日本社区养老论文文献综述

The aging of the population in the 21st century the major social problems, the international community of the hot issues of common concern of China's social, economic and overall development with the major strategic issues. In recent years, China's traditional family and community-based old-age pension services, both in the event of significant changes. Now, on this issue with the international experts and counterparts to exchange some cases. (A) At present, China is the world's most populous country in the elderly, accounting for about one-fifth of the world's elderly population. Since the end of 2000, the elderly population over the age of 60 to percent average annual growth rate last year, China's water for more than 60 elderly people have reached 136 million, accounting for 10 percent share of the total population of more than the aging of the population to enter the country. More prominent is that the elderly over the age of 80 has reached 13 million and an average annual rate of percent. The middle of this century, 60 years old or older will reach about 400 million, when one in four elderly people. China's population age structure into old age by the adult type, date from 1982 to 2000, only 18 years, compared with some developed countries, the speed of the base of the large number of the elderly population is an unprecedented of. Population aging in the process of development, although the growth rate of China's rapidly aging population, but from the beginning of the 21st century, the Chinese economy will achieve the development objectives of the third step, 30 to 21 years, the working population the proportion of the total population has remained more than 60%, with a long time in China's labor resources are still relatively abundant and low age of the older population accounts for 70% of healthy elderly. Therefore, the aging of the population on China's prospects, they do not have to worry, can not be negligent, as long as doing a good job, governance of China's population aging, we are full of confidence. It is worth noting that at the turn of the century about the importance of 20-year historical period, China's social and economic structure of many areas will face a "transition" process, and its future, will include old-age pension system, including the future of China's economy have a profound impact on the trend. One change from the scores of the planned economy era of planned economy to market economy and the coexistence of two-track, and then to a fairly complete socialist market economic system reform, China has demanded the establishment of the pension system and reform the idea of a variety of market economy should be closely the pulse of development in line with the requirements of the development of a market economy, constrained by the laws of the market. The second change, China has continued for more than a decade of rapid economic growth, the turn of the century will be continued. As to China's overall national strength has increased substantially and the national economy and employment structure of the industrial structure will be significant changes to speed up the urbanization process. Owing to the large number of rural surplus labor transfer to the second and third industries, and from rural areas moved to cities, rural areas will depend in large measure the traditional shake the foundation of the family pension. The third change in the turn of the century, China's aging population has entered the ranks of society. Elderly population in absolute numbers and in the total population increase in the proportion will change the age structure of the population, adding to the burden of social endowment. Of social labor market supply, the national economy, the proportion of accumulation and consumption and so on have a profound impact. The transformation of socio-economic structure, the decision of China's pension system will also be going through a "transition" process, leading from the main domestic economic leader in the social old-age pension to the transition. However, taking into account in the 21st century for a long period of time, China's existing urban-rural dual economic structure will continue to exist. Therefore, at present, China's pension system, the basic framework can be broadly summarized as follows: conform to their social, economic and demographic changes in the structure of the family old-age pension and track both the overall framework of the gradual transition to the social endowment. (B) China's old-age pension, currently mainly family-based old-age pension. People's Republic of China since the founding of the "Constitution", "Marriage," "People's Republic of China Law on the Protection of the rights and interests of older persons" such as laws, they affirmed the legal status of family pension, of which 29 August, 1996 promulgated " Old Age Law "clearly provides that" the elderly mainly depend on old-age home, family members should be the concern and care for older persons. maintenance of older persons should carry out to support the economic, social care and spiritual comfort of the obligations of the special care of the elderly needs. " China's family old-age model, has also aroused the concern of the international community. Held in Vienna in 1982, the United Nations World Assembly on Aging, the General Assembly, the Secretary-General pointed out: "with China as the representative of the Asian way to solve the problems of the elderly is the world's example." The so-called Asian way, that is, refers specifically to the way of family pension. In China, such a large population, the economy is not yet well-developed developing countries, to play the role of family pension, a very far-reaching significance. Moreover, adhering to and developing the tradition of old-age home for the aging of the population of developing countries to solve the problem, there will be a certain impact. From the social development, the family pension is not only reflected the inter-generational economic reciprocity between the mutual aid and, more importantly, embodies the spirit of mutual support the two sides consolation. No matter what kind of goods to the level of economic development, regardless of people's thinking, values and how the family structure changes, the traditional ethics of the Chinese nation still maintain the basic norms of a normal life. Because, in the family as a result of the formation of a common life and harmonious family relations, social relations, any other can not be replaced. However, the progress of society, the times are changing, China is not the old model can not be changed. Overall, China's old-age, elderly, whether rural or urban, 70% of the elderly have been relatively good maintenance. And the mobilization of all levels of government rely on the strength of all sectors of society to take a variety of old-age pension, so as to enable the broad masses of the spirit of the basic needs of the elderly. However, some elderly people to old-age pension is also not satisfied. Not satisfied with the proportion of claims for different, and some that are not satisfied with the 22 