Review of Studies on Day-Care Centers for the Elderly in Community ()
1. Introduction
Since China entered the aging society in 1999, the elderly population has been growing increasingly. By 2018, the elderly population aged 60 and above in China has reached 249 million, accounting for 17.9% of the total population, and the aging degree will continue to deepen in the future [1]. To cope with the continuous aging of the population, scholars have made active exploration. A search on CNKI with the theme of “community endowment” found that before 2010, it was mainly the exploration of the endowment mode, and the endowment mode was mainly home endowment, supplemented by community endowment and supplemented by institution endowment. Day care centers, as an important carrier of community care, originated in the United Kingdom, mainly to facilitate the discharge of mentally ill patients to continue to receive medical care in the community, and then gradually prevailed in some developed countries and regions. Some of them tend to be health-oriented, usually providing physical treatment for the elderly in conjunction with health institutions or hospitals [2], and providing multiple options such as legal advice and personal care, gradually becoming the mainstream mode [3]. The service mode relying on the community has been accepted by more and more residents, which can not only effectively alleviate the economic and psychological pressure of family caregivers [4], but also improve the happiness, sense of health and sense of community belonging of elderly users [4] [5] [6] [7]. Hong Kong, Tianjin and Shanghai of China, as the pilot areas for the construction of day care centers, have launched pilot home-based care services. In 2010, China issued the opinions on strengthening and improving the construction of urban community residents committee, and would build a community elderly care project with the content of community day care center for the elderly. In November of the same year, the ministry of civil affairs issued the “standards for the construction of community day care centers for the elderly”, when a large number of day care centers were put into practice in China. By 2018, there were 45,000 community care institutions [8]. But the research on the day care center is not enough. A total of 1078 articles were searched on CNKI. According to scholars’ research on the operation, there are still many problems in the day care centers, such as low participation of the elderly, different matching of hardware facilities and high idle rate of equipment [9] [10] [11] [12] [13]. Therefore, in order to deepen the utilization degree of day care centers for the elderly, researchers conducted further studies on location selection, type positioning, function allocation and service supply.
2. Location Selection
Site selection of facilities is an important factor influencing users’ choice intention, and the elderly tend to choose facilities close to them [14]. Bin Li, Dian Zhou [15] [16] research more confirmed this phenomenon, they respectively from pension facility location are analyzed and the spatial accessibility, found facilities accessibility and location affect the elderly will and demand on the facilities, the results showed that high travel frequency of pension service facilities service radius should not be more than 500 m, especially in the mountainous city is subject to the terrain factors, old people walk up to more have been narrowed down, thus Xinyuan Wang [17] advice, community day care center in Chongqing planning radius should be within 300 m. Xiaopeng Jing et al. [18] believed that the location and scale of old-age care facilities were not combined with the density distribution characteristics of elderly population, which was the main reason for the coexistence of facilities shortage and waste. Against a prominent phenomenon, they use the Location-allocation Model, proposed” the demand forecasting Model + LA “facilities endowment layout method, from “population forecast—facility Location—service area division—size” four aspects, in the case of known part facilities spatial distribution, according to the demand system by specific optimization Model, selected from the given candidate locations qualified facilities, reasonable determination of the number of facilities, location, size and scope of services.
3. Type of Positioning
Japanese scholar Shashi Fukuda [19] et al. compared the nursing facilities in Osaka and Shanghai, and believed that self-care elderly people and elderly people in need of care should not live together in the same facility, but should subdivide the corresponding nursing facilities for different care objects, and in addition, special nursing facilities for senile dementia patients should be arranged. Bin Li [20] compared the type systems of old-age care facilities in China and Japan, and found that Japan could provide us with more effective Suggestions on the classification of old-age care facilities. China’s “home” is designed to provide the life cannot provide for oneself, the old man lived, medical treatment, health care, rehabilitation and care facilities, for the same purpose, Japan could be divided into without hospitalization, but it still want to undertake rehabilitation training between elderly care facilities and cooperate with medical institutions for dementia old man care “day care”. China’s “nursing home”, “nursing home” and “welfare home” correspond to Japan’s “special care home for the elderly”, “collective home for the elderly with dementia”, “short-term residence”, “light-cost home for the elderly”, “life and well-being center for the elderly”, care home for the elderly “and other types. This study is the first to notice the shortcomings in the classification of the type of old-age care facilities in China, which provides a direction for future research. Yiming Wang et al. [21] believed that the poor operation status of the day care center was mainly due to the fact that the type positioning of the facility in operation and management was not clearly identified. In other words, there was a disconnection between theory and practice in the type positioning of the day care center. Then, the differences in the judgments of day care managers and researchers on the “safety”, “economy”, “service function”, “community interaction”, “accessibility” and “location relationship” of the day care centers for the elderly were compared. Overall, the researchers and managers are important facilities of “service”, “security” and “economic” three elements, that price features a community relations important facilities, but the two sides on the contents of “services” to cover each to his own opinion, specific performance for researchers to adhere to the “function to maintain” service should focus on “spiritual solace” service, and managers is just the opposite. The two reached a consensus on the importance of facility elements, but there were still differences in the focus of service supply. Therefore, it was imperative to investigate the elderly’s demand for the content of day care services, and the development prospect of day care centers would be brighter and brighter only if the supply side and demand side matched.
