New proposals from research results -Vietnam needs an overall process to improve the care quality for the elderly people to quickly respond to their demands, in line with the fast agein
Trang 1MINITRY OF EDUCATION AND TRAINING NATIONAL ECONOMIC UNIVERSITY
PHẠM VŨ HOÀNG PHAM VU HOANG
SOLUTIONS TO IMPROVE THE CARE QUALITY OF THE
VIETNAMESE ELDERLY
Specialty: Human Administration (Ergonomics) Code: 62340404
DOCTORAL THESIS ON ECONOMICS
Hanoi, 2013
Trang 2THE THESIS HAS BEEN DONE IN THE
NATIONAL ECONOMIC UNIVERSITY
Scientific supervisors:
1 Assoc Prof, PhD Tran Xuan Cau
2 PhD Nguyen Ba Thuy
Scientific feedback 1:
Assoc Prof, PhD Mai Quoc Chanh
Scientific feedback 2:
PhD Bui Sy Loi
Scientific feedback 3:
Assoc Prof, PhD Mac Van Tien
The thesis will be presented under the assessment of the Council for
thesis evaluation at university level
Meeting at the National Economics University
At day months in 2013
The thesis is available at:
National Library Library of the National Economics University
LIST OF RESEARCH PROJECTS MADE PUBLIC
BY THE AUTHOR
1 PhD Nguyen Quoc Anh, PhD Nguyen The Hue, MA Pham Minh Son, Nguyen Van Lieu, Nguyen Tuan Ngoc, MBA Pham Vu Hoang (involved
in writing Chapter 2) (2007) “The elderly people in Vietnam”, Hong Duc
Publishing, House, Hanoi
2 MBA Pham Vu Hoang (2007) “The application of Information Technology in State management- Population, Family and Children: Current state and recommendation” founded of Population and
Development, No 2 (71) February 2007
3 MBA Pham Vu Hoang (2011) “The ageing trends in the world and the problem facing developing countries” Journal of Population and
Development , No 9 (126), 9/2001
4 MBA Pham Vu Hoang (2011) “The material life of the elderly Vietnamese people- Current state and Recommendations” No.10 (2007),
10/2011
Trang 3INTRODUCTION
1 The Rationale
The United Nations forecast, that the XXI century would be an ageing
century as population ageing is a global phenomenon, observed everywhere and
affecting all nations The issue of ageing population has been the concern of
many countries In Vietnam, according to population census in 1979, 1989, 1999,
2009, the rate of elderly people (over 60 years old) increased from 7.1%, 7.25%,
8.2% and 8.9% in total population According to the result of annual population
and family planning survey on April 1st2011, the rate of elderly people (60 +)
was 9.9%, especially the rate of elderly people (65+) was 7% (the ageing is fixed
at 7%) Thus Vietnam has changed over to “The ageing population “structure For
Vietnam, a developing country, the ageing population will being pressure to bear
on to current infrastructure system, health services system, transport system,
pension system for the elderly people, as well as in family, psychological, life
style relationship Especially, many things will happen in case providing In
Vietnam the health care services are given more attention to through the specific
actions and policies However the elderly people’s care services are facing many
difficulties With the difficult conditions above, how does the care work for the
elderly people? How does the care quality for the Vietnamese Elderly? To answer
this question, we need to be clear about the characteristic of the Vietnam elderly
people as they are the research targets The research assesses the care situations
the elderly people on 3 subjects is very comprehensive (Health, physical and
spiritual) Hence the author selects the thesis “Solutions to improve the care
quality of the Vietnamese elderly” The Thesis will research, assess care
conditions, care quality for elderly people and give some solutions to enhance
care quality services for the elderly people in Vietnam at present in the years to
come
2.The research purpose
The dissertation is designed achieve some basis goals (1) systematize and
develop the rationale of care, the quality care for the elderly people (2) Research
analyses and assess the conditions of caring for elderly people and affecting
factors (3) Propose some directions, measure and recommendations to improve
the quality of care for the elderly people in Vietnam in the coming years
3 The approaches and hypothesis
The thesis approaches the care for the elderly people in the health care
aspect It meets basic needs of the elderly people’s life It will help the elderly
people to have a happy, healthy and useful life The research assesses the care
situation on 3 care subjects(health, physical and mental)to prove the following
research hypothesis:
(1) The care task of the Vietnamese elderly is interested
(2) With the limited condition in current, the care quality of the Vietnamese
elderly is still not guaranteed
4 Object and scope of research
Object of research: The theorical and practical issues related care for the elderly people in the context of Vietnam being ushered into the ageing population stage
Scope of research: In terms of space: nation-wide care for the elderly people In terms of time: From 1979-2009, baseline study to 2010, proposed solutions to 2020
5 Methods of study