percent of people, some 19% of the people that are not satisfied with, and some that are not satisfied with 26% of the people. In short, one-third of the elderly believe that the issue of the elderly more prominent pension of old-age pension is not satisfied with the situation. This is because the emergence of new family pension, the new situation. Its a common question is: the concept of family pension, old-age sense of desalination; "parents, not Travel" has been completely shattered the fetters; senior citizens more and more elderly, more and more empty-nest elderly, a growing elderly family more; rural old-age security has not been fully established, the rural collective economic base is weak, no more funds to address the issue of protecting the livelihood of the elderly; elderly family status has changed fundamentally. Old-age traditional family has faced unprecedented challenges. In the cities, increasing family size reduced, the core of the family, empty nest families, the elderly will be increasing number of families. "Family changes in trend analysis of Shanghai," Shanghai article pointed out that the main characteristics of the family: the family is always in continuous growth (the early 80s, the city's families a total of 3,146,000, the early 90s rose to 4,153,000, 10 in an increase of million); families increasingly shrink the average population (the city's family size to persons in 1949 to 1982, the city's average family size has dropped to people, the current average is less than 3 per person); single families, elderly households showed the trend of rapid growth (the city's million households in the elderly over the age of 65 accounted for percent of households than in 1990 increased by percentage points), the example of Shanghai, in a sense, reflects China's cities with the issue of universality. The above shows that with the historical development, social change, the family faced a series of new problems in old-age pension, old-age traditional family has become the aging of the population not meet the needs of the development. From China's economic, political, cultural traditions and the elderly and families for tolerance, it is necessary to ensure the dignity of older persons, both now or in the future, take the family old-age pension and social combination of roads, is to resolve the issue of China's old-age of a way out. (C) of the Chinese elderly people in urgent need of the community old-age pension of service to the community. Community refers to a certain geographical-based community social life, which includes a certain geographical region, the region of a variety of material and cultural resources, as well as through the blood, such as geopolitical relations linking people with common interests and organizations. Urban communities in China, generally refers to an office area or street. Community to serve the community of old-age pension is community-carrier-led community-based organizations play a government, communities, families and individuals a wide range of power, the full mobilization of community resources, material and human resources for the elderly, elderly, old-age provide a full range of support to the elderly according to their own desires to continue to stay at home and stay in a familiar environment, and pro-people familiar with the neighbors and friends with dignity. China's community service pension starting from the 80's, after 20 years of development has begun to take shape, at present, most large and medium-sized cities have begun to take shape the facilities and services, fixed services and door-to-door services as the main form of service, and form of life care, health care, mental health, culture and entertainment, participation and protection services as the main contents of the pattern of community service pension. In recent years, the Chinese government attaches importance to promoting community service to the community, and has introduced a "speed up the development on the views of community services" and "accelerate the achievement on the socialization of social welfare views." In some places on the promotion of community service to the community of old-age have also been actively exploring in the full use of various social forces to mobilize the community of human, material and financial resources, the establishment of multi-channel services to the cause of old-age community has made initial success. Such as Zhejiang, Shanghai, Guangdong and other provinces and municipalities have issued the relevant policies and regulations, social forces organized for the cause of social welfare has created a favorable policy environment, greatly improving the enterprises and institutions, social groups and individuals, as well as Hong Kong, Macao, Taiwan, and even foreign organizations to run social welfare initiatives to quicken the social and pension services. Up to now, China's community-based elderly care facilities has reached 200,000, community service organizations, 70,000 volunteers, community service more than 800 million volunteers, run more than 750 social welfare agencies. At present, China's endowment of the community social services to the main contents include: (A) the diversification of investment channels. Given China's current level of economic development, the Government can not do all the community facilities and services for the elderly, should be taken to the state, collectives and individuals shared responsibility approach. Part of government investment funds, the main force of the elderly services for the demonstration projects, and through preferential policies and encourage the community to draw on the strength of older facilities and services set up in order to greatly accelerate the community-the pace of development of elderly services to meet the growing elderly The demand for services and facilities. (B) community-based management approach. Arranged to change the way old-age welfare facilities, services and facilities, as appropriate, will be part of services to civil society groups to the operation and management, the Government has given some preferential policies, the adoption of policies and regulations at the same time monitoring and guidance, social service to the community to do. (C) the community of clients. Community services and old-age pension is not only simple facilities for the elderly or a small number of the Home object, but for all communities in need of the elderly. Units and corporate services and facilities for the elderly to all elderly people should be community-oriented, to achieve resource sharing. (D) community-based services. The professional services and volunteer activities, a wide range of community residents and area units for the elderly community obligations, to cover services. In addition, the level of China's social security than the western developed countries is still relatively low, for the welfare of the elderly care situation of growing demand, a number of urban communities to establish a time saving system to encourage young people to provide care for the elderly care for the elderly, for their own future care needs of the time savings.

