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Researches Community health care

Vũ Thị Thanh Nga et al.

Place of publication: The Health Strategy and Policy Institute
Year of publication:   2011
Vietnam is in a strong demographic transitional period. Since 2005 the Vietnamese population has changed from young population structure with median age of 25.5% to the threshold of aging population. The elderly rate keeps increasing quickly, from 8.2% in 1999 to 9.45% in 2007 and 9.9% in 2008. According to UN forecast, the elderly percentage would reach 26% in 2050. According to previous population forecasts, Vietnam would have aging population by 2015. However the facts have shown that the Vietnamese population would enter aging period in 2010, 5 years earlier than forecasted. 
The quickly increasing number of elderly will require a considerable number of manpower to provide support and ensure normal living for elderly. The “elderly respect” norm remains its value, recognized as one of the essential and important cultural value of the Vietnamese peoples. In fact the number of members who must work for earring living account for the majority of the family and the above cultural norm has been neglected and less concerned compared with the past. Therefore, recently in Vietnam there have appeared various types of elderly care services, especially private settings with certain achievements. Due to cultural norm and value systems, this remains a controversial issues. Thus, conducting a study at grassroots level on “Understanding the perception, attitude and living needs in elderly nursing centers in Vietnam” to find out the community needs of living in elderly nursing centers is needed to recommend effective governance measures, promote the development of such service types, improve service quality, socialize and mobilize participation of the whole community and society in elderly care and role promotion.

1. To understand perception and attitude of community towards the fact of elderly living in elderly nursing centers.
2. To find out Vietnamese elderly needs towards living in elderly nursing centers.

Study methods: descriptive.
Data collection methods: qualitative ( 49 in-depth interviews). 
Informants: elderly living together with children and those residing in elderly nursing centers, family members, leaders and staff of elderly nursing centers.
Study locations: Ha Noi, 1 commune in Tu Liem District, 1 ward in Dong Da District.
Key study results
Like recent controversial debate on mass media on the perception of best possible living environment for elderly: at elderly nursing centers or at home with children and grandchildren. Results of this study also have a different feedbacks. Some agree with the viewpoint “elderly should live in nursing centers” and some other reject strongly. Although Vietnam has stepped into the aging population period, a large proportion of study participants believe that no ones can take better care of parents than their children and the home based care model at present are rather relevant with the conditions, context and traditional culture of Vietnam. Particularly the above thoughts is not only from elderly but also young people. 
Mindset, perception and attitude of community towards this issue vary greatly from one to another living area. People living in cities or urban areas have more advance outlook and urban elderly are more likely to adapt to the life in elderly nursing centers than those living in rural areas.
Besides social pre-perception, living traditions the study shows that economic factors are a great barrier to the attitudes and needs of elderly and their families when they want to live in elderly nursing centers. To stay there they must contribute a considerable amount of money which not everyone can afford. This model can only meet the needs of better-off population. 
So who wish to enter into elderly nursing centers? Surveys at elderly nursing centers and community opinions report that the key groups living in elderly nursing centers are those having special circumstances like having no children, only daughters and no sons and dislike to live with son-in-law, children working far away, severe health conditions and cannot take care of themselves while their children are too busy. Those staying at the centers for other reasons account for a very small ratio. 
According to statistics by Tu Lien elderly nursing center, only 20% of elderly have good health. In reality, the current model in Vietnam is only for elderly with poor health conditions, who cannot take care of themselves and require others to do so 24/24 hours. There is no elderly nursing centers for healthy people who can enjoy a quiet and peaceful environment. Therefore elderly are expecting to have a elderly nursing center model, organized and operated according to the true meaning. Such model has been established in the western countries for a long time. 
The study also reveals that in Vietnam there is a urgent needs for elderly to live in elderly nursing centers. In 10-15 years’ time the next elderly generation will pay more concern about it. Therefore, right from now relevant agencies and the Government should study to issue relevant policies. 
In recent years in Vietnam, some elderly nursing center models privately managed have been established but there is no government coordination and management by relevant agencies. Besides good performance facilities there remain models which exist purely for profits.
Receiving elderly to private elderly nursing centers is currently too easy. In many cases, it only requires agreement between family and center, regardless of consensus by elderly. Such practice somehow are against the Ordinance on Elderly and may create conditions for bad children to abandon their parents, failing to fulfill their obligations and duties as children.
The quality of services provided by elderly nursing centers has yet to meet the demand and expectation by elderly for an ideal elderly nursing model. Without government support and incentives, elderly nursing centers are now operating with difficulties. Budget are mainly from family contribution. Operations are based on revenues to compensate for expenditures. As a result, there is no investment capital and space. Most elderly nursing centers have narrow area with few outdoor space for elderly and lack of physical infrastructure. 
In Vietnam, elderly care is not so urgent and the Government has not made any investment in training professional personnel. This remain a great challenge to businesses active in this area. 
Conclusions and recommendations
Socialization of elderly nursing centers is a necessity. However the Government should plan coordination and manage the operations of elderly nursing center models, especially those established by private, groups and organizations. Such coordination and management must be institutionalized by legal documents, regulations and decrees. With that the quality of elderly nursing centers can be raised and living conditions for elderly may be improved. 
The current elderly nursing center model can only serve certain groups. In the immediate future, the Government should only permit the establishment of pilot models. Once successful, replication should be made to avoid the abuse of legal entity to mushroom this service type.
The Government should provide general regulations for those establishing elderly nursing centers. The founders must come from the health sector and have management experiences. 
The elderly nursing centers can only be established once there is close cooperation ties with healthcare professionals and/or health facilities. This may help to address the situation in which elderly having health conditions will be referred to health facilities with sufficient conditions for timely treatment.
The Government should also prepare a general mechanism to receive elderly in elderly nursing centers. Such mechanism should be developed based on the Ordinance on Elderly.
The Government should have policies on budget and land support for individuals and businesses active in this field.
The Government should also plan to develop elderly nursing service model according to the approaches applied by kindergartens.
The Government should organize technical training for staff of elderly nursing centers, considered it as an important career. Thus, the service quality can be assured and keeps improving.

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