept of “embeddedness” was first proposed by Hungarian philosopher and political economist Karl Polanyi, who believed that individual actors are embedded in specific social relationship networks
[5]
. In the 1980s, Granovetter built on this to propose the theory of social embeddedness, pointing out that no individual actor exists in isolation but is embedded in specific social structures and networks to obtain information, emotions, services, and social support
[6]
. The “embedded” elderly care model is proposed based on the above concepts, where “embedded” nursing homes rely on the community, fully integrate into the community, and achieve a model of “local care” without leaving the familiar social relationships and living environment of the elderly, fully combining the dual advantages of community-based home care services and institutional care services
[7]
. However, due to the obstruction of traditional concepts of elderly care, limitations in community scale, land use, and construction funding, the “embedded” elderly care model faces many problems and challenges. Currently, the scale effect of “embedded” elderly care in China is at a disadvantage compared to community and institutional elderly care, with government planning concepts and policy implementation for “embedded” elderly care lagging behind, insufficient community elderly care service facilities, low occupancy rates of “embedded” nursing homes, high operating costs, low returns, and difficulties in coordinating community management and corporate operations being common issues
[8]
. To actively promote the development of “embedded” nursing homes, some scholars have proposed to relax and lower the construction thresholds for “embedded” nursing institutions, actively provide other supporting preferential policies, increase financial subsidies, offer certain land and tax incentives, and strengthen the supervision of special preferential policies, as well as establish a collaborative mechanism between communities and nursing homes to support and supervise each other, along with a series of policy recommendations to improve and perfect the “embedded” elderly care model
[9]
. Satisfaction with elderly care services is one of the important indicators for measuring the quality of elderly care services, and the satisfaction of the elderly with different elderly care service models will determine the development of elderly care services in China as it enters a deeply aging society and the era of the “silver wave”. Currently, existing research has evaluated community-based home care service satisfaction and institutional elderly care service satisfaction based on customer satisfaction models, using the SERVQUAL scale, setting different dimensions according to service categories and service attributes
[10-11]
. Some studies have used structural equation models to construct a satisfaction model for urban elderly home care that includes factors related to the living environment of the elderly, and introduced the commonly used structural equation model multiple-group analysis method from sociology and psychology to analyze the satisfaction of different elderly demographic groups in various communities with home care services
[12]
. Based on Maslow’s hierarchy of needs and customer satisfaction theory, a satisfaction model for integrated medical and elderly care services has been constructed using structural equation models, and statistical software such as SPSS and AMOS has been used for empirical evaluation and analysis of the satisfaction of elderly residents with integrated medical and elderly care services
[13]
[14-15]
. The level of satisfaction with elderly care services is influenced by various factors, including macro-level policy factors, meso-level community factors, and micro-level individual factors. Macro-level policy factors mainly focus on whether elderly care service policies are complete, whether the government provides financial subsidies, land, and tax incentives to communities and institutions, and whether it encourages social capital to establish “embedded” elderly care services through sole proprietorship, joint ventures, cooperation, joint operations, and shareholding methods
[16-17]
. Meso-level community factors mainly include the recognizability of the community name, the construction of community elderly care facilities, the convenience of services, the richness of service content, whether the community elderly care service management mechanism is sound, the number of professional service personnel, and their business quality and level
[18]
. Micro-level individual factors refer to the elderly’s gender, age, educational level, living status, self-care status, income status, marital status, quality of life, pre-retirement occupation and income status, class identity, and participation in community elderly care services
[19]
. In summary, existing research has defined the concept and advantages of “embedded” elderly care services and analyzed the satisfaction of elderly care services and their influencing factors. However, there are still some areas that need further exploration: first, existing research is mostly descriptive and lacks quantitative analysis using statistical methods on the satisfaction of elderly residents in “embedded” nursing homes and its influencing factors. Second, there is a lack of research on the satisfaction of elderly residents in “embedded” nursing homes from the demand side perspective. Therefore, this article first evaluates the satisfaction of elderly residents in “embedded” nursing homes based on the SERVPERF model from five dimensions: tangibility, reliability, responsiveness, assurance, and empathy; secondly, it analyzes the factors influencing elderly satisfaction from the government, community, and individual levels through multiple linear regression analysis; finally, it proposes relevant policy recommendations, which are of significant practical importance for promoting the vigorous development of “embedded” nursing homes, pushing forward the reform of elderly care services from the supply side, and meeting the diverse elderly care service needs of the elderly.