4. Functional Configurations
The spatial allocation of day care center is also an important factor affecting the utilization rate of the elderly. Some scholars have conducted researches on the combination of day care center and other functional facilities, seeking for an efficient combination of functional compatibility. Other scholars have rearranged the functional units in day care centers to provide more convenient services for the elderly.
4.1. Building Group Combination
At the same time, many scholars found that there were many drawbacks in the spatial layout of day care centers and tried to improve the operation status of day care centers through spatial optimization. Ying Shi [22] for facilities space optimization also gave her advice, with several different before, she focuses on claims from facilities outside space combination to optimize layout, use of building functional units vertical and horizontal layout combined, intensive utilization of land, in order to achieve the purpose of raise the utilization ratio of facilities and applicability, it can strengthen the interpersonal communication between the elderly. On the site selection of the space, the compatibility between the activity place for the elderly and the learning place for children and other public buildings can be encouraged to solve the problem of the single function of facilities and form a compound space for multi-generation communication [23] [24] [25] [26] [27]. Yunqiao Luo [28] noticed that the design of the leading space of the day care center played an important role in the implementation of users. He combined the physiological and psychological characteristics of the elderly to design the leading space of the day care center in Shenzhen in terms of traffic flow, spatial layout, functional configuration and other aspects.
4.2. Internal Functional Space Combination
Yanmin Zhou, Yan hu et al. [29] [30] made an in-depth analysis of the advantages and disadvantages of facilities in the design of internal space, and advocated the transformation of internal facilities, such as reducing the lounge area to increase the number of rooms, widening the toilet door to facilitate wheelchair access and other measures to facilitate the daily life of the elderly and the work of service personnel. Wenjie Lin, Shengnan Tang, Qian Zhang [31] the same internal space layout is put forward opinions on the facilities, they according to the day of the old man lives in a day care center behavior and activity characteristics, and put forward the combination functional rooms, think can combine functional compatible room set up to improve space utilization, such as a restaurant can be Shared with multi-purpose function room, multi-function hall can be divided into different plates for the elderly on rehabilitation training room, reading room, etc. And the rest room should be set up independently to provide a quiet nap environment for the elderly. Some scholars then proposed to redistribute the area of each functional space to improve the space utilization [32]. Huiqin Hu, Yibing Zhao [33] think due to the different professional background, architects generally consider only hardware supplies, managers prefer to service supply problem, in the construction of day care centers operating in the lack of comprehensive consideration of these problems, so they think comprehensively the day care center—day care the old and service staff daily behavior and the behavior of both the corresponding functional space, simulate the behavior—space system, found that not every kind of mode is suitable for day care centers.
5. Service Supply
5.1. Service Type Segmentation
In December 2016, the general office of the state council issued several opinions on fully opening up the old-age service market to improve the quality of old-age care services, which shifted the goal of old-age care facilities construction from improving the quantity to improving the quality. The foothold of old-age care work gradually changes from “government management orientation” to “elderly demand orientation”. Before that, a large number of day care centers had empty functional rooms. Yan Wu, Wenjie Lin et al. [34] [35] conducted a comparative study on the space needs and use differences of the elderly in day care centers, and the study shifted from simply summarizing the current situation of operation and construction to focusing on the needs of the elderly. In the later research, scholars pay more attention to the difference between the actual needs of the elderly and the current situation. Bin Li, in accordance with Yiming Wang [36] investigated the elderly in Shanghai and its influencing factors, the demand of the urban community endowment service found that the old man body self-care ability and choice of pension service classes have close relations, provide for oneself the old man often choose family endowment and pair love, half to care for the old man usually selected institutional pension, and disability elderly preferred day care.
