XahQihQc.sd3(143),201S
CHAM SOC NGl/dl CAO TUOI 6 VIET NAM VA MOT SO VAN DE CHINH SACK C A N QUAN TAM
NGUYEN HOXI MINH'
Tdm til: Bai viit phan lich mql s6 dac Siim nhan khiu vd Unh iS-xa hgi gin vdi qud trinh gia hda ddn s6 hien nay d Viet Nam vd nhung nhu cdu dgt ra ddi vdi vi?c chdm sdc ngudi cao tudi. Hgc vdn vd mirc sdng dugc ndng cao cho phep cdc gia dinh cham sdc ngudi cao tudi tdt han, tuy nhien, ddi vdi nhieu ngudi cao tuoi, tdi sdn tich luy vdn khdng dit chdm lo cho cudc sdng. Ty 1$ ngudi cao tuoi tdng len, ddng thdi vdi qud trinh gidm muc sinh, quy md hg gia dinh nhd han, mirc do tich lUy tdi chinh hgn che... dd lam tdng nhu ciu vk chdm sdc ngudi cao tudi. Trong khi dd, cdc dich v^ xd hdi ve vdn de ndy cdn hgn che vd gia dinh tiep titc Id thiet che chinh trong viec chdm sdc ngudi cao tuoi. Tir ket qud phdn tich, tdc gid dS xudt mgt sd khia cgnh chinh sdch cdn quan tdm trong chdm sdc nguai cao tudi, xet tii gdc dg vai trd cda nhd nudc, cgng dong, gia dinh, hg hdng, vd thi truimg.
Tir khda: gia hoa dan so, cham soc nguoi cao tuoi, gia dinh, ciiinh sach xa hoi.
Nhgn bai: 14/9/2018 Giii phdn bifn: 20/9/201S Duyft ddng: 27/9/2018
1. Gia hoa dan so d Vi^t Nam
Gia hoa dan s6 hay con gpi la giai doan "dan so dang gia" duac tinh idii ty 16 nguoi tit 60 tudi tro len chijm tut 10% t6ng dan s6 trd len. Do Ik kit qua cua su qua dO nhan khiu hoc khi miic chSt va mile sinh d6u giam, lam giam ty 1? tre em dudi 15 tu6i v4 tang ty If nguoi cao tu5i. Trong nhiing nam qua, tu6i thp trung binh cua ngucri dsin Viet Nam da tang len kha nhiSu. Tuoi thp trung binh cua nguoi dan Vi?t Nam tir 63 nam vdri nam va 67,5 nam vcri nir v4o nam 1989 da tang dSn 16n 70,8 d6i voi nam vk 76,1 d6i vdi nii vao nam 2016 (Ban chi dao TDTDS, 2010; T6ng cue Thdng ke, 1991; 2012; 2015; 2017b).
Gan vdi vi$c tang len cua tudi thp tnmg binh, ty 1? ngudi cao tudi ciing tSng len.
Theo Tong dieu tra dan sd va nha d 2009, ty 1? ngudi cao tudi (60 tuoi hoac cao hon) d Viet Nam da tang tir 7,1% nam 1979, len 7,2% nam 1989, 8% nam 1999 va g ^ 9% nam 2009. DSn nam 2012, ty If nay da len tdi 10,2% (Ban chi dao TDTDS, 2010; Tdng cvc Thdng ke, 2012). Nhu vay, dan s6 Vi$t Nam da dat dSn ngudng dSn so dang gia ke tit nam 2012.