3. Research Design(1) Theoretical ModelBy reviewing domestic and foreign literature on elderly care service satisfaction and its influencing factors, this study analyzes the factors affecting the satisfaction of elderly residents in “embedded” nursing homes from three levels: government, community, and individual. Government factors include policy support and financial support; community factors include informatization facilities in nursing homes, the richness of service content, the number of service personnel, and the professional level of service personnel; individual factors include the elderly’s age, degree of disability, educational level, and pension level.Since the dependent variable is the satisfaction of elderly residents in “embedded” nursing homes, which is a typical numerical variable, a multiple linear regression model is used to explore the influencing factors of satisfaction of elderly residents in “embedded” nursing homes. The article decomposes the dependent variable satisfaction of elderly residents in “embedded” nursing homes based on the Likert scale into “very satisfied=5; relatively satisfied=4; generally satisfied=3; not very satisfied=2; very dissatisfied=1”.
y=b0+b1x1+b2x2+⋯+bkxk (1)
Where:b0is the constant, b1, b2, …, bkare the partial regression coefficients, which indicate that when other independent variables xj(j≠i) are fixed, the average change in the dependent variable y for each unit change in the independent variable.(2) Research Hypotheses1. Government FactorsPolicy formulation and financial investment are important prerequisites for the establishment and effective operation of “embedded” nursing homes. With the further opening of the elderly care service market, encouraging foreign investors to establish non-profit nursing homes, and allowing them to enjoy the same preferential policies as non-profit nursing homes established by domestic investors, lowering thresholds, broadening access, and simplifying procedures
[19]
. The development of “embedded” nursing homes must be based on sufficient funding. For non-profit nursing homes, the government must increase initial financial investment and broaden financing channels to support the development of nursing homes, ensuring high-quality elderly care services
[20]
. Based on this, the article proposes research hypotheses H1-1 and H1-2, as shown in Table 1.
2. Community Factors
The community is an important living place for the elderly after retirement. One of the important reasons why “embedded” nursing homes can develop rapidly and are welcomed by a large number of elderly people is the close integration of “community” and nursing homes, like a “nursing home without walls,” allowing the elderly to enjoy diversified and professional elderly care services while not leaving the warmth of home. The level of informatization facilities in nursing homes has a positive incentive effect on improving the satisfaction of elderly residents. At the same time, to promote the vigorous development of “embedded” nursing homes, a stable, high-level, and high-quality elderly care service team is urgently needed to provide rich service content to meet the personalized, diverse, and multi-level elderly care service needs, achieving a transformation of elderly care services from “quantity” to “quality,” thereby enhancing the satisfaction of elderly residents
[21]
. Based on this, the article proposes research hypotheses H2-1, H2-2, H2-3, and H2-4, as shown in Table 1.
