3.1 The necessity of multiple subjects participating in home care for the disabled elderly
At present, a global agreement is within reach that population aging has been a tough sell exerting a profound influence on the sound development. China is no exception[6]. Moreover, China’s aging population is characterized by aging, empty nesting, high disability rate, and high incidence of chronic diseases. It is more difficult to tackle the problem[7]. Affected by the Chinese traditional culture, the elderly is reluctant to leave their familiar living environment and go to the institutions of health care[8].
On the one hand, with the further increase of disabled elderly, and decrease of family size, the home care provided by children and family members is becoming more and more inadequate[9]. On the other hand, welfare pluralism theory provides a theoretical basis for the multiple subjects to participate in the process of home care. The theory of welfare pluralism notes that through the interaction and coordination among the multiple subjects, care resources can be effectively integrated, so as to maximize welfare[10]. However, the survey results show that family members still play a key role in supporting the disabled elderly in China. The government takes main responsibility for social disadvantaged groups, , family doctors may only play a guiding role, but social organizations play a very little compensation role. In addition, due to the large number of disabled elderly, the large demand and the long duration, care resources provided by a single sector cannot tailor to the needs. Therefore, it is necessary for the government, family members, family doctor team, society and other multiple subjects to participate in the home care system, and form an integration mechanism in which multiple subjects share the responsibility. In a bid to wield the resources from relevant sectors to popularize home care, the cooperation among multiple subjects can complement each other’s advantages and provide home care resources more efficiently and accurately.
3.2 Inefficient coordination mechanism among multiple subjects in home care for the disabled elderly
Although the government, family doctors, family members, society, and even the disabled elderly themselves, all perform the different functions of home-based care services for the disabled to varying degrees, the research results show that the coordination mechanism among the subjects has not yet been formed. After extensive review of relevant literature and repeated discussion by panel experts, this study has summarized the functions of multiple subjects in the home care of the disabled elderly, as shown in Table 4 below:
Table 4 The functions of multiple subjects in home care of the disabled elderly
|
Subject
|
Government
|
Family Doctor
|
Family Member
|
Society
|
The Disabled Elderly
|
Non-profit
Organization
|
For-profit
Market
|
Role
|
Supplier;
Policymaker; Supervisor
|
Supplier
|
Supplier, Consumer, Supervisor
|
Supplier, Supervisor
|
Supplier
|
Supplier, Consumer, Supervisor
|
Motivation
|
Government Responsibility,
Public Interests
|
Duty,
Responsibility
|
Responsibility,
Family Interests
|
Spontaneity, Public Interests
|
Profit
|
Independence, Health Rights
|
Aim
|
Promote Health Equity
|
Protect Health
|
Maximize Self-utility
|
Maximize Social Benefits
|
Maximize Benefits
|
Maximize Self-Health Rights
|
Mechanism
|
Bureaucracy
|
Job duty
|
Family Mutual Aid
|
Voluntary
|
Market
|
Autonomous Participation
|
Advantage
|
Authoritative Guidance
|
Professional Assistance
|
Emotional
Support
|
Free Supplement
|
Diversified Services
|
Proactive Cooperation
|
Dis-
advantage
|
Government Dysfunction
|
Low Responsibility
|
Weak Support
|
Voluntary Dysfunction
|
Market Dysfunction
|
Capability Limitations
|
3.2.1 Lack of consistency in the goals of multiple subjects
The above table shows that each subject has its own focus, and there is a lack of unified consensus about caring for the disabled elderly people. Long-term elderly care services can help meet the greatest needs of the disabled elderly and improve their life quality, which are provided by their family members on the basis of blood relationship and ethics. While family doctors, inspired by their duties and job requirements, provide medical care and medical insurance for all patients within their personal responsibilities[11]. As the final target of the for-profit market is pursuing maximum benefits, quality and types of care services for the disabled elderly can be improved through competition under such circumstances. Until recently, increasing access and well-being for seniors with disabilities has been regarded as one of the government’s medium-and long-term plan. However, the harsh terms of assistance and low subsidies are far from meeting the general needs of the disabled elderly[12]. Moreover, the disabled elderly with self-awareness hope to meet their personal needs and maintain their personal health, which reflects the interest appeals for multiple subjects from different sides.
