Research on the Problems and Causes of Home and Community Elderly Care Services

: From the development status of home and community elderly care services in XX County, we can see the following problems in this field: insufficient public participation; The effectiveness of public value creation is insufficient; The realization of public value is insufficient. These problems are mainly attributed to the following aspects: single publicity means of government and relevant departments, no enough promotion of it, unchanged public pension concept and insufficient government funding.


Introduction
Due to the implementation of family planning in China in the 1980s, most families are small. Moreover, due to the development of urban phenomenon, a large number of young and middle-aged people flow to big cities, leading to the phenomenon of empty nest further prominent. The ability of family members to provide old-age care has been weakened, weakening the traditional familyoriented way of old-age care. The report to the 19th National Congress of the Communist Party of China proposes to "actively respond to the aging of the population, build a policy system and social environment for elderly care, show filial respect and respect for the elderly, promote the combination of medical care and care, and accelerate the development of undertakings and industries for the elderly " However, China has a large population and unbalanced regional economic development, which requires the participation of all social parties to solve the old-age problem. In this paper, from the perspective of public value management, taking XX County, an old mountainous area, as an example, to discuss how to solve the problem of home and community pension, in order to solve the problem of pension smoothly, and then realize the public value of the government.

The elderly population situation
Up to now, XX county permanent resident population has reached 141,000, the county population 21,500 people, aged 60 years old and above, it accounts for 15. 3% of the county registered population, 1. 2 percentage points higher than the province, is expected to reach 25,000 elderly population in 2020. The rural elderly population is significant, the county's rural elderly population of 17,900 people, accounting for 83% of the county's elderly population, forming an urban-rural inversion pattern of aging, and the overall development of rural economy and society lags behind, elderly service facilities are weak; The trend of empty-nesters is prominent, the outflow of young population is greater than the inflow, and the trend of empty-nesters is becoming more and more obvious. At present, there are 0. 2 thousand empty-nesters in the county. The aging population of XX County is in a period of rapid development, showing the characteristics of "getting old before getting rich", facing an increasingly aging situation. The number of elderly people is increasing year by year, and XX County has become one of the deeply aging cities in Fujian Province.

Basic information of home-based and community elderly care services
Up to now, XX County has built 45 home and community elderly care service facilities, including 6 township nursing homes, 1 community home care service center, 3 rural community elderly care centers, 5 community home care service stations, and 30 rural happiness hospitals, accounting for 40% of the total number of villages. In terms of community home-based care service, relying on Heping Community home-based care service Center and introducing professional institutions of Fujian Xiyanghong Pension Co. , Ltd. to establish a one-click call service information platform of "Internet + medical care", according to the service model of "combination of online and offline" and "combination of home-based care and community care". To provide emergency call, rescue linkage, domestic service, health consultation, spiritual comfort, cultural entertainment, life care and other old-age care services for more than 600 special elderly people in the urban area. Since 2016, the county government has invested a total of more than 800,000 yuan to provide online and offline purchasing services for specific elderly groups, such as subsistence allowance and entitled groups.

There has yet to be a fundamental shift in old-age thinking
According to the data analysis of the questionnaire, influenced by thousands of years of filial culture and tradition, many children in rural areas think that their parents need to be supported by themselves when they are old. It is not filial to not support the elderly at home, and there is a lack of emerging pension concept. And most of the elderly adhere to the parents have children, children foster parents of the old theory, feel old, must be taken care of by the children, more people think that let the parents live in the nursing home or ask a nanny management is the practice of treason, [1] These ideas lead to many elderly people are not willing to live in the township nursing home or happiness home.

The effectiveness of public value creation is insufficient
Pension work is a comprehensive work, which is not enough to rely solely on government departments and community staff, but also on various social forces, especially the volunteer service team. [2] However, according to the survey, home and community service volunteers mainly participate in the service of Gongqing women's organizations on holidays. The small number of service volunteers and insufficient participation in the service affect the quality of old-age support services, restrict the development of the elderly cause, and finally affect the public value created by the government for aging.

Insufficient realization of service value
According to the survey, as a result of XX county, the old population is less, currently engaged in the home and community endowment institutions only a sunset that XX county health care facilities, and the center of the professional service staff, mainly is more than fifty years old, although these people after a short service skills training, but the lack of system of the whole service team the professional training of the professional skills. On the contrary, due to the restriction of treatment problems, some of the elderly nursing staff trained by the professional system, and most of them do not want to enter the field of home care services. [3] The function of the core functions of the government is service, the government is neither "paddle" nor "steering", the government should focus on establishing on to provide high-quality public services for citizens, however, pension service personnel skill not jing directly affects the quality of the service for the elderly, lead to not fully realize the public value of government service.