The Thesis uses a combination of several research methods including: Statistical analysis, synthetic analysis, assessments, comparison Consultation sociological investigations, observations, in-depth interviews (4 times) and questionnaires (60 elderly people) at Thien Phuc Center for Health care in Dong Ngac – Tu Liem Hanoi selecting models of health care for elderly in community
by privately – based management
6 Overview
It was not until 50s of the XX century that the elderly population research was paid attention to by nations and international organizations First in the developing countries and later in the developed countries In Vietnam the elderly people issue has been great focus e.g information about the elderly people in population census including: The living conditions of the poor elderly people research in 2001 by Help Age International The case study of some characteristics of health care model applied (2005) by The Population – Family Planning – Children committee: The Survey collecting and processing information on the elderly people (2007) by The Ministry of Labor- Invalids and Social Affairs: The research, survey on elderly people status in Vietnam (2004): The over 80 – year olds (2009) by Vietnam Elderly People Research Institute The doctoral Thesis on the life quality of the elderly people research and experimental interventions in Chi Linh district, Hai Duong province (2010) by Duong Huy Luong The research on the elderly people has only focused on collecting the elderly people’s information, mostly some characteristics of elderly people or study about the elderly people living in special areas to provide recommended health care solutions for the elderly people In fact, there has not been any comprehensive research about health care for the elderly people in
Vietnam
7 The scientific contributions of the Thesis
New academic and theoretical contributions
The dissertation provides and makes clear some new academic points of learning specifically:
Trang 4- The care for the elderly people is basically to meet the 8 key demands of
the elderly (health, housing, clothing, travel, study, entertainment, information,
communication) for the elderly people to live the happily, healthily and usefully
Four resources of care for the elderly people (1)Elderly people/
family/relationship (2)State services and public services (3)Volunteer
organizations and international non-government organization (4)Private services
not in -dependent but mutually supportive
Of them, the informal care of elderly/family/relationships plays the key role,
care of the state and community plays a supporting role Along with the process,
the narrowing scale of the traditional family has weakened the informal care It
requires the intensively the formal care of the state and community
- The quality of care for the elderly is the expected result of the overall care
for the elderly people care in physical and spiritual health, meeting the elderly
people demands The research has pointed 5 affecting factors (1)The need for
care of the elderly people; (2)Care resources; (3)Structure and family size; (4)The
sustainability of social security system; (5)The ageing rate 10 criteria areproposal
to assess the actual care quality for the elderly people divided into 3 groups:
Health care, physical care, spiritual and maximization of the role of the elderly
people
New proposals from research results
-Vietnam needs an overall process to improve the care quality for the elderly
people to quickly respond to their demands, in line with the fast ageing rate,
social –economic condition and development such as:
- Strengthening the monitoring role of the …and branches concerned
program implementation process of the elderly people care policies Improving
the participation of the local associations of the elderly people while monitoring
the implementation of the law on the elderly people
- Renovating the advocacy method about the elderly people’s care quality
advocacy method to the behavior changing from the communication in the target
groups
- When the new social security system is focused on supporting part of the
elderly people through social insurance and social support, alongside social
insurance reforms and effective investments in social insurance funds,
establishing the “Saving fund for the old people “based on compulsory
contributions of every citizen This activity is likely to strengthen individual
responsibility, ensure social security and improve the care quality for the elderly
- Setting up and implementing the model “ The daily care center “ in
community especially in big cities encouraging the model of long-term home
based care and short–term home based care
- Recommending a system of care quality criteria in the elderly people care
model in community to identify the standardize of the services provided
8 Conclusion
Apart from the introduction, conclusion, table of contents appendices and list of reference, the thesis includes 3 chapters:
Chapter 1- Rationale of the care and its quality for the elderly people Chapter 2-Assess the actual quality of the care for the elderly people in Vietnam Chapter 3-Some solutions and recommendations to improve the care quality for the elderly people in Vietnam
Chapter 1- RATIONALE AND THE QUALITY OF CARE FOR THE
ELDERLY
1.1 THE ELDERLY AND THEIR BASIC CHARACTERISTICS