This is at variance with the definition of a day care center in the “basic requirements of Community Day Care Center for the elderly”, which reads “provide certain facilities for the elderly, such as meals and personal care for the self-care and semi-self-care elderly in the community.” In view of this phenomenon, Bin Li, Yiming Wang and others believed that the types of care facilities should be diversified and proposed to divide the day care facilities into four types. “Community Welfare Medical Treatment” is for the poor economic conditions, poor health of the elderly to provide care and health services; “District Welfare Living” is to provide basic living services for the elderly with low income and moderate self-care ability; “District Fee-Paying Living Style” provides basic living services for the elderly with better economic conditions and self-care; “Community Welfare Recuperation” is designed to provide nursing and health care services for the elderly with poor economic conditions and better self-care ability than the first type of care object. Let the elderly choose care facilities independently according to charging standards, service contents and other factors [37]. The subdivision of nursing facilities not only fits the actual needs of the elderly, but also effectively reduces the duplication of functions of nursing facilities.
5.2. Demand Differences for Services
In the study of service content, the elderly showed the highest intensity of demand for catering service, which was consistent with the research results of Bing Hou, Mei Bai et al. [38] [39]. In the future, low-cost restaurants for the elderly should be vigorously developed to meet the needs of the elderly. The advanced experience of developed areas at home and abroad for reference, also can yet be regarded as a good solution, quartz, Qingfan Yuan, Dake Wei and Fei Wang [23] [24] [25] [26] [27] refer to the United States, Japan, Britain and Hong Kong and other parts of China community day care center construction experience, that my country is rich in day care centers should be service content, provide diversified services for the old man rather than a simple lunch service and chess entertainment activities. Some other scholars, such as Lan Yong, Congbo Zhang et al. [40] [41], evaluated the accessibility and service quality of community elderly care services. The evaluation results showed that home-based elderly care services in China have basically achieved full coverage. Affordability, acceptability and adaptability are relatively good. The pricing of various community pension services needs to be adjusted, and the acceptance and satisfaction of the elderly need to be improved. The availability score was the lowest, and the elderly were not satisfied with the number and types of service, which provided a basis for the improvement of service quality in the care center.
5.3. Increasing Demand for Health Care
With “on health care and pension service of combining the guidance”, the public line of sight gradually focus on the elderly pension demand on basic health, file points out that the demand for a disability and partial disability elderly, organization to rely on, completes the rehabilitation nursing service, strive to protect health of special difficult old man endowment service needs [42]. The file as an indicator of home endowment facilities development direction, leading the daycare endowment industry development in the direction of medical raise combination, studies have shown that the promotion of community care is of great significance to improve the lives of local residents satisfaction [43], and at that time “active aging” “healthy aging” has become the public familiar words. Since then scholars from the perspective of nursing, day care service investigation and evaluation of such as opportunities, Wei Liu, Zhizhen Yao, Bin Zhang et al. [44] [45] [46] studied the effects of day care on the physical functions of the elderly, and found that the physical functions of disabled and mentally retarded elderly were greatly improved after systematic physical therapy in day care centers, which proved that long-term group rehabilitation activities had a great effect on the optimization of physical functions of the elderly. This coincides with the findings of western scholars. The difference is that foreign studies not only focus on the improvement of cognitive function of dementia patients, but also pay attention to the psychological reconstruction of elderly patients with depression as early as possible [47] [48] [49] [50]. However, the actual needs of the elderly to this kind of “optimization” is not ideal, Jiyan Sun etc. [51] confirmed that is a big potential demand for community care in the elderly, especially that of the old man, but due to various conditions to limit the actual demand is not high, so they think should strengthen the construction of community public health service facilities, stimulating community care of potential demand. Shasha Guo et al. suggested that services should be formulated according to the different physical conditions of the elderly, such as providing leisure and entertainment services for self-care elderly with good health, and providing rehabilitation medical treatment and day care services for special elderly with physical injury [52]. “Combination of medical care” and “elderly” were used as the retrieval conditions for the annual literature publication retrieval on CNKI, as shown in Figure 1. After 2013, the number of related literature publications surged, and it is expected to reach 144 by 2019. The shift in focus has much to do with the policy documents issued by the government during this period. According to statistics, the average life expectancy in China is 77.0 years in 2018, but the average healthy life expectancy in China is only 68.7 years. The proportion of elderly people suffering from one or more chronic diseases is as high as 75%, and over 40 million disabled and partially disabled elderly people [53]. Faced with a large base of potential clients, most pension institutions are unable to provide professional medical services, and hospital beds are too scarce to provide sustainable care services, the combination of community care and medical care seems to be the best mode to solve the urgent problem. As for how to promote the development of “combining medical care with day care”, researchers are increasingly focusing on humanistic care. Yan Shao [54] believes that day care centers can make full
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Figure 1. Annual trends published by CNKI.