3. Individual FactorsThe elderly, due to their different ages and degrees of disability, will affect their willingness to participate in community home care services and their satisfaction with “embedded” community elderly care services. Elderly people who are older and have a higher degree of disability usually rely on various services provided by nursing homes and can receive more comprehensive care, leading to relatively higher satisfaction with services
[22]
. For elderly people with a higher educational level, in addition to basic life care, they also urgently hope to have opportunities and platforms to participate in cultural and sports activities to achieve self-actualization, and their expected service content and level are often higher, leading to some dissatisfaction with the services currently provided
[23]
. The level of pension is one of the important indicators for measuring the living standards of elderly care services. Elderly people who participate in pension insurance and have higher pension benefits can enjoy more types of services and thus have higher satisfaction. Although since 2005, the pensions of retirees in China have increased for thirteen consecutive years, from an average of 714 yuan/month to 2,875.92 yuan/month in 2017, the gap compared to the nursing home fee standards is still large
[24]
. Based on this, the article proposes research hypotheses H3-1, H3-2, H3-3, and H3-4, as shown in Table 1.(3) Variable Observation1. Dependent VariableThe satisfaction of elderly residents in “embedded” nursing homes is set as the dependent variable.2. Independent VariablesBased on the above theoretical analysis, the factors that may influence the satisfaction of elderly residents in “embedded” nursing homes are divided into government factors, community factors, and individual factors. Independent variables include policy support, financial support, informatization facilities in nursing homes, richness of service content, number of service personnel, professional level of service personnel, elderly age, degree of disability, educational level, and pension level. Among them, the variable assignments for policy support, financial support, informatization facilities in nursing homes, richness of service content, number of service personnel, and professional level of service personnel are based on the Likert scale, set as “very inadequate=1; not very adequate=2; generally adequate=3; relatively adequate=4; very adequate=5”. The variable assignment for elderly age is “young (60-69 years)=1; middle-aged (70-79 years)=2; elderly (80 years and above)=3”; the variable assignment for degree of disability is “normal=1; mild dependence=2; moderate dependence=3; severe dependence=4”; the variable assignment for educational level is “primary school and below=1; junior high school=2; high school and vocational school=3; college=4; undergraduate and above=5”; the variable assignment for pension level is “below 1,000 yuan/month=1; 1,000-1,999 yuan/month=2; 2,000-2,999 yuan/month=3; 3,000-3,999 yuan/month=4; 4,000 yuan and above/month=5”.4. Data Analysis(1) Data Source, Research Methods, and Reliability and Validity Analysis1. Data SourceThe research team on the improvement path of community elderly care services under the “Internet+” initiative conducted a survey on the current situation of “embedded” elderly care services in Shanghai from July 2017 to August 2018 using a typical sampling method. A total of 380 questionnaires were distributed through one-on-one interviews with community leaders, staff, and elderly residents, with 359 valid questionnaires returned, resulting in an effective rate of 94.47%.2. Research MethodsThe dependent variable of the article is the satisfaction of elderly residents in “embedded” nursing homes, which is a numerical variable, and since there are many independent variables, multiple linear regression analysis is used to study the various factors affecting the satisfaction of elderly residents in “embedded” nursing homes.3. Questionnaire Reliability and Validity AnalysisThe article uses SPSS 22.0 software to test the reliability and validity of the questionnaire, with a Cronbach’s alpha coefficient of 0.832, indicating good reliability; the significance of Bartlett’s test of sphericity is 0, and the KMO value is 0.803, greater than 0.8, indicating good validity. In summary, this indicates that the questionnaire has reliability and stability and is meaningful.