THE SCIENTIFIC CONTRIBUTIONS OF THE THESIS THE SCIENTIFIC CONTRIBUTIONS OF THE THESIS

MINITRY 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 THE THESIS HAS BEEN DONE IN THE NATIONAL ECONOMIC UNIVERSITY LIST OF RESEARCH PROJECTS MADE PUBLIC BY THE AUTHOR 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 Scientific supervisors: Assoc Prof, PhD Tran Xuan Cau 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 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 (71) February 2007 MBA Pham Vu Hoang (2011) “The ageing trends in the world and the problem facing developing countries” Journal of Population and Development , No (126), 9/2001 MBA Pham Vu Hoang (2011) “The material life of the elderly Vietnamese people- Current state and Recommendations” No.10 (2007), 10/2011 1 INTRODUCTION 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 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 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 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 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 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 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 The scientific contributions of the Thesis New academic and theoretical contributions The dissertation provides and makes clear some new academic points of learning specifically: - The care for the elderly people is basically to meet the 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 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 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 Conclusion Apart from the introduction, conclusion, table of contents appendices and list of reference, the thesis includes 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 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 5 1.2 CARE FOR THE ELDERLY 1.2.2 Care for the elderly Take care of the elderly is in essence to meet the 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 The elderly/familiy/ relatives Market/ Private sector States Voulunteer /NGOs 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 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 factors in “Welfare diamond”- Pijl The elderly /family/relatives State and public service sector Volunteer organizations and international non-government organization Private sector Content Health care Material care Physical care and increase of the elderly people role Formal care States areas Private sector Profit Non profit Informal care The elderly/family/relatives • Home based care Model • Combinationed care of care • Community based care 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 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 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, 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 10 simulated ageing was 7%) Though Vietnam had changed into the ageing population structure, 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 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 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 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 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 11 12 people 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 - 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 to diseases, 75.6% 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 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 not 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 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 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 Resources States areas Formal care Private Sector Profit Non profit Informal care Elderly/Family/R elatives Content - Policies - Information/ The forms of Health care consultant physical care for the elderly - Hospital/Geriatrtr people 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 Source: Author’s resource Health/disease of the elderly The elderly people self care model Long term home based care 13 14 - 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 Formal care State areas Non profit of Private sector Informal care The elderly /family/ Relatives Content physical care for the elderly people - Policy - The model of - The accumulated - Social security health care center from previous - Stable income for the - Self-care by the for the elderly elderly people elderlypeople people managed by - The model health agencies /associates - Family/close care in community family support and charity for the elderly people organizations : - The convalescence home for the people credited with revolutionary activities - Social care center 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 15 16 percentage 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 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 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 17 18 Visits and support from relatives/descendants to the elderly people: The Vietnamese tradition is to behave dutifully and respectfully towards grandparents and parents According to the date of the Ministry of Culture, Sports and Tourism, for 12 months, 95.9% the grandchild now not living with the elderly people visit their grandparents or parents, including daily visits, 28%, some days in the week 21.5, some days in the month 17.8%, some days in the year, 24.3% and 47.3% of the relatives or descendants not living with the elderly people and provide materials support to them Visits, supports from the local government to the elderly people: Visits, supports from the government to the elderly people are the responsibility the local authority However visits are few and far between, most being done by the elderly people’s association Centers of cultural, education, sports and entertainment for the elderly people are small in number Stadiums (43.1%), cultural houses (43.2%) clubs (28.8%) and swimming pools (3.4%) Maximizing the elderly people’s role The support of the elderly people to the descendants: Besides education, and the transfer of experience to descendants, the elderly people have also provided physical assistance, house chores including teaching and educating children, cleaning, housekeeping… Over 90% of the elderly people said that they participated in the activities mentioned above Participation in social activities by the elderly people: The elderly people have actively participated in the hamlet, communal, street activities, especially in such particular work as: 3.68% in leading role, only aged 60-74); 4.41% in reconciliation team, 2.43% people’s security team, 80% in the senior citizens’ associations and other organizations Thus, the quality of care for the spiritual life for the elderly people is relatively good The elderly people’s role is to promote life in all socio-economic aspects of the family and society The spiritual care is primarily provided by the elderly people/family/relatives and the local government authorities However, due to