• Vien Nghien am Gia fmh va Giii, Vien Han Idm Khoa hi/c xahoi Vi$t Nam
Nguyen Hicu Minh 43
Mgt chi bdo quan trgng khdc cua su gid hod ddn s6 Id chi s6 gid hod, duoc tinh nhu la ty s6 giua so nguiri tu6i 60 va gid hon tren 100 nguoi tu6i duoi 15. Chi so gia hod ddn s6 cr Viet Nam da tang tir khoang 18,2 ndm 1989 lgn 24,3 nam 1999, 35,5 ndm 2009 vd 50,1 nam 2016, cao hon so voi miic tnmg binh eua khu v\rc Dong Nam A (30). Dieu nay cho thay giai doan gia hod dan so 6 Viet Nam dien ra rdt nhanh chong trong 3 thap ky qua (Ban chi dao TDTDS, 2010; T6ng cue Thdng ke, 1991; 2012; 2017b). Theo tinh todn, thoi gian dk dan s6 ViSt Nam tCr 65 tu6i trd 16n tang tir 7% len 14% trong t6ng dan s6 la ngdn hon nhiSu nuoc: Phdp mdt 115 nam, My mdt 69 ndm, Nhat Ban va Tnmg Qu6e mdt 26 ndm, trong khi Viet Nam mat co 20 ndm. Day thuc su Id mot thach thiic ldn cho vi$c cham soc nguoi cao tuoi d Vi$t Nam khi trinh dp phdt trien kinh te-xd hpi con chua eao nhu hien nay (UNFPA, 2011).
Su ehenh l?ch giGa tuoi thp tnmg binh vd tu6i thp khoe manh, ttic Id so nam trung binh song c6 b6nh tdt, la mpt chi bao rat quan trpng khi xem xet vdn de gia hoa. Muc tieu cua cac xa hpi khong chi la ndng cao tu6i thp tnmg binh ma quan trpng hon la nang cao tuoi thp khoe manh, song lau nhung phai song khoe. Tuy nhien, theo so lifu cua WHO, so nam tnmg binh song c6 benh tat d Vi$t Nam la tuong doi cao so vdi cdc nudc khdc. O Viet Nam, nu song cd benh tat tnmg binh khoang 11 ndm vd nam gidi khodng 8 nam (dan theo Bp Y te va Nhom ddi tac Y t^, 2018).
Xu hudng gia hda dan so mpt mdt khdng dinh chat lugng cugc song cua ngudi dan da tang len, nhung tu khia eanh ve eham sde ngudi cao tuoi lai ddt ra nhGng nhu cau cham sdc mdi doi hoi phdi dupc ddp ting. Nhu cdu chdm sdc con the hi^n khae nhau theo khu vuc sinh song va nhdm ddn s6. So lieu tu Dieu tra Gia dinh Viet Nam 2006, Didu tra qudc gia Ngudi cao tudi vd cdc cupc Dieu tra dan sd gan ddy cho bidt ty Id phu thupc d cac vung do thi thdp hon d ndng thdn, vimg co miic sdng trung binh trd ldn thdp hon so vdi cac vung ngheo va tuong tu, cac hd gia dinh cd muc sdng tdt hon thi cd ty Id phu thudc thdp hon cac hg ngheo (Bp Vdn hda. The thao va Du lich va co quan khdc, 2008;
UNFPA, 2011; Tdng cyc Thdng kd, 2015; Tdng cue Thdng ke, 2017b).
2. M^t sS dac tnmg nhan khau-xa h9i gdn vdi vi^c cham sdc ngvol cao tuSi o*
Viet Nam
Cung vdi qua trinh gid hda dan sd, mpt sd ddc trung nhdn khdu khac cung ed s^r bidn ddi trong mdy thdp nien qua va cd nhirng dnh hudng tiem ndng den viec cham soc ngudi cao tudi. Tnrdc het Id miic sinh ngay cang gidm. Tdng ty suat sinh nam 2001 la 2,25 va ddn nam 2009 tdng ty sudt sinh d Vi?t Nam dd gdn bdng miic sinh thay thd vdi 2,03 con, ddn ndm 2012 la 2,05 va 2016 Id 2,09. Cd sy khac biet dang kk giira mirc sinh 6 do thi va ndng thdn. Nam 2009, tdng ty suat sinh d khu vuc dd thi la 1,81 con va d ndng thdn Id 2,14 con. Sd lieu hrong img ddi vdi nam 2012 la 1,80 va 2,17 va ndm 2014 la 1,85 va 2,21; nam 2016 la 1,86 va 2,21 (Tdng cue Thdng ke, 2015; 20i7b). Sd con it di ham y kha nang cham sdc ngudi cao tudi tir thanh vien gia dinh se gap khd khdn hon trong giai doan hien nay va nhiing nam tdi.