(2) Sample CharacteristicsAmong the surveyed subjects, in terms of gender, there are 188 males, accounting for 52.4%; 171 females, accounting for 47.6%. In terms of age, those aged 60-69 account for 60.2%, 70-79 account for 19.5%, and 80 years and above account for 20.3%. In terms of educational level, those with primary school and below account for 18.1%, junior high school account for 14.5%, high school and vocational school account for 27.0%, college account for 24.2%, and undergraduate and above account for 16.2%. In terms of marital status, married individuals account for 73.0%, widowed account for 21.4%, and divorced and unmarried each account for 2.8%. In terms of degree of disability, those who can take care of themselves account for 78.6%, mild dependence accounts for 13.3%, moderate dependence accounts for 7.0%, and severe dependence accounts for only 1.1%. In terms of pension level, those earning below 1,000 yuan/month account for 0.3%, 1,000-1,999 yuan/month account for 4.2%, 2,000-2,999 yuan/month account for 10.5%, 3,000-3,999 yuan/month account for 29.0%, and 4,000 yuan and above/month account for 56.0%. In terms of participation in pension insurance, 66.9% of the elderly participate in basic pension insurance for urban employees or urban residents, while 33.1% do not participate in any pension insurance. Regarding whether they have enjoyed government-provided elderly care service subsidies, 53.5% of the elderly have enjoyed them, while 46.5% have not.(3) Services Provided by the Surveyed “Embedded” Nursing HomesSince the second half of 2014, Shanghai has actively explored multifunctional and comprehensive “embedded” models, building single-type “elderly care homes” and comprehensive “community elderly service centers” according to local conditions in various communities. This survey mainly examined three locations: the Chuanbei Zhihui Fang in Sichuan North Community, Hongkou District (Sichuan North Community Liyang Elderly Care Home), the Beizhan Community Comprehensive Elderly Service Center in Jing’an District (Beizhan Zhihui Fang and Kangjian Station), and the Aizhaohu Elderly Care Home in Wanshan Street, Putuo District. The specific service content is shown in Table 2.
(4) Satisfaction of Elderly Residents and Analysis of Influencing Factors1. Satisfaction Analysis(1) Applicability Analysis of the SERVPERF ModelCurrently, domestic and foreign scholars have confirmed through a large number of empirical studies that the five original dimensions of the SERVPERF model: tangibility, reliability, responsiveness, assurance, and empathy have high internal consistency and convergence, which can well reflect service quality. As a type of service, “embedded” elderly care services possess characteristics of general service products, making the use of the SERVPERF model for evaluation reasonable. Therefore, this article selects the five dimensions of tangibility, reliability, responsiveness, assurance, and empathy for evaluating the quality of community home care services, as specifically designed in Table 3.
(2) Satisfaction Evaluation of Elderly Residents in “Embedded” Nursing HomesSurvey data shows that the satisfaction of elderly residents with “embedded” elderly services is not high, with very satisfied and relatively satisfied accounting for 16.4% and 9.2%, respectively, generally satisfied accounting for 24.0%, and not very satisfied and very dissatisfied each accounting for 34.8% and 15.6%. In terms of specific service items, elderly residents have the highest satisfaction with daily care services, with satisfaction for medical care services slightly higher than that for emotional comfort services, as shown in Table 4.
In terms of daily care services: the responsiveness indicator is rated the highest, with very satisfied and relatively satisfied each accounting for 18.2% and 16.5%; the reliability indicator is rated relatively high, with very satisfied and relatively satisfied each accounting for 15.3% and 13.8%; the tangibility indicator is rated generally, with very satisfied and relatively satisfied each accounting for 12.5% and 13.0%; the empathy indicator is rated lower, with very satisfied and relatively satisfied accounting for 13.2% and 10.8%; the assurance indicator is rated the lowest, with very satisfied and relatively satisfied only accounting for 11.2% and 12.4%. In terms of medical care services: the responsiveness indicator is rated the highest, with very satisfied and relatively satisfied each accounting for 14.5% and 15.6%; the reliability indicator is rated relatively high, with very satisfied and relatively satisfied each accounting for 6.4% and 19.2%; the assurance indicator is rated generally, with very satisfied and relatively satisfied each accounting for 16.5% and 7.6%; the tangibility indicator is rated lower, with very satisfied and relatively satisfied accounting for 10.5% and 