3.2.2 Low participation and insufficient resources input of multiple subjects
At present, a multi-subject coordination mechanism involving home-based care for the disabled elderly has initially taken shape, but the existing service forms are merely the accumulation of functions among various subjects. Family members are still the main provider of home care. In addition, the survey results indicate that the insufficient engagement of multiple subjects in home care leads to a low level of services supply and the total resources input cannot meet the demands of the disabled elderly. As a result, families are forced to assume responsibilities that do not accord with their abilities[13].Moreover, it is difficult for the government to consider the needs of each disabled elderly due to limited resources and difficulty in equal allocation. Also, the scale and number of staff also hinder family doctors from serving the disabled elderly better. What’s more, public welfare social organizations are not engaged in home care at the most time because they do not have sufficient motivation[14], while the limited purchasing power of the disabled elderly in for-profit market leads to a long payback period, which restrict the development of service forms, standards and even the whole industry[11].This indicates that social resources and power have not been fully utilized. Therefore, the above problems reside in the fact that multiple subjects are neither fully involved in home care of the disabled elderly nor motivated properly to provide sufficient resources for those disabled people.
3.2.3 Lack of coordination among multiple subjects involved in the process of home care
It is obvious that the actions of multiple subjects involved in the process of home care lack coordination, and the home care resources that government, family doctors, family members, society provided for the disabled elderly don’t coordinated [15]. With the increasingly serious aging of Chinese society, the disabled elderly and their families are suffering more from triple stresses of the finance, body and emotion. They are still the primary undertakers of home care. Hence, the government has the responsibility to provide care and assistance through Care Payment or other forms to relieve financial burden of the disabled. Family doctors should play an important role in the health management and medical care for the disabled elderly. Public welfare social organizations take the initiative to provide the voluntary services, and the profitable market triggers a cycle of virtuous competition[16]. In this way, multiple subjects can provide certain supplementary services through their own platforms, thus reducing the burden of the disabled elderly and their families. However, there are differences in the roles and responsibilities among these different subjects, which makes it difficult to coordinate and integrate the resources of each subject, and the quality of home care for the elderly with disabilities is poor.
3.3 The diversified care services supplied by multiple subjects to satisfy various demands of the disabled elderly
3.3.1 Government guidance
3.3.1.1 Improve the subsidy policy and guarantee the disabled elderly’s legitimate rights and interests
In 2019, the Beijing Municipal Civil Affairs Bureau formulated the policy of “Administrative Measures for the Administration of Subsidies for Elderly Care Services in Beijing”, which assesses the eligibility of the disabled elderly who have submitted the application for subsidies. Then, according to the different degree of disability of the elderly, the government will provide nursing subsidies ranging from 200 yuan to 600 yuan to them[17]. However, many disabled elderly families can hardly pay for their expenses. Taking care of the disabled elderly at home makes things worse, and government subsidies are just a drop in the bucket. Most disabled elderly families live in poverty and suffering. Therefore, the government should dynamically adjust the social welfare subsidy policy in combination with the regional economic development level and CPI rising index, give full play to the functional role of the financial department in social security reform, and steadily improve the social security level of the disabled elderly people[18].
Currently, the subsidy for disabled elderly people is issued by the government to their Incapacitated Security Card, a personal account that can only be consumed at certain service stations such as the elderly-care post, and this kind of allowance is not available for withdrawal. Consumer services provided by the elderly post include: helping the elderly take a bath, cleaning their rooms, and changing the urine pads and so forth. Although the government has made great efforts, the effect of subsidy policy is less than satisfactory. Unreasonable consumption pattern and imperfect service model hinder those elderly from enjoying their legitimate rights, unaffordable price and poor quality of services in senior stations contribute to the unhealthy tendency in Chinese society. Therefore, government departments should improve the social recognition of the subsidies for the disabled elderly, strengthen the dynamic supervision of elderly care stations in society, and evaluate the service qualifications of third-party organizations, especially service price and quality. Moreover, the government should establish a reasonable and effective supervision and feedback mechanism to ensure that the disabled elderly and their families can enjoy services without being restricted by location. [19].
