Constable J F, Remund D D, Gallagher K W
Health Prog. 1988 Dec;69(11):50-4.
To survive financially and better meet the needs of the elderly, hospitals must take the lead and collaborate with community leaders to enhance home healthcare, which can help the elderly maintain their independence and prevent institutionalization. Informal home healthcare is provided mostly by women, primarily wives, daughters, and daughters-in-law. These care givers often take the elderly person into their own homes, which can increase tension and conflicts, crowd the home, and propagate adverse perceptions by the spouse or children. Many care givers quit their jobs, thereby forfeiting income and relinquishing the mental stimulation of co-workers. Care givers who remain employed sacrifice their free time, family time, and other social opportunities. Other factors that influence the degree of stress and burden on the care giver include the type, extent, and duration of care needs; the location of home care; use of formal services; and the care giver's age, health status, and relationship to the elderly patient. Without help from formal home care agencies and local support groups, informal care giving at home may diminish rapidly due to physical and emotional exhaustion, sometimes resulting in abuse of the elderly patient. Government intervention is necessary if informal home care is to continue as a viable source of long-term care. In addition, local community medical societies must develop a team approach involving physicians, social workers, and nurses to adequately supplement home care givers or help single homebound elderly. Hospital administrators must work with community leaders to implement formal networks of home care services, such as respite care, adult day care, meals on wheels, and nursing care.
为了在经济上维持运营并更好地满足老年人的需求，医院必须发挥带头作用，与社区领袖合作，加强居家医疗保健服务，这有助于老年人保持独立并避免被送进养老院。非正式的居家医疗保健服务大多由女性提供，主要是妻子、女儿和儿媳。这些护理人员常常把老人接到自己家中，这可能会加剧紧张和冲突，使家里变得拥挤，并引发配偶或子女的负面看法。许多护理人员辞去工作，从而失去了收入，也放弃了与同事相处带来的精神激励。仍在工作的护理人员则牺牲了自己的空闲时间、家庭时间和其他社交机会。影响护理人员压力和负担程度的其他因素包括护理需求的类型、程度和持续时间；居家护理的地点；正规服务的使用情况；以及护理人员的年龄、健康状况和与老年患者的关系。如果没有正规居家护理机构和当地支持团体的帮助，由于身体和情感上的疲惫，居家的非正式护理可能会迅速减少，有时还会导致对老年患者的虐待。如果要让非正式居家护理继续作为长期护理的一个可行来源，政府干预是必要的。此外，当地社区医学会必须制定一种团队协作方法，让医生、社会工作者和护士参与其中，以充分补充居家护理人员或帮助独居在家的老年人。医院管理人员必须与社区领袖合作，建立正规的居家护理服务网络，如临时护理、成人日托、上门送餐和护理服务。