13.5%; the empathy indicator is rated the lowest, with very satisfied and relatively satisfied only accounting for 9.5% and 13.0%. In terms of emotional comfort services: the empathy indicator is rated the highest, with very satisfied and relatively satisfied each accounting for 14.9% and 11.6%; the reliability indicator is rated relatively high, with very satisfied and relatively satisfied each accounting for 13.7% and 11.3%; the tangibility indicator is rated generally, with very satisfied and relatively satisfied each accounting for 10.7% and 12.0%; the responsiveness indicator is rated lower, with very satisfied and relatively satisfied accounting for 9.1% and 11.7%; the assurance indicator is rated the lowest, with very satisfied and relatively satisfied only accounting for 5.3% and 15.3%.2. Influencing Factors Analysis(1) One-Way ANOVAThe article uses one-way ANOVA to analyze ten variables from policy factors, community factors, and individual factors. The results show that at a significance level of α=0.05, in terms of policy factors, policy support (0.003<0.05) passed the significance test, indicating a significant impact on the satisfaction of “embedded” nursing home services. In terms of community factors, informatization facilities in nursing homes (0.007<0.05), richness of service content (0<0.05), and professional level of service personnel (0.016<0.05) passed the significance test, indicating a significant impact on the satisfaction of “embedded” nursing home services. In terms of individual factors, the degree of disability of the elderly (0<0.05), educational level (0<0.05), and pension level (0<0.05) three independent variables passed the significance test, indicating that these three factors have a significant impact on the satisfaction of “embedded” nursing home services. Given that financial support, number of service personnel, and elderly age did not pass the one-way ANOVA, it proves that the hypotheses H1-2, H2-3, and H3-1 of the article are not established.(2) Multiple Linear Regression AnalysisThe article takes the satisfaction of elderly residents in “embedded” nursing homes as the explained variable and uses multiple linear regression to conduct empirical research on the data obtained from 359 elderly residents through the survey questionnaire, analyzing the impact of policy, community, and individual factors on the quality of community home care services. The adjusted R2 determination coefficient is 0.638, indicating a good overall fit of the model, and the significance test of the regression equation passes, confirming that the linear relationship between the explained variable and the explanatory variables is significant, verifying that the satisfaction of elderly residents in “embedded” nursing homes is related to various influencing factors in a linear regression model, as shown in Table 5.
First, policy factors. As shown in Table 5, policy support has a significant positive effect on the satisfaction of elderly residents in “embedded” nursing homes, with a standardized regression coefficient of 0.346>0, indicating that an increase of 1 unit in policy support can bring about a 0.346 unit increase in the satisfaction of elderly residents in “embedded” nursing homes, confirming the previous hypothesis H1-1. This also indicates that the government providing a series of supporting preferential policies for “embedded” nursing homes, including actively supporting social forces to establish “embedded” nursing homes, offering certain land, water, electricity, natural gas discounts, and tax reductions, helps accelerate the development of “embedded” elderly services and improve the satisfaction of the elderly with services.Second, community factors. As shown in Table 5, informatization facilities in nursing homes have a significant positive effect on the satisfaction of elderly residents in “embedded” nursing homes, with a standardized regression coefficient of 0.446>0, indicating that an increase of 1 unit in informatization facilities can bring about a 0.446 unit increase in the satisfaction of elderly residents in “embedded” nursing homes, confirming the previous hypothesis H2-1. In recent years, the rapid development of information technology has brought new opportunities for the development of community elderly care services in China from a technical perspective. For example, the Aizhaohu Elderly Care Home in Wanshan Street, Putuo District, based on artificial intelligence and big data technology, utilizes developed networks and informatization platforms to provide various services for elderly residents, significantly improving their satisfaction. The richness of service content