1.1.1 Concepts
- The elderly: The elderly also known as the old people The senior citizens
are those who have lived through a certain age, which is stipulated by the laws of
a given country In Viet Nam, the laws on the old people rules that’s “A person considered old is a citizen of the Social Republic of Vietnam upward of 60 years old
- The ageing population:The ageing population is a process in which the
rate of adults and the elderly increases in the population structure, while the rate
of children and teenagers decreases This process results in the increases of the medium age of the population It can be divided into 3 stages (1) Ageing Population stage (2) Aged Population stage (3) Super aged Population stage
1.1.2 Characteristics of the elderly
1.1.2.1 Demographic characteristics of the elderly
(1)The larger scale of the elderly people in the world the faster and greater
the rate of the elderly population than other age groups and the faster the number
of the elderly people in the poor countries (2) In the world, ageing population is developing in the elderly themselves (3) There is big difference in the distribution
of the older population between developed countries and developing countries
1.1.2.2 Characteristics in terms of health
The elderly are less sensitive in responses themselves abatement decline with age They are often meet the physiological changes
1.1.2.3 Characteristics of the elderly people socio –economic
The elderly, more often than not are back the period when they have to depend on the family, because they become old are likely to be deprived of the ability to self-sufficiency, self-existence, even of cognition
Trang 51.2 CARE FOR THE ELDERLY
1.2.2 Care for the elderly
Take care of the elderly is in essence to meet the 8 basic demands of the
elderly (Health, clothing, housing, travel, study, entertainment, information and
communication) for the elderly to live in happiness, health and a useful life
Taking care of the elderly and maximizing the role of the elderly are two closely
interrelated actions
Diagram 1.1.Maslow needs pyramid
Source: Abraham Maslow , Abraham Maslow's hierarchy of needs Motivational Model,
http://www.businessballs.com/maslow.htm
1.2.2 Contents, resources and forms of care for the elderly
Contents of care: (1)Health care for the elderly to be physically healthy To
have less disabilities and accidents; (2)Thanks to the material care: By assuring of
income through social welfare security and appropriate jobs; (3)Spiritual care and
promotion of the elderly people role : For the old people to integrate in social life,
contribute to the family and community with their different experiences
Resources of care for the elderly: In all countries in the world, the
responsibility and the care resources for the elderly are divided based on different
factors such as: Welfare, policies but in general they include 4 factors in
“Welfare diamond”- Pijl
The elderly /family/relatives
State and public service sector
Volunteer organizations and international non-government organization
Private sector
Diagram 1.3 Resources of care for the elderly
Source: Pijl’s “welfare diamond” – The elderly differs from country to country It depends on tradition, laws system, health care policies national finance, demographic, trends
Form of care for the elderly:
(1)Self –care and informal services from the elderly families/ relatives are the forms the self-care and the support provided by family members and close relatives at home;
(2) Formal care of the state and society, such as home based-care for the elderly Models of combined care: home based care and periodical sanatorium – based care and then back home Models of community–based care: The old people’s home, sanatorium social home–care center, social protection and support center
Table 1.3 Model of care Resources
Content
Formal care Informal care
States areas
Private sector
The elderly/family/relatives
Profit Non
profit
Health care Material care Physical care and increase
of the elderly people role
Source: Author’s resource The development of a great variety of models well suited for a nation affected by many policies of government and traditional moral culture of each country
1.3.THE QUALITY AND EVALUATION CRITERIA OF THE QUALITY OF CARE FOR THE ELDERLY PEOPLE
1.3.1 The quality of care for the elderly people
The elderly/familiy/
relatives
States
Voulunteer /NGOs
Market/
Private sector
Model
of care
• Home based care
• Combinationed care
• Community based care
Trang 6The quality of care for the elderly is the overall level of expected results in
the care activities on health, material and spiritual aspects (care for the elderly
including the promotion of the elderly people of role) to meet the 8 key demands
specially health, clothing, housing, travel, study, entertainment, information and
communication of the elderly
1.3.2 Standards to assess the care quality for the elderly people
Currently, Vietnam has not any system of criteria to assess the quality of
care for the elderly people, 3 groups including 10 norms for assessing the quality
of care proposed by the author are:
(1) Set of the criteria assessing the health care quality
Health/illness of the elderly people