The realization of outcome value is insufficient
The government provides specific government services for geriatric care institutions, aiming to provide better and more effective geriatric care services for the elderly. In order to fulfill government duties, professional service personnel are unable to fully meet the needs of the elderly, especially for spiritual comfort, due to their lack of professional skills. According to the survey, the vast majority of the elderly do not get spiritual comfort, and the elderly, as a special group, especially need spiritual comfort, which fully shows that the outcome value of the government pension is not fully realized.

Stationed there
According to the survey, most villages in XX County do not have similar activity centers for the elderly, nor have they held cultural and recreational activities. The elderly have fewer social activities, most of which are visits and chats between neighbors. In particular, the left-behind elderly feel more lonely and lonely. On the one hand, the left-behind elderly do not understand the policy clearly. After the implementation of a series of social security system reform and poverty alleviation policies, the quality of life of the left-behind elderly is still not significantly improved. On the other hand, the lack of community activities leads to the loneliness of the elderly in their later years. Their spiritual needs are mainly to be cared for and respected, to obtain various information from the outside world, to communicate with others emotionally, and to enjoy the rich fruits of social culture. Professional social work organizations or public welfare organizations can fully meet the spiritual needs of the elderly, improve the quality of life of the elderly, give play to the surplus heat for the elderly, and show their advantages.

The propaganda means are single and insufficient
Through reading the policy information published on the official website of XX County government and the relevant bulletin board of the Civil Affairs Bureau, it is found that the competent department of XX county does not have any content and information about pension propaganda except for the publicity on special holidays. Actually for pension related policy and information service, county civil affairs bureau didn't quantitative direct publicity, only through television publicity on a regular basis (a task), post (as a policy propaganda, in village halls are usually old people seldom watch phone or purposely to village halls to see, so take this single propaganda, it is difficult to achieve the purpose of the pension service. It is precisely because the government and relevant departments of the elderly service policy propaganda means of the single and insufficient investment, resulting in the public awareness of the policy and related information is not high, resulting in the whole society publicity respect for the elderly, love the elderly atmosphere is not strong enough, cut the realization of public value.

Lack of effective supervision of elderly care services
According to understand, XX county has only one professional pension services that sunset pension co. , LTD. , fujian province, and the agency service scope is limited to the city community old people, and XX county as the population less, less financial investment, service population is less, and pension invest more, cycle is long, lead to the agency to provide old-age service is less, In order to support the development of the pension institution, the government has not carried out strict and effective supervision on the services provided by the institution, resulting in the service provided by the institution cannot fully meet the needs of the elderly, affecting the realization of public value.

Insufficient public participation.
In the view of public value management, "public preference is the center of public value. In a democratic country, only the public can decide what is truly valuable for them". Public value is ultimately defined by the public, and the effective implementation of any policy is inseparable from public participation. Therefore, public value advocates to expand public participation. However, according to the author's investigation and statistics, before this, the government rarely conducted investigation and research on the needs of the elderly. Only the Civil Affairs Bureau arranged a survey to obtain the needs of the elderly by asking the village cadres and the rural ministry. Most of the elderly are reluctant to choose pension institutions, especially under the influence of traditional pension concepts such as thrift, saving money for their children, high charging standards of pension institutions and psychological shame, which directly block the realization of the public value of government pension services.

The quality of service personnel is not high
According to the survey statistics, at present, XX county around the community pension institutions in the pension service personnel education is generally low, most have not received strict professional training, lack of professional geriatric care, geriatric psychology and other knowledge, service quality is difficult to meet the needs of the elderly. At the same time, there is a certain prejudice on the elderly service work in the society, that the elderly service work status is low, poor treatment, and hard work, more lead to a small number of people willing to set foot in this industry.

Insufficient capital investment
For home-based and community elderly care services, there must be sufficient funds as a basic guarantee. However, XX County is a poor county. Weak funding has led to a decline in the standard of government procurement subsidies and a sharp decline in the level and quality of services, which has resulted in the elderly not being able to get basic security from public policies. The true value of public policies for elderly care cannot be realized. However, due to the high investment, low profit and long investment recovery cycle in the pension industry, XX County is a small county with a small elderly population and little demand, so it is difficult to attract social funds for investment.