The Multi-Subject Cooperation Mechanism of Home Care for the Disabled Elderly in Beijing: A Qualitative Research
Authors: Zhang Ruyi , Zhang Zhiying , Peng Yingchun , Zhai Shaoqi , Zhou Jiaojiao , Chen Jingjing 
Published: February 2022

Abstract
Background: Currently, population aging has been an obstacle and the spotlight for all countries. Compared with developed countries, problems caused by China’s aging population are more prominent. Beijing, as a typical example, is characterized by advanced age and high disability rate, making this capital city scramble to take control of this severe problem. Moreover, influenced by traditional culture, disabled elderly people prefer to stay at home rather than go to nursing home. Home care for the disabled elderly is facing pushback from the whole society, such as lack of professional medical care, social support and humanistic care, and the care resources provided by a single department cannot meet the needs of the disabled elderly. Therefore, in order to meet the diverse needs of the disabled elderly and improve their quality of life, it is urgent to strengthen joint efforts of the government, society, family members, etc., and establish a collaborative mechanism to provide home-based care resources more efficiently and accurately.Objective: Based on the demands of the disabled elderly and their families, this study aims to explore the current status of homse care service supply process that multiple subjects involved in, and to give some advice on how to build a multi-subject coordination mechanism of home care for the disabled elderly in Beijing.Methods: A total of 118 disabled elderly people and their primary caregivers were selected from four districts of Beijing by using multi-stage stratified proportional sampling method. A one-to-one and semi-structured in-depth qualitative interview study was conducted in the study to find out the health status of the disabled elderly, the relationship between the disabled elderly and their primary caregivers, and utilization of elderly care resources, etc. Thematic framework analysis was utilized, the researchers summarized six aspects to express. All the methods were carried out in accordance with relevant guidelines and regulations.Results: Multiple subjects (such as the society, government, family doctors, family members and the elderly themselves) play a large role in the home care. But there is a lot of space need to improve, including a lack of high levels of interaction. In internal factors, the qualitative research results showed that the average age of 118 disabled elderly is 81.38±9.82 years; 72.9% (86) is severe disability; 89.0% (105)is plagued by chronic diseases; the average duration of disability is 5.63±5.25 years; disease is the principal cause of disability(95, 80.51%); the psychological problems of the disabled elderly are prominent; and the disabled elderly are not aware of the relevant pension policies; most of disabled elderly have 2.56±1.44 children, but the primary caregiver is their own partner (42, 35.6%), and there is an uneven sharing of responsibilities for the disabled elderly among their offspring in the process of home care. In external factors terms, the demands of the disabled elderly in home are not yet met; the disability subsidy is low and not in full coverage. As a result, establishing multi-subject coordination mechanism of home care for the disabled elderly has further to run. Conclusions: In a nutshell, the disabled elderly and their families in Beijing grapple with heavy financial burden, physical and psychological problems; however, the current home care provided by multiple subjects is insufficient and is short of a multi-subject coordination mechanism. Therefore, more home care services should be considered and better cooperation among multiple subjects should be set up for the disabled elderly and their caregivers. Specifically, family members act as the guardians of the disabled elderly, they should take more responsibility for the daily lives’ care, like creating a warm and family-friendly atmosphere and giving more time to stay together and so forth; family doctors should provide professional technical guidance and assist other subjects to participate in the process of home care; the government should establish relevant pension policies, and unveil more incentive policies to encourage more family doctors and social groups to create a concerted effort ; social groups as a supplementary role to provide care services at need and promote the development of the service industry. Multi-subject coordination mechanism represents different subjects bearing respective responsibility for the disabled elderly, reducing the financial burden is the top priority to solve. Keeping consistency in the goals of multiple subjects, expanding the participation and health care service and enhancing cooperation is essential, the cooperation among multiple subjects exert each other’s advantages on home care leading to providing home care resources more efficiently and accurately. Multi-subject coordination mechanism working well and closely ensures a positive future for the disabled elderly.