Needs for health checks/and health services for the elderly people
Health care for the old people
The satisfaction of the people as regards health care and health services
(2) Set of criteria for assessing the quality of material life care for the elderly
people
Material lives of the elderly people
Material life care for the elderly people
Difficulties in the elderly people’s daily life
(3) Set of criteria for evaluation of spiritual care for the elderly people and
promotion of the elderly people’s role
Spiritual life of the elderly
Spiritual life care for the elderly
Promoting the role of the elderly
1.3.3 Improving the care quality for the elderly people and the necessity to
improve it
1.3.3.1 Improvement of care quality for the elderly people
Improving the care quality for the elderly is an active process destined to
change root and branch the expected in the elderly’s care activities in terms of
health, material and spiritual health to the higher expected level The elderly ‘s
care quality improvement must well suit the traditional culture and must also be
subject to the condition and level of social –economic development of each
country
1.3.3.2 The necessity to improve the elderly‘s care quality
Ageing Population goes side by side with irreversible development This is a
general trend of every nation The elderly whose characteristics are material and
spiritual declining with age badly need good care services The developing
countries with economic, health, social security conditions… in face of the rapid
increase of the old age population group have posed great challenges ad also set
out to find solutions to improve the quality of care for the elderly
1.4 FACTORS AFFECTING THE CARE QUALITY OF THE ELDERLY
PEOPLE
Some factors affecting the quality care for the elderly include:
The needs for the care of elderly are changing and increasing
Care resources
The family life style of the elderly family
The sustainability of social security system
1.5 THE EXPERIENCE OF OTHER COUNTRIES IN ENSURING THE QUALITY OF CARE FOR THE ELDERLY
The experience of many countries in the world, especially such countries in the region as: Korea, Thailand, Singapore, Myanmar to ensure the quality care for the elderly people
Develop and improve policies, programs and plans of action for the elderly.Build all specific round policies for the elderly people issue polices in
preparation for the elderly people, set the rule for everybody at some particular for old age to contribute to the fund “Preparation for old age” to enjoy care benefits Combine budget support with the socialization of the activities in
interests of the elderly people
Mobilize resources; choose the appropriate care methods for the elderly:Make efforts to maintain the many –generation family styled, informal
care from family/close relatives play a key role Informal care, from the state and community plays a supportive role(economic support health , the models of home based care and based community)
Diversification of care for the elderly people in community The model
of Sanatorium in appropriate with a modern society and provided a great variety
of options for the elderly The model of social housing for the physically weak, helpless elderly provided by the government and non-government organizations
Stable income from appropriate jobs for the elderly people Through
vocational orientation recommendation of appropriate jobs for the elderly
Chapter 2-ASSESS THE ACTUAL STATE OF THE QUALITY CARE
FOR THE VIETNAMESE ELDERLY PEOPLE
2.1 ANALYSIS OF THE BASIC CHARACTERISTICS AND THE ROLE OF THE VIETNAMESE ELDERLY PEOPLE
2.1.1 The demographic characteristics of the Vietnamese elderly
Scale and distribution of the elderly
The scale of the old people increased very fast, in 2009, the rate of the old people (60+) was 8.9% especially that of the old people (65+) was 6.62% According to the result of Census population on 1st April 2011, the rate of the old people (60+) was 9.9% and the rate of the old people (65+) was 7% (the
Trang 7simulated ageing was 7%) Though Vietnam had changed into the ageing
population structure, 5 years earlier than forecast that Vietnam population
structure would change into the structure of ageing population in 2017 According
to the United Nations report in 2008, the population of Vietnamese elderly would
reach 26.6% in 2050 Of the high level in ASEAN after Singapore (39.6%)
Thailand (26.4%)
The elderly people mostly living in the rural areas (70%) are 3 times higher
than the elderly people living in cities Most ò them are farmers, doing farm
works The elderly people not evenly distributed are concentrated in the 3 details:
The Red River delta (28.6%) The Mekong Delta (18.7%) and Northern and the
Central Vietnam and Coasters delta (24.4%) However the proportion ò the
elderly in cities increases quickly as result of the urbanization process
Gender and marital status of the elderly
Most of the aged are women of every 100 old males there are 141 old
females The gender ratio (female/male) of the aged increases with age group
from 120 (60-64 group) to 290 (80+ group)
The number of the elderly living single (without spouse) is high, especially