3.3.1.2 Enhance the policy publicity and ensure the disabled elderly to enjoy their benefits timely
One of the criteria for evaluating the effectiveness of government’s efforts is the strength of policy publicity. Therefore, the propaganda department should enhance the popularization of the policy, ensure the disabled elderly and their families can know it in time, especially for those living in impoverished areas. Local neighborhood committees should become the bridge for information transmission, connecting the government and the elderly disabled families. Council members in the committee should undertake their responsibilities for its management and policy publicity in local regions. Besides, the Civil Affairs Department should implement relevant public welfare policies and accelerate assessing the qualification of the disabled elderly to ensure that the rights and interests policies for the elderly are fully implemented.
3.3.1.3 Promote the development of palliative care and speed up the legislation construction on euthanasia
Compared with other developed countries, the work of palliative care in China started relatively late. In July 1988, Tianjin Medical College established the first hospice care institution in mainland China, namely “Hospice Care Research Center of Tianjin Medical College”. Since then, palliative care institutions have sprung up across the country, but most of them are concentrated in metropolises such as Beijing and Shanghai. Owing to the unreasonable distribution of medical and health resources, it is difficult to meet the general needs of patients for palliative care.
Palliative care includes multi-level service, aiming at alleviating the pain of patients at the end of their days and improve the quality of life[20]. However, influenced by Chinese traditional culture, there is a general dispute about palliative care that whether patients should give up treatment. Ancient Chinese regarded hair as life, just as the saying goes, “Skin and hair are given by the parents, and they dare not hurt them.” While palliative care is a treatment to relieve, rather than cure. Restricted by their traditional ideas, the Chinese people ignore the advantages of medical services and the importance of death education [21].
Along with palliative care, China has also proposed the legalization of euthanasia since 1993, but it has not been put into practice so far[22]. The focus of this proposal is to give the suffered a right to choose death with dignity and bring the tortured an end when they can’t bear the pain of illness. As there are many diseases that can’t be cured by medicine, and there is still a long way to go in medical technology. Those critical patients suffered from both physical and emotional pains, so some of them may choose death with dignity. Therefore, it is urgent for the government to promote the development of palliative care and the legalization of euthanasia, and to ensure that dying patients such as the disabled elderly can make their own choices.
3.3.2 Family doctor assistance
3.3.2.1 Strengthen contract spirit and implement health management of the disabled elderly
More than 4,100 teams of family doctor have been established in Beijing. By 2019, 7.4 million people have signed up with family doctors, with an average of nearly 1,800 people in each team. Among the residents who have signed the contract, the signing rate of key group such as elderly patients with chronic diseases reached over 90.The National Health Commission made an announcement about family doctor service in 2019, which ask family doctors to “provide door-to-door medical and health services for disabled and semi-disabled elderly, disabled people, terminally ill patients and other people who are in urgent need, and extend the contracted services from institutions to communities and families.”[23]
Disabled elderly people, as a key group, are in urgent need of family doctor services. The community health service institutions located in Beijing all have all started signing up services for the disabled elderly people. About 4% to 5% of the contracted clients of each doctor team are disabled elderly people. In this study, 2 of the 118 disabled elderly people mentioned that they had signed with their family doctors but had never received any services, which indicated the contract between family doctor and the patient is invalid. Low contact frequency and trust may cause a bad contract service relationship. Currently, the effects of family doctor project are not obvious. Therefore, family doctors should deliver health eduction to their disabled clients and make them realize the advantages of having a family doctor. Through long-term health education, family doctor can establish a stable relationship with their clients and the elderly themselves can also enjoy the benefit from such contracted services [24]. At the same time, family doctors should actively connect with their clients, spread their services, increase the frequency of regular home calls, detect the health problems of the disabled elderly [25], and provide health management in time [24]. Only in this way can family doctor team bridge the gap between the doctors and the disabled elderly, and make their contract services more effective.