44 Chdm soc nguai cao tuoi a Viet Nam hien nay...
K6t qua cac cudc Tdng diSu tra dan sd va nhiing cupc dieu tra mau qudc gia (nhu Dieu tra BiSn dpng dan s6 hang nam, Biha tra Mirc sdng hp gia dinh) trong may thap ky viia qua cung cho thiy quy md gia dinh nhd di va ciu true cua gia dinh ciing ngay cang don gian hon theo hudng hjt nhan hda tire la gia dinh chi gdm va chdng va cac con chua trudng thanh cua hp. Sd ngudi trung binh trong hd gia dinh la 3,6 nam 2016; 3,7 nam 2012; 3,8 nam 2009; 4,6 nam 1999; 4,8 nam 1989 va 5,2 nam 1979. Quy md gia dinh d khu vuc dd thi la nhd hem d nong thdn (3,6 ngudi d khu vuc dd thi va 3,7 ngudi d khu vuc nong thdn nam 2016) (Ban chi dao TDTDS, 2010; Tdng cue Thdng ke, 1991;
2012; 2015; 2017b). KSt qua khao sat Mile sdng dan cu 2014 cung cho bi& la quy mo trung binh hd gia dinh cua cac hd ngheo thudng cao hon hp giau, cac hp d mien niii cao hem d cac hd ddng bing (Tdng cue Thdng ke, 2016). Quy md gia dinh giam di lam anh hudng tdi kha nang cua cae thanh vien gia dinh cham sdc ngudi cao tudi do cd it ngudi d nha hon.
Viec giam quy md hd gia dmh cd anh hudng tich cue den cudc sdng hang ngay noi chung, trong dd cd kha nang ho trg vat chat va siic khde tinh than tang len. Ve su ho tro vat chit, thu nhap tnmg binh va chi tieu trung binh cho mpt ngudi tang len khi quy md gia dinh giam xudng. Nguac lai, mpt sd hSu qua tiSu cue cung the hien kha rd, kha nang nhung ngudi cao tudi phai sdng mpt minh se tang len.
Tinh trang hdn nhan ce y nghia quan trpng ddi vdi ddi sdng ngudi cao tudi vi doi vdi ngudi cao tudi viec sdng ciing vg/chdng cd nhieu y nghia tieh cue nhu cau tuc ngir
"con cham elia khdng bang ba cham dng". Dac diem chung hien nay la da sd ngudi cao tudi sdng vdi va/chdng, tuy nhien cd khac biet co ban giiia nam va nu. Sd li?u Tdng diSu tra dan sd va Nha d Tnmg ucmg 2009 cho biet, tinh chimg cd 84,9% nam gidi tudi 60 Ud len sdng vdi va nhung chi ed 44,1% ph\i nir tudi 60 trd len sdng vdi chdng vao thdi dilm khao sat (Ban chi dao TDTDS, 2010). Ty le tuong ling vao thdi dito 2014 la 85,8% va 47%, cdn vao thdi dijm 2016 la 86,2% va 48,% (Tong cue Thdng ke, 2015 va 2017b).
Trong sd nhihig ngudi cao tudi khdng sdng vdi vg/chdng vao thdi diem khao sat, dai bp phan la goa va ty le phu nii goa cao hon rd r?t so vdi nam gidi. Cung theo sd li?u Tdng di6u tra dan sd va Nha d Trung ucmg 2009, ty le nam gidi 60 tudi trd len d tinh trang goa vao thdi dilm dilu tra la 13,8% (ty le nam gidi 60-64 tudi goa la 4,47%; 65-69 la 7,64%; 70-74 tudi la 12,64% va 75 tudi trd len la 27,36%) va ty 1$ phu nii 60 tudi trd len d tinh trang goa vao thdi dilm tren la 52,6% (ty le tuong ling vdi cac nhdm tudi 14:
30,55%; 42,04%; 52,43% va 73,22%) (Ban chi dao TDTDS, 2010; Tdng cue Thdng ke, 201 la). Kit qua dilu tra dan sd giita ky 2014 cho thiy, ty Ip nam gidi 60 tudi trd len goa la 12,6%, trong khi dd ddi vdi nir ed 47,6% ph\i nft tudi 60 trd len la goa chdng. Cac sti lieu tuong ling d Dilu tea dan sd giua ky 2016 la: ty le gda cua nam gidi 60 tudi ttd len la 11,9% va nii 60 tudi trd len la 45,0% (Tdng cue Thdng ke, 2012; 2015 va 2017b).