women The percentage of the women living without spouse accounted for 55.8%
of women much higher than men (15.1%)
2.1.2 Health Characteristics of the Vietnamese elderly
The Vietnamese elderly have a long life expectancy (73 years old) but a low
average healthy age (64 years old) ranking 12/193 in the world
The Vietnamese elderly people are carrying double burdens of diseases due
to the trend of changing from infectious diseases to non-infectious and chronic
ones The common diseases are osteoarthritis, high blood pressure, eye disease
and memory loss.It takes 4-5 times and 3 times longer for the elderly people and
the adult respectively compared to the children
2.1.3 Economic and social characteristics of the Vietnamese Elderly people
Educational and professional level:The education of the elderly is not
high: 1.35 million elderly (18.1%) cannot read and write mainly women and the
rural people
The professional level of the elderly is still limited with a large difference
between males and females However a small number of the elderly people is
highly qualified
Living standards: The living standard of the elderly people is for form
high enough, 23% of the aged people live a poor life There is a big difference
between the elderly people’s family living standards in the urban and rural areas,
the percentage of the rich elderly family rich in rural areas is only half compared
with urban area (1.13% and 2.47%) respectively and for that of the poor family
opposite (13.56% and 27.6%) respectively
2.1.4 Role of the Vietnamese elderly people
The Vietnamese elderly people play a very important role in the family and society Politically, the elderly are a support of the party, state and society Economically, the elderly are the contributors to accumulation of the national and economy development, investments in the past and present now, of every 2 the elderlyd people; one is involved in economic activities.Culturally educationally, the elderly are a treasure of valuable experience for the youth In terms of scientific research, beside the application of technical scientific progress, the elderly still participate in technological scientific research
2.2 ANALYSIS OF THE ACTUAL POLICY CARE OF THE VIETNAMESE ELDERLY
2.2.1 Annalysis of the actua care policy for the Vietnamese elderly
The formation and development of the policies for the elderly from the national formation in 1945 can be described as follows though different stages
The 1945-1994 periods (50 years).There was not as yet a policy for the
elderly: The policy was integrated into general policies Hence not complete and comprehensive The Government focused on providing care and support for part
of the elderly Specifically the government provided material support to part of the personas from the state sector, the helpless old people: The government provided health care and health services for the elderly people upward of 100 years old by providing free health care and medical insurance card and annual health checks for the elderly are also stipulated as priority
The 1995-1999 period (the formation period): The policies mainly focused
on the economic care of the elderly group particularly the retires in the state sector, The lonely helpless elderly through social safety welfare and social support Legal documents continue to be integrated and amended
The Vietnamese association of the elderly was founded in 1995; it is the nationwide organization of the elderly It helped the government develop care for the elderly at low The organization is all 63 provinces/ cities down to all provincial towns, districts, Sub association are all up in all village, and hamlets all over the country
From 2000 up to now (The improvement period).This state experience a
strong change in the policy of government for the elderly and the care for the elderly In ten years from 2000 to 2010, the government issued specific policies particularly for the elderly In 2000, Vietnam had a policy especially for the elderly namely the ordinance and the law on the elderly (2009), The Prime Minister approved of the National Plan of action on The Vietnamese elderly people The 2005-2010 periods
The content of the elderly people’s policies at present including:
(1) Care for material life: The policies still focus mainly on economic
support for a particular group of the elderly namely retires and lonely helpless
Trang 8people through social welfare and social insurance system but there is a wider
coverage than in previous stages
(2) Medical care and health care: The elderly people have priority in health
medical check –up and treatment The government and community give medical
and health care to the elderly people at hospital, geriatrics hospital and state and
private medical facilities and the government has issued regulations about
the medical care – care for the elderly in the state health system
(3) Spiritual care for the elderly and encourage elderly people to participate
in activities, and movement s to improve their roles: The ever improving policies
about enhancing the spiritual life of the elderly include:
System of policies about the Vietnamese elderly is further amended and
completed after 55 years of preparation and planning (1945-1999) The legal