inadequate awareness of the elderly people issues there are some shortcoming in the care for the spiritual life for the elderly people: + Daily communication of children and grandchildren with the elderly people has not been giving proper consideration to particularly there is still maltreatment and neglect of the elderly people + At the grassroots level, the elderly people’s association has been responsible for the spiritual care for the elderly people Some local governments have not given pay attention to the elderly people’s spiritual life + Physical facilities for cultural and the elderly people’s and spiritual life at the local grassroots level have been under funded 2.2.3 Analysis of the care quality status in the elderly people’s care models To support the family in the care for the helpless elderly people and particularly for the lonely and helpless elderly people the Government and community provide formal support through services and the elderly people care models 2.2.3.1 Model of home based care for the elderly people Family doctor model: is the modelof the first ofhome based care for the elderly people, a spontaneous model initiated by factors of market demand and supply to meet in time the demand of the elderly people But the quality of this care model is not uniform Policies and the policy and management mechanism of services to be provided are yet to be completed Health care model for the poor, lonely elderly people based on volunteers at the community: The model to implement for health care support for the poor, lonely elderly people It also supports to improve the physical and spiritual life for the elderly.The model is suitable to the Vietnamese culture, meeting the aspirations of the poor and lonely elderly people in families cared for by their neighbors The new model is piloted and gradually expanded hence, there are some shortfalls in the quality care mainly the care skills of volunteers 2.2.3.2 The home based care model for the elderly people in community Models counseling and health care for the elderly: is the model which only focuses on one of thefirst medical/health care contents for the elderly people in the community The model is suitable to Vietnamese culture, meeting the aspirations of the poor and lonely elderly people in families cared for by their neighbours The new model is piloted and gradually expanded hence it is limited in the best quality care mainly the care skills of volunteers Sanatorium model for people with revolutionary contribution: The facilities of the model enjoy capital investment, nursing teams are basically trained The quality care for the elderly people is guaranteed in all health, physical and spiritual aspects Center of social protection model: Poor physical facilities, staff shortage Monthly funding of the State subsidy being low, the welfare nearly quality of care is not guaranteed There are no conditions to care much for the spiritual life of the elderly people The Sanatorium/Care center model for the elderly people by Associations and agencies/organizations/charity organizations: The model operates on the principle of charge free, mobilizing the participation and contributions of community for the elderly people in lonely, poor conditions, it is small in scale and limited in funding and facilities, with absolutely no stage support, hence the limited quality of care for the elderly people Model of consultation and health care for the elderly people: The model represents the socialization of health care for the elderly people Being underfunded the consulting capacity is limited and covers only a small number of the elderly people The privately managed nursing area/care centers of the elderly people model: Customers are mostly highly educated elderly people and persona The 19 20 elderly people are cared for in centers mainly because their children are too busy to provide special care Financial support for the elderly people at the Center is from their children’s help combined with pension and savings Models of this kind have very good age – appropriate facilities The elderly people enjoy the overall care for the health and spiritual life and are pleased with this.The centers, sanatoria, and models often the competitive market mechanism model provides even better quality care and service However, high service charges serve only one group of customers with good financial conditions The state has no general standards of service quality of this model The State has only preferential policies to develop the model However, in practice this model has not enjoyed this privilege 2.2.4 Factors affecting the quality of care for the elderly people Care needs for the elderly people in Vietnam are changing and increasing: The transformation of disease patterns and new disease caused by lifestyle changes, and the much needed care for the elderly people are the cause of increasing demand of the care for the elderly people today Changes in care resources for the elderly people: In the context of women participating more actively in the social production, enhanced formal care is from the State and community, especially demand for qualified staff and quality nursing care for the elderly people Changes in Vietnamese family structures: The shrinking of the traditional family model whereby the elderly people live with their children means greater demands in the form of formal care for the elderly people by the State and Society The sustainability of social welfare system: The design of the social insurance system under the current financial mechanism will no longer be appropriate in the future, especially when the population ageing rate is quicker and step much be taken to ensure sustainability of the social welfare system in response to the quality of care for the elderly people The quick rate of population ageing: Vietnam is held back the restriction on economic conditions, health systems, social security so the fast population ageing rate has a major effect on economic growth as well as social welfare programs necessary to meet the needs of the elderly population considered to be the most disadvantaged and vulnerable group Chapter 3- SOLUTIONS AND RECOMMENDATIONS TO IMPROVE QUALITY OF CARE FOR THE ELDERLY PEOPLE IN VIETNAM 3.1.VIEWPOINTS AND METHODS TO IMPROVE THE QUALITY CARE FOR THE ELDERLY PEOPLE IN VIETNAM 3.1.1 Viewpoints on care for the Vietnamese elderly people Care for the Vietnamese elderly people in the context of international economic integration, socialist-oriented market must be thoroughly imbued with these basic viewpoints It is the responsibility of the Party, people and society to care for the elderly people in line with the conditions and levels of economic-social development of the county - The basic policy on the elderly people should be based on these studies, to assess the current status, trends and issues of the elderly people and should vision - Informal family care plays as the central