d Viet Nam, tinh trang "ly hdn" la khdng phd biln. Tuy nhidn, ttong nhitag nam gan day ty ttpng ly hdn da cd xu hudng tang len. Sd lipu cac cudc tdng dilu tta dto sd cho thiy ty le dan sd 15 tudi trd len ly hdn (tai thdi dilm khao sat) la 0,5% nam 1989; 0,8%
nam 1999; 1,0% nam 2009; 1,5% nam 2014 va 1,8% nam 2016. Xu hudng tang ty 1$ ly
Nguyen Hicu Minh 45
hdn the hidn d ed khu vuc do thi va ndng thdn, nam ciing nhu nii nhimg cao hon ddi vdi nii va d khu vuc do thi. Ddi vdi ngudi cao tu6i ty Id ly hdn ciing ed xu hudng tang len.
Vdo thdi diem 01/4/2014, ty le ly hdn ddi vdi nam gidi va phu nfi tudi 60 trd len la 0,6%
vd 1,2%, cdn thdi didm 2016 la 0,6% va 1,8% (T6ng cue Thong ke, 2015 va 2017b).
Cac sd lieu tren cho thay, nhin chimg ngudi cao tudi nam gidi thudng sdng ehung vdi vo cdn mdt ty Id ddng kd ngudi cao tudi nii khdng sdng vdi chdng. Dieu dd tao ra nguy CO vd nhiing tdn thuong cd thd xay ra trong cudc sdng do thidu mdt trong hai ngudi, ddc biet ddi vdi phu nii vi phu nii thudng de tdn thuong hon ddi vdi cae cu sdc ve kinh te- xa hdi (Pham Thdng va Dd Thi Khanh Hy, 2009, dan theo UNFPA, 2011). Didu nay doi hdi chinh sach chdm sde ngudi cao tudi phai chii y d8n xu hudng nay.
Van de tidp theo cdn quan tam la ngudi cao tudi cd sdng chung vdi con cai hay khdng.
Sd lieu cdc cupc dieu tra miic sdng dan cu cho thay rdng ty le ngudi cao tudi sdng vdi con cai van rat cao nhung cd xu hudng gidm (tir gan 80% ndm 1992/1993 xudng cdn 62% nam 2008) (UNFPA, 2011). Ty Id nhung ngudi cao tudi sdng cd don tang tir 3,47% nam 1992/1993 ldn 6,14% nam 2008. Da sd ngudi cao tudi sdng cd don la d ndng thdn va Id phu nii. Ngodi ra, ty le hg gia dinh chi cd vgr chong ngudi cao tudi cung tdng hon 2 lan trong giai doan 1992/1993- 2008. Trong bdi canh an sinh xa hdi cdn ban che thi viec sap xep eude sdng nhu vay la mdt khd khan rat ldn ddi vdi viee cham sdc ngudi cao tudi (UNFPA, 2011).