use of the medical resources of community and township health centers, and reach long-term cooperation with them to provide long-term care services for the elderly in need. ke Su advocated to promote the integrated development of medical and nursing care in the way of physiological needs, safety needs, belonging needs and respect needs of the elderly by taking four measures [55]. Haotian Wang [56] also expressed his support for this approach of double repair of software and hardware to achieve high-quality development of elderly care services. The implementation of the new measures is not plain sailing, it comes with many challenges and the possibility of more, Lei Xue, Xian An noted endowment the scarcity of nursing staff is our country medical keep combining service is facing a big dilemma [57], in response to this problem countries broadened the old-age care entry conditions, to the employees by the junior high school education background levels dropped to no degree required [58], but this does not mean that the aged care industry can be good and evil people mixed up, instead of empathy, nursing care, [59] and the professional nursing skills put forward higher and more comprehensive requirements. It is worth mentioning that American scholars have pointed out that day care centers for the elderly may become the most ideal place for hospice care [60], and about a quarter of day care centers in the United States have provided hospice care education for employees [61]. The ministry of education of China has also indicated that it will expand the scale of personnel training for relevant majors, and establish a talent system at different educational levels, including secondary vocational, vocational, undergraduate and graduate students [62]. From this point of view, making full use of the existing medical care resources and developing high-quality nursing personnel training plan, the development of the mode of combining day care with medical care in China can be expected in the future.
6. Conclusions and Prospect
Through sorting out relevant literatures in the field of day care, we find that the construction of day care has gone through three stages: the initial stage of “pilot city first”—the optimization stage of “improving hardware supply”—the progressive stage of “focusing on demand difference and paying attention to humanistic care”. According to time sequence carding the research content of the published literature can be roughly the time course of the three stages of development. 2010-2015, was China’s construction of day care facilities fledgling stage, the reference in other parts of the experience, also made the corresponding national standards, but was still in the trial and error practice way for social reality in China, during the same period, scholars mainly aimed at the operation present situation investigation and evaluation that reflected the care center in the operating mode, many problems of the management system and so on. The day care center operation problem of poor needs to find a solution. Then years experts committed to the care center in the process of internal and external space combination and operation type orientation angles such as looking for optimization approaches, there are some scholars that draw on the experience of advanced western countries, put forward the constructive strategy, in this short year, day care required highly improves the hardware facilities. Demanding along with the increasing of people a better life and the government, in 2016-2019 studies also focus on the humanistic care, day care services not only suppliers provide what kind of service, and towards to the demand of the practical need, when scholars in facility location and spatial accessibility, function space configuration, service quality evaluation and medical combination mode of trial.
The development of the day care center will encounter more opportunities and challenges in the future. It cannot be ignored that there are still several problems to be solved:
1) The service functions of community old-age care facilities are not clearly divided, resulting in overlapping of multiple functions, resulting in waste of resources. “Day care center” and “elderly activity center” belong to a community within the scope of life circle that should be equipped with facilities, compared the two found that they all can provide a wide range of leisure and entertainment services for the elderly, the difference is that the former can also be daily care services for the elderly. However, the position of these two types of facilities in the community pension service system has not been clearly divided. It is not clear whether their roles are parallel to each other? Complementary to each other or whether one can completely replace the other?
2) Of the service object set, there is a big deviation of community day care center in the national standard set of oneself is to the old man and half to care for the old man provides a variety of pension service facilities, but in the survey disability, old people tend to choose day care endowment, self-care and half to care for the old man often tend to family endowment and institution endowment. Therefore, it is necessary to carefully define the service objects of day care centers, provide corresponding services according to the main needs of different objects, or consider subdividing the types of day care centers.
3) There is a lack of guidance on the construction of day care facilities in rural areas. Facilities and equipment configuration of day care centers for the elderly in community and basic service requirements of day care centers for the elderly in community only limit the scope of implementation of the standards for day care facilities in urban areas, while there are no relevant guidance documents for rural areas. The author visited the rural areas of Mianyang city and found that the facilities in the day care centers were generally monotonous, and the operation mode of many day care centers deviated from the original intention, which was the same as the ordinary chess and card rooms, and could not provide services for the elderly.
Supported
Supported by Postgraduate Innovation Fund Project by Southwest University of Science and Technology (Grant No. 19YCX0082); Science & Technology Department of Sichuan Province (Grant No. 2019JDR0119).