document system about the Vietnamese elderly is quite sufficient and advanced,
shows the State and Party‘s interest to the care of the elderly people’s policies
The current policy environment creates many conditions to enhance the quality of
life, in response to the care demands of the elderly However the implementation
by care providing organization of care activities and promote the elderly people’s
role is still limited, not sufficient and untimely, not at all appropriate with the
ageing population stage Especially, the issuance of guidelines of the relevant
department is not timely and specific; therefore grassroots levels meet difficulties
and challenges in policy development and implementation
2.2.2 Analysis of the real state of the quality of care for the elderly
2.2.2.1 The analysis of the real state of care quality for the elderly
Health care included overall activities from self-physical exercise, health
care, prevention of diseases to health care when the elderly are sick so that they
can to get better and strong and have fewer diseases
Table 2.2 Forms of health care for the elderly people
Resources
Content
Formal care Informal care
States areas
Private Sector
Elderly/Family/R elatives
The forms of
physical care
for the elderly
people
- Policies
- Information/
Health care consultant
- Hospital/Geriatrtr
ic hospital/ states clinics/health care insurance
- Private hospital
- Family doctor model
- Elderly care center management by private
- Health care
of the elderly people rely
on the volunteers model
- The elderly people self care model
- Long term home based care
Source: Author’s resource
Health/disease of the elderly
- The health condition of the elderly The elderly have poor health and
trending increase in over 10 years The rate of poor health’s people is up to 56.3%% and concentrates in the older age The male elderly has better health than the female one There is still the gap between the urban and rural areas The elderly in the urban has better health (1,13 times) than the rural one
Especially, 23.5% the elderly people meet difficulties in daily work
- Diseases of the elderly:The elderly suffer much disease with 90% having
from 1 to 4 diseases, 75.6% 1 disease The rate of disease in female elderly is higher than in men and not depending on the age The elderly people suffer chronic diseases.The rate of the elderly people suffering chronic disease is high (70%) and tends to quickly increase recently
Health care demands/health care services for the elderly people
Due to poor health and burden disease the demand of medical care, health care for the elderly people is very great
- The rate of the elderly people suffering illness or injury which requirestreatment:Onaverage, there is 1/2 of the elderly population groups needs
treatment when they are sick or injured, 1.6 time to 3 times more than the general population’s needs
- The needs for health care of the elderly people: Most the elderly people
want to have the medical care at their commune health centre / wards (63.6%) and at the state’s hospital at the district, provincial and national levels (30.7%) However, in fact,the ratio is 46.9%, 30.6% and 19.5% at the state’shospitals,healthprivate sector and commune health center / ward for outpatients respectively.In case of inpatient treatment, the elderly will use state hospitals (94.3%), commune health center / wards (2.8%) and private sector (2%) Therefore, the demand for the type of medical services of the elderly people has not been met
The health care and medical treatment for the elderly people
- Doing physical exercise and home-based care for the elderly people: The
rate of the elderly people who do not do physical exercise, is high (59.1%) for a great variety reason of: Weak health, economic difficulties, lack of facilities/ equipment and campaigns
- Periodic health examination: The Vietamese elderly people do not have
the habit of taking periodical medical examination The rate of the elderly taking health examination is very low (27.7%), accounting for 1/3 compared to the rate
of medical examination of the elderly people Among the elderly people, who do not take regular health check, 60.9% only go to the health care center or hospitals when they are sick, the rest often buys medicines by themselves without doctor’s prescription
- Home based medical care for the sick elderly people: Family members
make a study of diseases to provide of their sick parents (91.12%) with great care
Trang 9- Most common diseases in the elderly people and how to keep them fit:
About more than 50% of the elderly people are made know of these diseases and
are guided keep themselves healthy at old age The main reason of this situation
is lack of resources in commune, clinics and information from higher authorities
- The capacity to provide geriatric services for the elderly people: The
health care & medical treatment services network for the elderly people is not
complete from the central government to the localities there is not adequate
investment for the health care – health system for the elderly people
In the state health system, apart from the National Geriatric, hospital, there