in nursing homes has a significant positive effect on the satisfaction of elderly residents in “embedded” nursing homes, with a standardized regression coefficient of 0.206>0, indicating that an increase of 1 unit in the richness of service content can bring about a 0.206 unit increase in the satisfaction of elderly residents in “embedded” nursing homes, confirming the previous hypothesis H2-2. Providing diversified and multi-level elderly care services based on demand is an inevitable trend for future development and is also beneficial for improving the satisfaction of elderly residents. The professional level of service personnel in nursing homes has a significant positive effect on the satisfaction of elderly residents in “embedded” nursing homes, with a standardized regression coefficient of 0.154>0, indicating that an increase of 1 unit in the professional level of service personnel can bring about a 0.154 unit increase in the satisfaction of elderly residents in “embedded” nursing homes, confirming the previous hypothesis H2-4. As people age, physiological and psychological differences become more pronounced, and elderly residents require more specialized care, personalized services, and humanistic care, not just in terms of daily living and care but also in terms of thoughtful warmth and emotional support. Only service personnel with a high professional level can meet the needs of elderly residents.Third, individual factors. As shown in Table 5, the degree of disability of the elderly and the pension level have a significant positive impact on the satisfaction of “embedded” elderly services, with standardized regression coefficients of 0.178 and 0.330, respectively, both greater than 0, indicating that an increase of 1 unit in the degree of disability can bring about a 0.178 unit increase in the satisfaction of elderly residents in “embedded” nursing homes; an increase of 1 unit in the pension level can bring about a 0.330 unit increase in the satisfaction of elderly residents in “embedded” nursing homes, confirming the hypotheses H3-2 and H3-4 of this article. Generally speaking, the worse the health level of the elderly, the more they rely on the services of “embedded” nursing homes, and the higher their satisfaction with the services. Moreover, at the current stage of economic development in China, elderly residents with higher retirement wages have more ability to purchase and enjoy specialized high-end customized elderly care services, thus achieving higher satisfaction. The educational level of the elderly has a significant negative impact on the satisfaction of “embedded” elderly services, with a standardized regression coefficient of -0.102<0, indicating that a decrease of 1 unit in educational level can bring about a 0.102 unit decrease in the satisfaction of elderly residents in “embedded” nursing homes, confirming the previous hypothesis H3-3. The elderly residents’ demand for elderly care services in “embedded” nursing homes inevitably varies due to differences in educational background. Elderly residents with longer years of education and higher educational levels generally have higher demands and expectations for elderly care services, not only pursuing material aspects of “elderly care” but also seeking spiritual aspects of “enjoying old age,” that is, “being useful in old age and enjoying life in old age,” making full use of their remaining energy and enjoying a beautiful retirement life. However, currently, the vast majority of “embedded” nursing homes lack high-quality cultural services, which need to be further expanded.5. Conclusion and Policy Recommendations(1) ConclusionThe satisfaction of elderly residents in “embedded” nursing homes is not high. Overall, more than half of the elderly express dissatisfaction with the services provided by “embedded” nursing homes across all 15 evaluation dimensions designed. In terms of specific service items, elderly residents have the highest satisfaction with medical care services, with satisfaction for daily care services slightly higher than that for emotional comfort services. Factors that have a significant positive impact on the satisfaction of elderly residents in “embedded” nursing homes include policy support, informatization facilities in nursing homes, richness of service content, professional level of service personnel, degree of disability of the elderly, and pension level. The educational level of the elderly has a significant negative impact on the satisfaction of “embedded” elderly services.