一、引言 我国作为世界上人口最多的国家，同时也是世界上老龄化人口最多的国家，社会保障和医疗保健压力巨大。根据国际通用解释，若65岁以上人口的比例超过总人口的7%，就是老龄化的社会；超过14%，就是老龄社会。目前，大多数发达国家都属于老龄化的社会，如法国、美国、英国、日本等等。据统计，从65岁以上人口的比例超过总人口的7%上升到14%，法国用了114年，美国用了65年，英国用了45年，日本用了24年，而我国只用了20年，预计到2050年中国老龄化人口将会达到全国人口的三分之一。 老龄化问题产生的原因主要两个：一为寿命延长，伴随着人们生活水平和医疗保健水平的提高，中国的人均寿命由1949年的35岁达到现在的75岁，翻了一番还多，反映出祖国的社会变迁，这是国富民强的象征；二为非均衡生育，未实行计划生育政策前，中国“一家多胎”现象严重，自1983年开始的计划生育政策，减缓了中国的人口增长速度。 如何解决中国老龄化问题，基于以上两点原因，提出不同的对策。寿命延长导致的老龄化问题不可避免，由此带来的后果通常为养老金不足和养老保障措施不配套，只能通过延迟退休和加强养老保障措施来解决；非均衡生育带来的老龄化问题，只能通过均衡生育来应对，根据2010年的人口普查结果，显示在过去的10年中，中国人口增加了7000多万，但是生育率却低于，即每个负率平均生了不到个小孩，远远低于的更替生育率，这就意味着中国的下一代人会比上一代人的数量少30%，不远的将来，中国人口将进入负增长的时期，人口老龄化问题将更加突出。 二、城市老人生活现状 （一）家庭基本状况 计划生育政策实行30年来，第一二代出生的独生子女已经进入结婚和生育的年龄，在这种背景下，“四二一”家庭模式逐渐普遍起来，即四个老人，一对夫妻和一个孩子的家庭模式。四个老人需要两个独生子女赡养，同时还要抚养一个孩子，加上独生子女本身存在的严重依赖性，在社会飞速发展、竞争压力剧增的今天，往往力不从心，照料不及。 另外，“空巢家庭”和鳏寡孤独家庭逐渐增加，其原因多种多样：（1）老年人希望独立生活，不愿离开久居的环境；（2）老人希望与子女住在一起，但由于生活方式、价值观念的不同，为避免冲突矛盾而选择独立生活；（3）子女工作忙、住房紧张，客观条件不允许；（4）因子女婚嫁离开父母异地成家；（5）不愿赡养父母等。 （二）经济状况 与农村老年人相比，城市老年人退休后基本上都有退休金，加上普遍存在的储蓄习惯，因此经济收入和消费水平较高。据统计，城市中85%的老人退休后的主要来源为退休金，13%的老人依靠子女的资助。由此可见，老年人的主要收入来源为退休金。但是，不同单位的退休人员在退休金待遇上有明显差距，机关事业单位退休人员待遇较企业离退休人员高很多。 （三）健康状况与医疗需求 随着医疗水平的不断提高，城市老年人的寿命不断延长。但是，寿命的延长不代表健康状况的延长。目前，我国城市老年人的健康状况堪忧，只有1/3的老人身体健康状况较好，其余2/3的老人都患有不同程度的疾病，所患疾病多以慢性病为主，其中较常见的为高血压、高血脂、糖尿病等，一半的城市老人还同时患有多种以上疾病，城市老年群体的生活自理能力、身体健康状况都不如人意。 老年人的医疗需求中遇到的最大困难是经济因素，其次是手续繁琐，再有是行动和交通不便。除了上述因素，不同地区的老人还有不同的困难，在城区的老人还经常面临报销不便，挂号难、住院难等，而郊区的老人面临的主要问题是周围没有好医院，常常无法及时就医。调查显示，慢性非传染性疾病已经成为危害城市老人健康的最大杀手，但是有三分之一的患病老人没有去治疗，而且有四分之一的患病老人由于各种原因无法就诊。