Ddi vdi nhiing ngudi cao tudi khdng sdng cimg con cai thi khodng each noi d giua bd me vd con cdi la mdt van de dang quan tam trong viec eham sde ngudi cao tudi ve vdt chdt vd tinh thdn. Cd mdt sir khac biet giiia khu v\rc do thi va ndng thdn. 6 ndng thdn, con cdi sau khi ket hdn khdng sdng cung cha me thudng de dang lien he vdi cha me do sdng gan. Tuy nhien dieu nay khd khan hon d mdi trudng dd thi do thieu dat dai, ddc bi?t la giai doan trudc Ddi mdi 1986. Tir khi Ddi mdi, ngay edng cd nhieu co hgi hon cho dan cu dd thi tim kidm ngdi nha thich hgp, gan gui vdi nha bd me. Vi the bd me va con cdi cd the de ddng giiip nhau. Tuy nhien, ty Id eon cai sdng ridng nhung gdn vdi noi d cua bd me d dd thi vdn thdp hon d ndng thdn. Cugc khdo sat nhan thiic va thai do ve gia dinh d Ha Ndi 2010 ehi ra rdng, trong sd 196 ngudi cao tuoi (60 trd len) vdi 549 ngudi con dd kdt hdn hidn khdng sdng chung nhd, cd 41,9% ngudi con sdng each nha ngudi cao tudi trong ph^tm vi 15 phiit di b0 va 26% trong pham vi 15-30 phiit di xe. Ty 1? tuong ung d khu v\rc dd thi Id 27,9% va 3 6 , 1 % cdn d ndng thdn la 48,9% va 2 1 % (Vien Nghidn cim Gia dinh va Gidi, 2011).
Mong mudn cd con trai cd lien quan chat che vdi van dd chdm sdc ngudi cao tudi bdi le con trai duoc ky vgng la se sdng vdi va cham sdc bd me sau nay, ddm bao ngudi cao tudi cd an sinh khi tudi gid ("tre c^iy cha, gia cdy con"). Thuc te eho thay mong mudn cd con trai thd hien mpt each manh me trong xa hpi Viet Nam thdng qua chi bao ty sd gidi tinh khi sinh' tang cao qud miic binh thudng tir 2006 den nay. Theo ket qua cua Didu tra
^ TJ s6 gidi tinh khi sinh dirge xdc djnh bang s6 b^ trai trfin 100 hi gii dupc sinh ra ciia m$t thin ky, thuimg Ik m§t nam lich. Ty s6 niy thong thirimg 1^ 104-106/100 v4 nhin chung 6n dinh qua thai gian vi khong gian gitta cic chiu lyc, quoc gia, khu v\rc vi chung tgc ngudri.
46 Chdm soc nguai cao ludi a Vi4t Nam hi4n ngy..
bidn dgng dan sd 2006, ty sd gidi tinh khi sinh d Vi?t Nam la 109,8 tre em trai vdi 100 tr^
em gai sinh ra. Nam 2007 va 2008 ty sd gidi tinh khi sinh Id 111,6 va 112,1. Xu hudng do tiep tuc vdi con sd 112,3 nam 2012, va 112,2 nam 2016. Ddng bdng sdng Hdng la vimg cd ty sd gidi tinh khi smh cao nhdt trong ca nude, vdi cac ty sd 115,3 ndm 2009; 120,9 nam 2012 va 118 nam 2014 (Tdng cue Thdng ke, 2012; 2015; 2017b). Ben eanh ly do mong mudn cd eon trai thi chinh sdch cd tir 1 ddn 2 con, sy phat tridn ciia cdng ngh^ mdi cho phep lua chgn gidi tinh thai nhi (sieu dm vd nao thai) khi cac bac cha m? mudn vd cdng tac quan ly cac tidn bg y hgc chua chdt che Id mgt sd nguyen nhdn quan trgng ciia tinh trang ndy (Vi?n Nghien ciiu Gia dmh va Gidi, 2012). Ty sd gidi tinh tdng cao qua miic bmh thudng se anh hudng ddn kha nang lap gia dinh cua ngudi dan va viec cham soc ngudi cao tudi sau nay.
Theo so lieu Didu ha Gia dinh Viet Nam 2006, ty Id hg gia dinh cd ngudi cao tudi 60 trd len la 32,6%, vdi tuong img 35,7% d khu vyc do thi va 31,4% d khu vyc ndng thdn (Bd Vdn hda, Thd thao va Du lich vd cac co quan khdc, 2008). Tinh chung toan qudc co khodng 30% ngudi eao tudi dupc nhan luong huu, phu cdp nghi huu trudc tudi hay cdc quy^n lgi hang thdng khac, va hon 70% ngudi cao tuoi tiep tuc lam viec va sdng vdi trg giup ciia con chau (Uy ban Cae vdn dd xa hdi cita Qudc hgi, 2006). Can cii vao sd lieu ciia Bp Lao dpng-Thuong binh va Xa hpi nam 2006, mdt phdn ba sd ngudi cao tudi la ngudi ngheo hodc can ngheo va dang gap nhirng khd khdn trong cudc sdng vat chat, d^c biet la nhimg ngudi sdng d ndng thdn va mien niii; hon 100.000 ngudi cao tudi phai sdng trong nhung ngdi nhd tam vd nhieu ngudi khdng cd du do am mac trong mua ddng. Tinh trang con chau ddi xd khdng tdt hoac thidu chdm sdc bd me, dng ba van cdn tdn tai (Bd Lao dgng-Thuong binh vd Xa h^i, 2006).