3.3.2.2 Expand the aspects of services to satisfy diversified demands of the disabled elderly
Unlike healthy elderly, the disabled elderly have greater demands for family doctor services (General Practitioner Services), particularly for family care bed. Currently, the community health service (CHS) centers in Beijing provide limited medical resources for the disabled elderly, and the contract services are poor, which limits the benefit of those in need. For one thing, with limited family beds, it is difficult for those disabled elderly to fully enjoy home-based injections, infusion care and other services; for another, they also face many difficulties when going to the hospital for medical treatment due to their bad physical situations. Consequently, the disabled elderly have great demands for family doctors to bring indoor medical services, such as injection and infusion.
In addition, studies have shown that early intervention of disability has a significant effect on controlling the disease process and improving health condition[18], and the elderly with mild disabilities have a great demand for rehabilitation training in this survey. While, the family doctor team lacks rehabilitation training services at present and the team doesn’t have any rehabilitation physiotherapist to meet the diverse needs of the disabled elderly in community.
What's more, staying at home for a long time leads to a sharp decline in social relations of the disabled elderly, and they are grumpy or depressed; their family members also have psychological burden after long-term care [25]. In this study, disabled elderly people often consider that they are worthless and no longer able to contribute to society or even the family. They think that there are many drastic changes in their lives, which will bring great difficulties to their families. Therefore, it’s necessary for family doctors to expand contacted services, pay more attention to the mental health of the disabled elderly and their families, and provide them with more medical assistance and psychological counseling, so as to improve the life quality of the disabled elderly.
3.3.3 Family member guardianship
“Getting old before getting rich” is the mainstream trend of China’s aging society[26]. As a developing country, China cannot totally assume the responsibility of elderly-care. Therefore, home care is still the basic care mode for the elderly[27]. Young people who provide care and support responsibilities for the elderly are still the backbone of elderly-care.
3.3.3.1 Clarify the division of responsibilities within the disabled elderly’s family
The results show that in most disabled elderly families, spouses are the main caregivers, accounting for 35.6%. They gradually replace their offspring to become a major caregiver of the disabled elderly[28], which is consistent with relevant studies. The families interviewed have 2.56±1.44 children, which is not affected by China’s family planning policy. It can be said that family elderly-care is guaranteed, but the fact is that children in families of the disabled elderly are shouldering less and less responsibility. Generally, those children have their own family life and are busy with work, which makes the sharing of family responsibilities unbalanced, and further causes one of the dilemmas for the disabled elderly[28].
There is a deep-rooted idea of “raising a son as a guarantee against old age” in China, which comes from China’s traditional filial piety culture[29]. Most elderly people with son and daughter said in the survey that they would choose to live with their son. A common phenomenon is that children take care of their disabled parents in turns. When the core value of filial piety culture returns back to kinship, it weakens the binding force of children’s support for their parents[30]. As a result, in some families, children have great disputes over pension and daily care for their parents, and even shirk their responsibilities.
Therefore, when it comes to supporting parents, the offspring in multiple-child families should be fair and just, and distribute responsibilities according to income and residence distance to the elderly, particularly in the distribution of pension and medical expenses[28]. These measures can prevent children from disharmony, and protect one person from undertaking too much pressure on himself/herself due to improper arrangements. What’s more, the eldest son or daughter should play a leading role, coordinate family relationship, strive to create a positive family atmosphere and make sure the disabled elderly live in harmony.
3.3.3.2 Provide financial support, high-quality care and company
Family care usually includes three aspects: material support, daily care, and spiritual comfort. Family members, as the guardian of the disabled elderly, are the first to bear the disabled elderly’s healthcare expenditure. They should provide financial support to meet the material needs of the disabled elderly, and protect health benefits for the elderly by purchasing movable beds, installing anti-slip rails, and other equipment suitable for them[19].