role, the Government and communities provide variety forms of formal care to support families in improving the quality of care for the elderly people - The policy on the elderly people is a policy assisting them synchronized in food and closing, housing, health care, education, information, communication… with a “community friendly” character suitable for the elderly people, in line with practices in Vietnam However it is necessary to consult and inherit the international achievements of in terms of policy and friendly with elderly people model - To promote the socializations of care activities for the elderly people 3.1.2 How to enhance the quality of care for the elderly people in Vietnam - Raise awareness and changes behavior of leaders at all levels, all people on the issue of population ageing with the rapid increase of the elderly people as well as the issues related to this care - Enhance the elderly people’s healthy and improve the national capacity for health care of the elderly people - Reform the social security welfare system Develop the elderly people’s care fund alongside and social economic growth and development, and gradually improve the material life of the elderly people - Facilitate the enhancement of the spiritual life and maximize the elderly people’s role in family and community - Encourage and support the community – based care for the elderly people, gradually improve and expand home based services and care for the elderly people - Strengthen state management of people’s matters, promote international cooperation, share and learn from other countries’ experience in dealing with the elderly people’s issues 21 3.2 SOME SOLUTIONS TO ENHANCE THE QUALITY CARE FOR THE ELDERLY PEOPLE IN VIET NAM 3.2.1 These sets of solutions related to the media to promote the change of behavior, awareness, attitude and care about the elderly people and care for the elderly people Renovate advancing methods improve the quality of care for the elderly people from the advancing method to communication under to change behavior in target group and specific behaviors Strengthen advocacy campaigns to raise awareness of the Party, government, policy makers of the challenge posed by “ageing population “ for the care and promotion of the elderly people’s capacity in particular, the sustainable economic development of the country socio in general Promote advocacy to change the behavior of the people, agencies, organization and family on the responsibilities to respect, help, care and promote the role of the elderly people Strengthen advocacy to mobilize society in order to create the based support and participation of the social organizations and community in the care for the elderly people and particularly community-based care for the elderly people 3.2.2 Set of solutions related to finalizing the policy and policy implementation about the elderly people and care of the elderly people Support the empowerment the care policy for the elderly people Support the empowerment the care policy for the elderly people Perfect the system of state management agencies at all level of the elderly people’s issues from the central to grassroots level Strengthen the supervision by different ministries in implementing programs and policies to take care of the elderly people Promote the participation of the elderly people’s local association in the process of monitoring implementation of the law on the elderly people 3.2.3 Set of group solutions to improve the health care quality for the elderly people Strengthen national capacity on the elderly people’s health care Develop the geriatrics network throughout the country Develop and improve the network of health care for the elderly people on the basic of allocating equally resources on health and rehabilitation for the elderly people, particularly the poor elderly people in rural and remote areas Improve the quality of care and treatment: enhance control over spreading diseases chronic diseases Empow`er training and research related to health care for the elderly people 22 Improve the quality of medical care by health insurance cards for the elderly people Provide more information about the care and treatment more information about the care and treatment for the elderly people in the community Consolidate, develop and improve the quality of sport and physical exercise movements for the elderly people Promote the socialization policy of the party and state in medical examination and treatment for the elderly people 3.2.4 Set of group solutions to improve the quality of material care of the elderly people Ensure social welfare system: when the new system focuses on supporting part of elderly people through social insurance and assistance, in addition to reforming social insurance and investing effectively social insurance funds Diversifying types of insurance into increase accessibility for the old population promote the implementation of social protection for the elderly people and organize “savings fund for old age based “on compulsory contributions of each citizen, this activity will enhance personal responsibility Ensure social welfare and improve the quality of care for the elderly people Create decent jobs suitable for the elderly people Promote the socialization of material care for the elderly people 3.2.5 Set of group solutions to improve the quality of spiritual care and promote the role of the elderly people Raise awareness improve physical facilities to better the elderly people’s spiritual life Maximize the role of the elderly people, especially the role of elderly people at the grassroots levels 3.2.6 Diversifying forms to support the elderly people, promote development of care models for the elderly people in community Improve the home based care capacity for the elderly people Promote strongly the development of the community based care model for the elderly people In addition to the development of the care model in a nursing home/care center for the elderly people and build a network of nursing care centers for the elderly people, implement the “The elderly people’s day care center” in the community especially in large cities, encouraging the joint model care coordinating long term home-based care at home with community based short term care Promote support and encourage different organization and individuals to provide care models for the elderly people in community 3.2.7 Work out a system of assessment criteria in quality care of the elderly people in the community based care model 23 24 Give proposals to build a system consisting of criteria for evaluating the quality of community based care for the elderly people The criteria included sets: (1) Sets of criteria for evaluating the facilities of the model: (2)Set of criteria for evaluating health care quality of the elderly people in the model (3) Set of criteria for evaluating quality of spiritual care and promote the role of the elderly people in the model 