are 22.4% of provinces with hospital having special geriatrics department but
with limited resources The network of clinics in commune/villages has a tree-like
structure but they are not equipped with special equipment At present we have
just two geriatrics training centers in the country The training modules for
geriatrics are still few in number The health care model for the helpless elderly
people based on volunteers in communes has just been set up
In the private medical sector, private hospitals taking part in health check for
the elderly have reduced pressure on state hospital with high quality but the price
is high, hardly accessible for the elderly people The model of family doctor
newly established in big cities suitable for the elderly people or rich families
because they have to pay for the health care services
The issuance and use of medical insurance cards of the elderly people for
health check and medical treatment The number of the elderly peoples using
medical insurance cards for health check makes up 1/3 of the elderly people with
health insurance The main reason is the complicating of the administrative
procedures It takes then a long time, they have to go to the right level while the
quality of health check is not quite good The centers providing health check
services by insurance cards are always overburdened
- The application of medical insurance cards of the elderly people for health
check and medical treatment: Thanks to the changes of the policy in issuing and
distributing health insurance card such as: free card for the elderly people over 80
years old or seriously disabled people, the number of the elderly people go for
health check with health insurance card or the free medical insurance
cardincreases double to 73.4% in 2010 compared to 36.8% (in 2002)
The level of satisfaction of the elderly people in health care and
medical treatment service
The elderly people are not really satisfied with the health care and medical
treatment services Nearly 47% the elderly people evaluated the quality of health
care services and medical treatmnent at medium rate and even have 4,7% rated
the quality is poor
In fact, the elderly people’s health is poor , vulnerable a lot of diseases, the
demand of health care is high, the state, society and family have made efforts to
develop several solutions to improve the quality of health care and medical
treatment for the elderly people, but the quality of health care is not ensured, the elderly people’s satisfaction is low, for a great variety of reason:
+ The self-health care and routine health check of the elderly people are not good
+ The dissemination of information about health care and illness to the elderly people is still limited: Home-based health care services for the senior sick have not been underway
+ The health care and medical treatment system for the elderly people is under invested, hence not complete We are still weak in health resources, especially in geriatrics, health care services in community
+ The use of health care services with medical insurance cards still has shortcomings
+ The quality of medical treatment in general and by health care insurance for the elderly people need is limited
2.2.2.2 The Analysis of the quality of for the material life care of the elderly people
The material life care for the elderly people included: overall economic activities of the elderly people themselves, from the support of family members to the physical help of government through social security policies, stable incomes creation of appropriate jobs for the elderly people to enhance their living standards and life conditions
Table 2.4 The Different forms of physical care for the elderly people
Resources
Content
Formal care Informal care
Private sector
The elderly /family/ Relatives
physical care for the elderly people
- Policy
- Social security
- Stable income for the elderly people
- The model health care in community for the elderly people :
- The convalescence home for the people credited with revolutionary activities
- Social care center
- The model of health care center for the elderly people managed by agencies /associates and charity organizations
- The accumulated from previous
- Self-care by the elderlypeople
- Family/close family support
Source: Author’s resource
The material life of the elderly people
The living conditions of the elderly people: In the period 1999-2011, the
housing conditions of the elderly householdshaveremarkablyimproved The
Trang 10percentage of heelderlyhouseholds living in semi-permanent house has increased
from 70.09% (1999) to 93.3% (2011) However,
percentage of the elderly people living in temporary households remains at
6.7% The other living conditions are also limited The using of tap water and
sanitary latrines are still limited 0.5% of the elderly people’s households have not
yet accessed to the electricity 2/3 of the elderly people’s households do not have
clean tapwater.18.9percentage does not have sanitary latrines
The living standards of the elderly people are still low, with a big rate of
23% living in poverty The rate of the elderly household (14.1%) is always higher
than the poor one (12.6%) in general and the rate of poor and the elderly people