(2) Policy Recommendations1. Improve the policies for “embedded” elderly servicesAt the national macro level, the government should continuously introduce a series of specific quantitative goals and implementation strategies for “embedded” elderly care, vigorously support the establishment of “embedded” elderly care services through various means such as government subsidies, public-private partnerships, and purchasing services, and lower the construction thresholds for “embedded” nursing homes. At the local level, governments at all levels are responsible for implementing relevant work and improving supporting policies for “embedded” elderly care services. This mainly includes: improving the land approval mechanism for “embedded” nursing homes, providing rent subsidies for enterprises building nursing homes in leased houses, and offering land policies and tax incentives for enterprises establishing nursing homes; increasing financial subsidies, providing discounts on water, electricity, and natural gas for “embedded” nursing homes to reduce operating costs, and encouraging social forces to establish “embedded” nursing homes.2. Establish a collaborative mechanism between communities and “embedded” nursing homesTo fully coordinate the distribution of responsibilities for community and nursing home operations, it is urgent to establish a clear division of labor and a collaborative mechanism. First, communities and elderly service enterprises must reach a consensus that providing high-quality and efficient elderly care services for the elderly is the top priority. Second, when signing cooperation agreements, the responsibilities, service content, target audience, and maintenance of elderly care service materials should be clearly defined. Finally, communities and elderly service enterprises should support, supervise, and promote each other, actively coordinating conflicts in operations, and ensuring that the advantages of “embedded” nursing homes are realized, extending “embedded” elderly care services to all elderly residents in the community.3. Strengthen the construction of the elderly care service workforceFirst, continuously expand the workforce of elderly care service personnel. Establish a vocational qualification system for elderly care service personnel and training schools for elderly care services, encouraging universities to offer courses in elderly care services and implementing various preferential policies to attract enrollment. Second, enhance the professional level of elderly care service personnel. Based on practical needs, further refine the vocational qualifications of elderly care service personnel, emulating Japan’s implementation of the “nursing profession level system,” categorizing nursing personnel into seven levels based on their abilities in daily care, communication, emergency response, and collaboration, further enhancing their professional level to ensure high-quality elderly care service supply. Finally, improve the stability of the elderly care service workforce. Establish a remuneration system that matches labor compensation, appropriately increasing and ensuring the treatment of elderly care personnel through market adjustments, and increasing professional subsidies through policy adjustments. Enhance the social recognition of elderly care personnel and reduce turnover rates.4. Provide diversified “embedded” elderly care services“Embedded” nursing homes, also known as “nursing homes without walls,” allow elderly residents to be just “a bowl of soup away” from their families, filled with warmth and care. However, due to inevitable differences among elderly individuals, providing services based on demand has become a necessary requirement. With the arrival of the “Internet+” era, it is recommended to rely on the internet, big data, and cloud technology to promote “online + offline” daily care services, achieving a free switch between community institutional care and home care; promote “Internet + medical” services, connecting platforms with local smart medical services to provide each elderly resident with various forms of health education, medical information inquiries, electronic health records, disease risk assessments, online disease consultations, electronic prescriptions, remote consultations, and remote treatment and rehabilitation services, accelerating the medical process for the elderly; help elderly residents communicate online with children living far away through devices like mobile phones and computers; regularly organize elderly residents to gather and participate in various cultural and recreational activities, enriching their spiritual and cultural lives, truly achieving “relying on the elderly, caring for the elderly, enabling the elderly, and enjoying life in old age.” References:[1] Yang Yansui. Be Prepared for the Crisis, Pensions Must Actively Respond to Population Aging [J]. Talent Resource Development, 2017(19): 88-89. [2] Zheng Gongcheng. Construction of a Multi-Level Social Security System: Current Situation Assessment and Policy Ideas [J]. Social Security Review, 2019, 3(1): 3-29.