3.2.8 Develop of basic research as well as professional research on the elderly people in Vietnam Conduct the nationally respective survey on the elderly people, basic researches to provides the basis for the formulation of the elderly people’s policy, improve the quality of their care GENERAL CONCLUSION 3.3 RECOMMENDATIONS 3.3.1 To the National Assembly Pay more attention to the elderly people’s issues in monitoring and law making Such as give more attention to voluntary insurance to help people prepare for their old age: stipulate retirement age of the scientific staff especially retired women aged 56-60 and the section of elderly people’s with good health, technical and profession knowledge and experience 3.3.2 To the Government and relevant Ministries The ministries/ ministries level bodies to formulate and issue circulars to implement the law on the elderly people, build national target programs, about caring for the elderly people; in their competence and responsibility Develop mechanisms to encourage the socialization of the care for the elderly people Strengthen the role of the National Committee on the elderly people’s issues, direct and coordinate interdisciplinary care activities and promote the role of the elderly people Strengthen the inspection and examine the implementation on the law on the elderly people Create all favorable conditions, increase resources for the elderly people’s Associations participating in national programs related to the elderly people’s interests 3.3.3 To the Local Authority Thoroughly understand the Party’s and State’s guidelines, the provisions of law on the elderly people by civil servants, and people in the care for the elderly people Implement the laws on the elderly people Build and operate effectively the elderly people’s care fund at the grassroots level, plan to build physical facilities for the elderly people at provincial level Support and replicate centers, clubs of the elderly people in the community With the theme titled “Solutions to improve the care quality of the Vietnamese elderly” Which is an independent research of thematically and practical significance The thesis has fulfilled the research objectives set out The thesis clarifies the theoretical system of the elderly people, the care and quality of care for the elderly people On the basis of analyzing the basic characteristics of the elderly people and evaluate the actual quality of care in general and in the elderly people’s care in the community, the thesis has raised some views, trends and recommended sets of large solutions with many specific solutions to improve the quality of care for the Vietnamese elderly people The thesis also offers three sets of recommendations to the National Assembly, the Government and the ministries/agencies involved, local authorities to successfully implement the solution [...]... clarifies the theoretical system of the elderly people, the care and quality of care for the elderly people On the basis of analyzing the basic characteristics of the elderly people and evaluate the actual quality of care in general and in the elderly people’s care in the community, the thesis has raised some views, trends and recommended 8 sets of large solutions with many specific solutions to improve the. .. for the elderly people; in their competence and responsibility Develop mechanisms to encourage the socialization of the care for the elderly people Strengthen the role of the National Committee on the elderly people’s issues, direct and coordinate interdisciplinary care activities and promote the role of the elderly people Strengthen the inspection and examine the implementation on the law on the elderly... the grassroots level, plan to build physical facilities for the elderly people at provincial level Support and replicate centers, clubs of the elderly people in the community With the theme titled “Solutions to improve the care quality of the Vietnamese elderly” Which is an independent research of thematically and practical significance The thesis has fulfilled the research objectives set out The thesis. .. consisting of 7 criteria for evaluating the quality of community based care for the elderly people The criteria included 3 sets: (1) Sets of criteria for evaluating the facilities of the model: (2)Set of criteria for evaluating health care quality of the elderly people in the model (3) Set of criteria for evaluating quality of spiritual care and promote the role of the elderly people in the model 3.2.8... structures: The shrinking of the traditional family model whereby the elderly people live with their children means greater demands in the form of formal care for the elderly people by the State and Society The sustainability of social welfare system: The design of the social insurance system under the current financial mechanism will no longer be appropriate in the future, especially when the population... at all level of the elderly people’s issues from the central to grassroots level Strengthen the supervision by different ministries in implementing programs and policies to take care of the elderly people Promote the participation of the elderly people’s local association in the process of monitoring implementation of the law on the elderly people 3.2.3 Set of group solutions to improve the health care... and the elderly people care models 2.2.3.1 Model of home based care for the elderly people Family doctor model: is the modelof the first ofhome based care for the elderly people, a spontaneous model initiated by factors of market demand and supply to meet in time the demand of the elderly people But the quality of this care model is not uniform Policies and the policy and management mechanism of services... community in the care for the elderly people and particularly community-based care for the elderly people 3.2.2 Set of solutions related to finalizing the policy and policy implementation about the elderly people and care of the elderly people Support the empowerment the care policy for the elderly people Support the empowerment the care policy for the elderly people Perfect the system of state management... hence, there are some shortfalls in the quality care mainly the care skills of volunteers 2.2.3.2 The home based care model for the elderly people in community Models counseling and health care for the elderly: is the model which only focuses on one of thefirst medical/health care contents for the elderly people in the community The model is suitable to Vietnamese culture, meeting the aspirations of the. .. development of care models for the elderly people in community Improve the home based care capacity for the elderly people Promote strongly the development of the community based care model for the elderly people In addition to the development of the care model in a nursing home/care center for the elderly people and build a network of nursing care centers for the elderly people, implement the The elderly