Family caregivers play an important role in the home care for the disabled elderly, and their knowledge affect the quality of home care[31]. As primary caregivers, family members should take initiative to learn health knowledge and actively participate in the care training organized by the contracted family doctor, so as to provide high-quality care for the disabled elderly in home. At the same time, they should keep in touch with the doctor to exchange the health condition of the elderly and ensure timely medical treatment if the elderly get sick.
In addition, there are many traditional festivals in China that symbolize family reunion, such as the Spring Festival, Mid-Autumn Festival and Double Ninth Festival[32]. The Chinese people pay more attention to the family reunion, and the long days of vacation give people a chance to stay with family. In this study, the disabled elderly have extremely high expectations for companionship, as 109 out of the 118 interviewees expressed that they wished to live with their families during traditional festivals. But the fact is that many children have little time to accompany the disabled elderly, except the family caregiver. Therefore, family members should actively coordinate their personal time, pay attention to create a good family atmosphere in traditional festivals, and provide care and companionship to the disabled elderly. In daily life, they should also focus on the psychological problems of the elderly and give timely assistance to reduce geriatric depression[33].
3.3.4 Society participation
3.3.4.1 Create a good social atmosphere to respect and care for the elderly
The current society has some uncivilized concepts and behaviors in the treatment of vulnerable groups such as the disabled elderly, which require great efforts to change. Related studies have shown that social support can relieve loneliness and depression.[34]. Surveys show that one of the obvious psychological problems of the disabled elderly is that they consider themselves a drag on their families, a burden on society, and deny their value in life. When they feel the discrimination from others, they are more worried about their old-age life. Therefore, it is necessary to enhance the cultivation of personal morality and social support, care for the physical and mental health of the elderly, improve the civilization of the whole society, and guide the people to practice the core socialist values.[14].
3.3.4.2 Promote voluntary and build a community service system
Facing the dual dilemma of insufficient care services provided by home caregivers and the government, community voluntary become a supplemental resource [34]. The survey results show that Beijing has not yet formed a systematic volunteer service system for the disabled elderly groups, who are in urgent need of services including accompanying the elderly to the local hospital, providing temporary care at home, purchasing daily necessities, etc. Therefore, community volunteers have great potential to ease the pressure on home care services.
First, long-term and stable interpersonal relationships make it easier for the disabled elderly and their families to release pressure and seek solace from the volunteers [35, 36]. In this study, most disabled elderly and their families hope to have a volunteer to help them. While the current volunteer activities in Beijing are carried out by some government institutions or staff, unable to provide sufficient funds and long-term voluntary service.
According to relevant studies, community activities, group participation, and friendship networks are beneficial to the elderly’s health condition[35]. Therefore, it is recommended that neighborhood committees and other social institutions actively mobilize party members or other volunteers in the community to establish a one-on-one assistance mechanism with the disabled elderly, so as to provide psychological care and support, and assist disabled elderly people to receive medications from hospitals and accompany them to receive medical treatment or other services.
Second, volunteers should receive systematic and standardized training on healthcare knowledge, and the neighborhood committees should accurately match the volunteers to the disabled elderly. Volunteers who have received training can help family caregivers to make simple and correct emergency treatments when facing with sudden health troubles of the disabled elderly, so as to protect their life[13].
Third, establish an incentive mechanism for volunteers. “Time Bank” or “Public Welfare Bank” may become an effective method to improve motivation. That means, every registered volunteer and their service time, types will be recorded in the digital file. Volunteers get credit when they help the disabled elderly, from home care to medical care. These credits can be saved in the “Time Bank” and spent when volunteers are in need. The elderly can also participate in volunteer activities. Research shows that the disabled may be a very important contributor of volunteer organizations, especially middle-aged and those with the potential to generate capital in social networks[36]. Such schemes can encourage volunteers to help the disabled elderly, make their services credit a heritage that can be passed to next generation. In addition, it can ensure sustainable voluntary services, give full play to the functions in social support and cultivate a good social atmosphere of mutual help.