因此，老年人的医疗服务呈现出个性化和多样化的特点。 三、养老模式探析 （一）家庭养老模式 目前最适合中国国情且经济成本最低的养老模式为家庭养老。现阶段很多老人都由子女赡养，与子女吃住在一起，身体健康的老人通常还会帮衬带带孩子，甚至买菜、煮饭。但是还存在一部分身患疾病的老人，需要子女照顾，特别是患有半身不遂、瘫痪在床的老人，身边不能没有人照料，这对普通公民的经济和生活状况无疑是雪上加霜。 为了改善家庭养老模式的现状，我们提出一种专业化家庭养老模式：中国城市中有40%的人群属于低收入群体，对于这类人群，可以给予选择提前退休去照顾自己家的老人，由政府拨出专项资金发放社会工资。这些回家照顾老人的劳动者，需要参加各种专业培训并与社区签订协议，通过社区的社会工作机构定期对劳动者的家庭照料做出评估，从而给予报酬。这样，不仅使老人得到悉心的照料，还解决了低收入群体的工作问题，一举两得。 （二）社区养老模式 社区养老模式是以老人的子女、亲戚、朋友为核心，以社区为依托，以专业化的服务队伍为依靠，为城市中在家居住的老年人提供生活照顾、医疗保健以及法律援助的养老模式。这种养老模式的特点是老人住在自己家里，得到子女照顾的同时，由社区的服务机构和专业人士提供上门服务，对老年人的身心健康有利，同时还弥补了因各种原因子女无法照顾老人的缺憾，并在一定程度上节省了建设养老院的资金。 社区养老模式不同于家庭养老模式，它的实质是社区中的家庭养老模式；与机构养老模式相比，将社会机构中的养老服务引入了社区，吸收了家庭养老模式和机构养老模式的优点，是处于社会转型期的中国面对老龄化问题提出的一种新型养老模式。 社区养老模式中主要服务群体为社工，目前我国社工的发展状况不尽人意，原因包括：（1）我国对社工这个职业的认识不到位，没有专门的机构对社工进行培训，内地大多数大学都没有社会工作会专业，而在香港和国外这个专业已经发展成熟；（2）政府对社工服务的投入不够，导致社会工作者没有良好的工资薪酬和福利制度，社会地位不高；（3）中国人传统观念严重，存在“家丑不可外扬”的思想，通常不愿雇佣社工来解决家庭问题。 （三）机构养老模式 机构养老模式的主体是养老院、福利院、医院以及各种康复中心，老年人通过入住养老院、福利院等养老机构，进行集中供养和居住，由专人负责照料日常生活。这种养老模式在一定程度上减轻了子女的负担，同时避免了因为生活习惯、价值观念等问题引起的生活冲突。其次，在一定程度上分散了家庭的养老风险，实现了养老资源的共济和共享。 社区养老模式的成本很高，同时无法满足老年人对亲情交流的渴望，无法提供精神慰籍。我国的养老院大部分都是早期建立，其服务设施和专业服务水平很难跟得上社会的发展和需要，养老机构的设备条件普遍很差，专业服务人员水平不高，管理模式滞后，无法满足标准化、规范化的管理。 四、对养老问题的一些想法 在生活方面，政府可否对老年人方法生活补助费，每月300元，独立于养老保险之外。截止到2013年，中国有大约2亿的老龄化人口，2×12×300=7200亿，而我国的2013年GDP预计将达到10万亿美元，不会对我国财政造成很大负担。 在医疗方面，政府可否对老年人开放免费医疗。虽然全民医疗到现在还不现实，但只是针对老年人的免费医疗并非不可行。 在精神需求方面，政府文化部门应经常组织针对老年人的文化活动，组织老人观看电影、戏剧等活动，同时建设老年大学和老年娱乐活动设施。 五、结束语 在现阶段，笔者认为应加强对养老问题的政府投入，以家庭养老模式和社区养老模式为主，机构养老模式为辅，使养老医疗服务专业化，资源配置合理化、社区规模体系化、管理标准化，建设具有中国特色的养老模式，更好的满足我国对养老问题的基本需求。