[3] Wen Haihong, Wang Yihuan. Evaluation System Construction and Application of Community Elderly Care Service Policy Implementation Effectiveness — A Case Study of Xi’an [J]. Social Security Research, 2017(1): 14-22. [4] He Wenjiong. On the Mutual Assistance and Solidarity of Social Security [J]. Social Security Review, 2017, 1(1): 43-52.[5] Karl Polanyi. The Great Transformation: The Political and Economic Origins of Our Time [M]. Hangzhou: Zhejiang People’s Publishing House, 2007: 40.[6] Granovetter M. Economic Action and Social Structure: The Problem of Embeddedness [J]. American Journal of Sociology, 1985, 91(3): 481-510. [7] Zhang Ping. Embedded Elderly Care: Research on Innovation of Shanghai’s Elderly Care Service Model [J]. Modern Management Science, 2016(6): 64-66. [8] Hu Hongwei, Wang Yu, Wang Xiaojun, et al. Current Situation, Evaluation, and Improvement Path of the “Embedded” Elderly Care Model [J]. Social Security Research, 2015(2): 10-17. [9] Zhu Qinhao. Research on the Development of Community Embedded Elderly Care Services in Shanghai — Exploration and Innovation of Elderly Work under New Situations [J]. Scientific Development, 2017(8): 103-109. [10] Song Fengxuan, Ding Yue, You Yang. Evaluation and Improvement Strategies of Urban Community Elderly Care Service Quality Based on the SERVQUAL Model [J]. Economic Research Reference, 2014(52): 34-39. [11] Li Jing. Research on the Service Quality of Elderly Care Institutions in Xi’an Based on Customer Satisfaction Evaluation [D]. Xi’an: Northwest University, 2017. http://cdmd.cnki.com.cn/Article/CDMD-10697-1017104500.htm[12] Yan Bingqiu, Gao Xiaolu, Yuan Haihong. Structural Equation Model of Urban Community Elderly Home Care Satisfaction [J]. Chinese Journal of Gerontology, 2015, 35(21): 6211-6215. [13] Chu Bowe. Research on the Satisfaction of Integrated Medical and Elderly Care Institutions [D]. Shijiazhuang: Hebei University of Economics and Business, 2018. http://cdmd.cnki.com.cn/Article/CDMD-10213-1016913130.htm[14] Saraceno C. Social Inequalities in Facing Old-Age Dependency: A Big Generational Perspective [J]. Journal of European Social Policy, 2010, 20(1): 32-44. [15] Burau V, Kroger T. The Local and the National in Community Care: Exploring Policy and Politics in Finland and Britain [J]. Social Policy & Administration, 2004, 38(7): 793-810.[16] Zhang Xiaoyi, Mei Qiang. Research on Factors Affecting the Quality of Community Home Care Services: A Perspective of Individual Differences [J]. Journal of Shanghai Jiao Tong University (Philosophy and Social Sciences Edition), 2011, 19(6): 23-30.[17] Stoddart H, Whitley E, Harvey I, et al. What Determines the Use of Home Care Services by Elderly People [J]. Health & Social Care in the Community, 2002, 10(5): 348-360.[18] Hou Zhiyang. Satisfaction of Urban Elderly with Home Care Services and Its Influencing Factors [J]. Journal of Beijing University of Science and Technology (Social Sciences Edition), 2010, 26(3): 31-37. [19] Zheng Bingwen. Promoting Full Coverage of “Home and Community Elderly Care Services” is an Important Reflection of Improving the Quality of Elderly Care Services [J]. China Civil Affairs, 2017(3): 23-24.[20] Wen Haihong, Ma Yujuan, Wang Yihuan, et al. Analysis of the Occupancy Rate of Elderly Residents in Nursing Institutions and Its Influencing Factors from the Perspective of Human Capital — A Case Study of Shaanxi Province [J]. Social Security Research, 2018(2): 21-29. [21] Qiu Sichun, Wang Jingmei, Huang Changyi. The Path of Innovation in Community Elderly Care Management System in New Era China [J]. Management World, 2018, 34(7): 172-173. [22] Tian Beihai, Zhong Zhangbao, Xu Yan. Empirical Research on the Life Satisfaction of Elderly Residents in Welfare Institutions and Its Influencing Factors — Based on a Survey in Hubei Province [J]. Learning and Practice, 2010(3): 108-115.[23] Zhang Sifeng, Zhang Zehu. Multi-Subject Responsibility for Elderly Care Services Adapted to Diverse Needs and Quality Improvement [J]. Population and Society, 2018, 34(4): 11-20.[24] Li Zhen, Wang Haidong. Research on the Target Replacement Rate of Basic Pension Insurance [J]. Insurance Research, 2012(2): 97-103.
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Journal of Beihang University (Social Sciences Edition) 2020, 33(2): 72-79.
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