3.3.4.3Improve market environment of home care and attract more enterprises to invest the elderly market
There are still many thorny problems in the service market of the disabled elderly. The families interviewed in this research have mentioned that they found it’s difficult to obtain reassuring services in the market when they need to hire nannies or enjoy other care services.
In 2016, in order to further stimulate market vitality and encourage social capital to enter this industry, the General Office of the State Council promulgated the “Several Opinions on Fully Liberating the Elderly Care Service Market and Improving the Quality of Elderly Care Services”, which provided loans for relaxing the access conditions of the senior care service industry. In 2019, the General Office put forward the “Opinions on Promoting the Development of Elderly Care Services”, in order to remove the obstacles to the development of the elderly care services industry, and carried out all-round work arrangements to eliminate obstacles to the elderly care services industry. However, the current market development of the home care services industry for the disabled is still sluggish.
Therefore, society should promote the concept of respecting and loving the elderly, attracting more enterprises to invest in elderly care services market, establish a comprehensive regulatory system to encourage benign competition and improve market climate of home care services. In this way, on the one hand, it can meet the demands of the disabled elderly and their families, thus liberating family labor[37]; on the other hand, a competitive care services market will help companies keep improving and provide better services in home care[38].
3.3.5 The disabled elderly cooperation
Traditional health theory suggests that when health hazards are related to the individual lifestyles and behaviors, and medicine don’t work, then the individual’s control of their own behavior will become an important way to promote health[39].In other words, when individual chooses an active and healthy lifestyle, they tend to have better health conditions and pay less on medical services. For example, abandoning unhealthy behaviors such as smoking and alcohol abuse would keep patients away from diseases. At the same time, related research shows that there are two arguments supporting the elderly to be responsible for their own health: one is for their own interests and the other is relief on social pressure[40]. That means, first, the elderly should protect their own health; second, they should reduce the medical burden of the society.
In terms of health, personal responsibility means reducing health risk factors to the extent that the individual can reasonably control them, and the fulfillment of personal health responsibility is mainly manifested in the management of one's own health and self-education[42], but there are limitations in personal health management for the elderly with disabilities. The survey demonstrates that most of the disabled elderly, especially these people who are in the bad situations, have lost the ability to manage their own health. They are bedridden for a long time, unable to defecate or eat on their own, and some of them even have lost their consciousness. Therefore, it is difficult for the disabled elderly group to become the first person responsible for their personal health, and it is impossible to be too strict with them. Other subjects involved in home care cannot rely too much on the disabled elderly’s self-care, whereby “self-care” is potentially unachievable and becomes care left undone. This will create a culture of blame for self-care, attributing the elderly’s poor health to their personal behavior[41]. This is obviously unreasonable for the disabled elderly to become the first person responsible for health. When the disabled elderly are still partially capable of acting, they should take initiative to protect personal health; when they are still conscious, they can actively adjust their personal emotions, seek assistance from others in time, and maintain their own mental health.
3.4 Advice on improving the coordination mechanism of multiple subjects involved in home care for the disabled elderly
After extensive review of relevant literature and discussion by panel experts, this study summarized a collaborative framework of multiple subjects involved in home care of the disabled elderly, as illustrated in Figure 2. From this pentagonal cooperation mechanism, we can see each subject has a close contact with others. The government formulates welfare policies for disabled elderly and their families, as well as incentive policies for family doctors to encourage them to help the disabled elderly, and gives policy guidance to social organizations. Other subjects in this cooperation mechanism give feedback to the government at the same time. Family doctors provide medical services for the disabled elderly, give professional technical guidance for the family members of the disabled elderly and they can also join the social organizations as volunteers, which is a useful supplement to keep this mechanism work effectively. Family members of the disabled elderly provide daily care for the disabled elderly, connect family doctor to report the health conditions of the disabled elderly and sometimes ask social organizations for help. Society plays a supporting role in providing help to family doctors, disabled elderly and their families. Therefore, in order to establish a multi-subject pentagonal cooperation mechanism for the disabled elderly people in Beijing, the following suggestions are presented.
