摘要
目前中国老年人长期照料的现状,一方面是长期照料的需求不断增长且日益呈现出多样性；另一方面是长期照料的供给还比较落后,远不能满足老年人的需要,供求的不平衡导致老年人长期照料面临的形势十分严峻。在这一个背景下,分析老年人长期照料的模式与决策从而制定切实可行的政策措施便具有重要的意义。
本文综合运用结构式问卷和半结构式访谈的研究方法,从需要长期照料即长期失能老人的角度出发,引入林南的资本理论来分析老年人的长期照料模式与决策。林南将资本具体划分为人力资本、社会资本两类。长期失能老人的照料模式,其核心的内容便是正式支持和非正式支持二者介入的程度及其关系。正式支持和非正式支持介入的程度,很大程度上取决于老人动员这两种资源的程度和能力,而这正是受到个人人力资本和社会资本的影响。长期失能老人的照料决策,主要体现在老人在正式支持与非正式支持之间的选择。林南(2006)认为：社会资本应该给为某个目的而行动的个体提供好处。对于长期失能老人而言,维持和增进自身福利的重点便是自己的照料和生活保障问题,当非正式支持缺乏或不可获得而选择正式支持时,实质上是一种资源扩展的行动,这种行动是建立在人力资本和社会资本变化的基础上的,因而长期失能老人的个人资本会对其照料决策产生影响。
本文研究发现,对于老年人长期照料模式而言：第一,正式支持与非正式支持之间可能既不是“替代模式”也没有达到“互补”的状态,更多的是一种“补充模式”。第二,长期失能老人的照料模式也并不是“任务主导”型的,即每一个照料任务并不是由最适合的人员承担,而更类似于“层级补偿”模式,因为在长期照料提供者由内向外层级补偿的扩展过程中,出现了一个“隔断效应”,即老人很多时候觉得子女是外人,当配偶去世或无法提供照料时,并不完全首先想到的是子女,在子女这一层级出现了部分的隔断效应,即有可能直接选择请钟点工／保姆或入住养老院。第三,长期失能老人的网络沿着社会网络——支持网络——照料网络逐渐萎缩的过程,对老人自身而言是一个必然的人生历程,这一过程也可看成老人的网络“核心化”的过程,即最后留在网络中的都是对老人起着最关键和核心作用的力量。
本文研究还发现,对于老年人长期照料决策而言：第一,家庭照料资源的不平等导致长期失能老人的正式支持依赖,资源不平等可能是由两个过程引起的,即资本的欠缺和回报的欠缺。资本的欠缺体现为长期失能老人由于丧偶、离婚、未婚、没有生育或子女死亡等原因而导致家庭照料资源的不足,这部分长期失能老人由于嵌入在一个家庭结构缺损的网络中,约束了资本的获得；回报欠缺体现为配偶或子女不愿意提供照料,或照料难以获得。第二,对于一部分长期失能老人而言,正式支持依赖源于为了将一部分资源转移给子女,在此基础上老人通过自己的损失来扩展子女的资源,体现了资源在首要群体内转移的优先性。
Today, Chinese elderly long-term care situation is severe, on the one hand, the long-term care demand is rising and increasingly diversity:On the other hand, the long-term care supply still lag behind, cannot satisfy the needs of elderly. In this context, analysis the pattern and decision-making of the elderly long-term care to make feasible policy measures has important significance.
This paper integrates the quantitative and qualitative research method, introduced the social capital and human capital to analyze the elderly long-term care patterns and decision-making. Formal support and informal support is the core content of Long-term care pattern, the extent of formal support and informal support intervention, depends largely on the old men's utilization degree of the two resources. Elerly long-term care decision-making, is mainly the choice between the formal support and informal support. Linnan (2006) think:social capital should be for a purpose to provide benefits for the individual action. For long-term disability, maintain and improve his own welfare emphasis the care and living security, when informal support unavailable.
As for elderly long-term care patterns:First, the relation between formal support and informal support is possible neither "alternative model" nor a "complementary state", is more of a "complement model". Second, elderly long-term care pattern is not the "task specificity model", namely every care tasks are not supplied by the most suitable person, is more similar to "hierarchical compensatory model", during long-term caregiving, providers from inside to outside the propagation process hierarchy compensation, there appears a "partition effect", namely, the old man many think children are outsiders, when a spouse unable to provide care they may directly employ Labour/baby-sitter or go to nursing home. Third, the long-term disability elderly's network is along social network-support network-care network and is gradually atrophic, the process can also be seen as the old man's network cohesive, namely finally left plays the most core and key role for elderly.
As for elderly long-term care decision-making:First, the family care resource inequality leads the long-term disability elderly to depend on formal support, resource inequality may be caused by two reasons, the capital deficit and the return deficit. The capital deficit because of widowed、divorced、unmarried、no birth or child deaths, which makes the long-term disability elderly embedded in a defect family structure in the network; the return deficit because of spouse or child is not willing to provide care, or is difficult to obtain. Second, for a part of the long-term disability elderly, formal support dependence due to resources transfer to children, the elderly sacrifice himself to expand children's resources, reflected the resources in the first group transfer in priority.
引文
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