in rural areas is always 3 times higher than the one in the urban area
Taking care of the material life for the elderly people
The elderly people’s income is of various forms from their descendants
(39.3%), from economic activities (30%), pension and allowance (25.9%) and the
accumulated properties (4.8%) Through these figures we can see that the
material care support for the elderly people is mainly made by
themselves/Family/Relatives and from the partly government
The material care for the elderly people through social security system: Due
to the limited resources, the government focuses on supporting the elderly people
in especially difficult conditions The social security system provides material
supports for nearly 2.97 million elderly people (39%) via social welfare
insurance, social policies for the elderly people credited with revolutionary
contributions and receiving social welfare However, the elderly people entitled to
social welfare said that it is difficult for them to access the program, the
allowance still is low, making up a small part in their’ expenses The government
has supported the physical life for the elderly people through nation target
program of poverty reduction gratitude and display
The rate of the elderly people who are living in temporary houses and the
poor conditions has quickly reduced to ¼ compared to the one in 1999 The rate
of the poor elderly household greatly reduced from 23.1% in 2007 to 14.1% in
2011 (9%) This is really a remarkable reduction compared with the reduction
rate of 2.2% of the poor people in general.The government is trying to build a
fund for the care of the elderly people 76% of provinces /cities have already
established the fund
Stabilizing income for the elderly people through job creation: With living
conditions is poor, they have to face with difficulties, but there is no small part of
the elderly still participate in economic activities at different levels In 2011 there
is more than 4.5 million (52.7%) of the elderly people participate in economic
activities, it means every two elderly people one people participate in economic
activity mainly in the rural areas (80.2%) They created agriculture jobs by
themselves with low and instable, instable much lower than other age groups
The difficulty of the elderly people in real life
Most of the elderly people (64%) said that they met with difficult is in the real life, of them, weak health (46%), allowance (34%) not enough money for medical treatment (17.8%), lack of care and respect from their children (1.8%) Therefore, faced with the real material life and the poor quality life conditions of the elderly people, the government and community, through some supportive forms have been taking care of and enhancing the living conditions of the elderly people However the quality of the material life is not ensured any the care for the material life is still limited
+ The new social security system has only supported part of the elderly people in difficult circumstances The allowance level is still low; the elderly people have difficulties in approaching the program
+ The poverty reduction and gratitude deeply programs have been implemented but not yet lipped the elderly people from temporary housing and extremely difficult, living conditions
+ The Care fund for the elderly people is in the building period
+ The elderly people is very active in particioate in the economic activities to improve their physical life by themselves, but the income stabilization and jobs creation for the elderly people have been not implemented
2.2.2.3 Analysis of the actual quality of spiritual care and promotion of the elderly people’s role
The spiritual life of the elderly people
The family’s atmosphere and the communication: The family’s comfortable
atmosphere and communication help the elderly people’s spiritual life, remove stress The rate of households awarded the cultural Family certificate was 76.4%, including 67% of households of the elderly people There who can talk with the elderly people every day are spouse (wife/husband 37.5%), children and grandchildren (248%) friends and neighbors (25.2%) not talkative (12.5%) Along with the industrial and modern life, the communication between descendants and the elderly people is not good enough The main reason is the lack of time the unwillingness to listen and the unmatched of intents between the elderly people and their children
Participation in cultural activities of the elderly people: At present the
elderly people’s spiritual life is quite various and constantly improved Most of the elderly people (91.6%) joined cultural activities such as: Reading books, newspaper and listening to the radio, watching TV … of them 71.2% frequent Besides joining the activities mentioned above the elderly people often go to pagodas, churches ,according to their belief
Neglected and maltreatment of the elderly people: To own regret them have
been a full case in with the elderly people are maltreated According to the Labor, Invalids and Social Affairs Ministry statistics 7.26% of the elderly people was victim of neglect
Taking care of the elderly people’s spiritual life