3.4.1 Strengthen the integration of internal resources within multiple subjects
Institutional structure, information asymmetry or other reasons lead to the mismatching of internal care resources and inefficient services. Therefore, there is an urgent need for concerning subjects to integrate their internal resources from different aspects.
Currently, policies related to elderly care are fragmented and implemented by different government departments. For example, the civil department is only in charge of care subsidies for the disabled elderly, and the medical security department only is responsible for the medical insurance reimbursement ratio. Under such management system, government has lower efficiency in resources distribution and there is a great gap between services provision and the demands of the disabled elderly. This results in the elderly with disabilities being an indivisible individual, but their demands are scattered. Because a clear policy and action plan can help reduce inefficiency and divide in the health care system. Therefore, the government should promote coordination and information exchange among departments[42] and establish a better management system to realize resources integration.
To integrate family doctor team resources, we should flexibly and dynamically adjust the composition of service personnel, and provide tailor-made services to the disabled elderly and their families to meet the diverse needs of the disabled people. [44].
To integrate idle human resources and finance is the main problem faced by family members. It is necessary for families to allocate human resources and financial resources reasonably, so that the disabled elderly can obtain the best home care service at the lowest cost[42].
Social resources integration requires information technology to sort out and match the demands of the disabled elderly and the care services they need.
3.4.2 Define the position of the responsibilities for the disabled elderly and promote the resources integration among multiple subjects
Responsibilities allocation and information sharing are prerequisite for multiple subjects to cooperate with each other and provide services for the disabled elderly in the process of home care.
First, the family and the disabled elderly themselves have a fundamental responsibility for the home care services[43].Traditionally, the individual are mainly responsible for their own health, and family members are the most natural and stable caregivers. However, there are many factors that affect the quality of home care for the disabled elderly, such as the change of family size, the duration of care extend, etc. These all increase the cost and difficulty of home-based care for disabled elderly. [44]. To maintain the basic roles of the family, the government should provide economic subsidies and policy support, and family doctors should offer technical guidance and health education to improve family members’ care. Social welfare organizations should reduce the pressure on those caregivers through sufficient assistance. At the same time, paid alternative care services should also be developed, so that families can have temporary rest by purchasing alternative services.
Second, the government is the last line of defense for home care security system. Therefore, government should introduce a series of measures to strengthen assistance for those vulnerable disabled elderly, pay more attention to solve the problems brought out by the elderly and their families and make sure enough living and medical resources are accessible to everyone. Encouraging family doctors and social groups to participate in elderly care services for the disabled is also an important step of the government. This point will be explained in detail as the following incentive policies for multiple subjects.
Third, the functions of family physician teams and other social groups are complementary[16]. Family doctor is a useful supplement to home care services, and through contracting services and health management, they can effectively extend the life span of the disabled elderly and improve their quality of life. Public welfare social organizations can bridge the gap when other subjects are unable to provide care services, and they will provide social support for the disabled elderly, and build a good mutual assistance system. Through competition, the for-profit market also can provide affordable and high-quality services for disabled elderly people.
3.4.3 Incentive policies for multiple subjects involved in home care services for the disabled elderly
In order to promote the collaboration of multiple subjects, it is necessary to establish incentive policies for them to take initiative to provide home care services. the government should plays its responsibilities in the care of the disabled elderly as they are vulnerable group. It is an important responsibility of the government to mobilize the active participation of multiple subjects[11]. For example, the government can give some subsidies or even weekly vacations to the caregivers in the families of the elderly with disabilities. In addition, targeted funding can be set up in the family doctor team to encourage doctors to provide high-quality care services to the elderly with disabilities. Moreover, the government can promote non-profit social welfare organizations to expand their social benefits and support the for-profit market with public facilities and uniform staff training.