Bao cdo eua Bd Y te ndm 2006 xac nhdn rang khoang 95% ngudi cao tudi hi b$nh tdt hdnh ha vd moi ngudi cao tudi trung binh gap phdi 2,69 b^nh, chii yeu la benh kinh nien vd khdng phai lay nhiem/nhiem trimg. Ty Id cua ngudi cao tudi cd siic khde tdt chi khodng 5-7%, nhiing ngudi siic khde kem chiem 23%, cdn lai la d mirc dp siic khde trung binh (Uy ban Cdc vdn de xa hdi ciia Qudc hgi, 2006). Didu tra ngudi cao tuoi Viet Nam ndm 2011 vdi dung lupng mau ed tinh dai dien qu6e gia cho thiy cd 65,4% ngudi cao tudi tu ddnh gid siic khde d miic yeu va rat ydu; 29,8% ddnh gia d miic binh thudng va chi cd 4,8% tu ddnh gia d miic tdt va rdt t6t (UNFPA, 2011). Didu nay cho thay nhu cdu rdt cao vd eham sdc siic khde cho ngudi cao tudi d Vi$t Nam hi?n nay.
Phdn ldn nhiing ngudi cao tudi Viet Nam hidn nay sinh ra va ldn len trong didu ki^n ddt nudc cd chien tranh va trudng thanh trong thdi ky ndn kinh td bao cdp. Khi ddt nudc chuydn sang nSn kinh td hoat ddng theo co chd thi trudng, nhihig ngudi nay phdi ddi di$n vdi nhidu khd khdn vd kinh td vi hg hodc khdng cd ciia cdi tich luy hodc tdi sdn tieh liiy khdng du dd hp sdng vd trg giiip siic khde cho hp khi tudi gia. Nhfing didu nay ddi hdi cdn cd su quan tam va chdm sdc tdt hon ngudi cao tuoi tir phia Nhd nudc, cpng ddng, gia dinh, va thi trudng.
Nguyen Hum Minh 47
3. Bien doi kinh te-xa hdi gan voi vi^c chSm soc nguM cao tuoi
Nhd thyc hidn eac chinh sach Ddi mdi (bdt d^u tir ndm 1986), ndn kinh xi Vi?t Nam da cd nhiing budc tdng trudng manh me. Miic dp tdng trudng GDP binh quan hang ndm la khoang 7,26% trong thdi ky 2001-2010, 5,9% trong ndm 2011 va udc cd ndm 2017 dat 6,8% (Dang Cpng san Vigt Nam, 2011; Chinh phii Viet Nam, 2011; Tdng cue Thdng ke, 2017a). GDP binh quan ddu ngudi Id 1.168 USD ndm 2010, tang khoang 3 ldn so vdi ndm 2000. Nam 2017, GDP binh qudn ddu ngudi udc tinh d^t 2.385 USD, tdng 170 USD so vdi ndm 2016. Vdi nhiing budc phat tridn mdi dd, Vi?t Nam da tCr mOt nudc ngheo trd thdnh nudc cd miie thu nhap trung binh thdp. Nhd ket qua ciia sy tang trudng kinh te, ddu tu cho cdc ITnh vyc xa hgi, trong do cd cham sdc y te dd tdng len. Theo so lidu ciia Bd Y td va Nhdm ddi tac Y td (2016: 49), ty le chi NSNN cho y td nam 2014 udc tinh la 8,2%, tang so vdi nam 2010 la 7,7%. Chi NSNN cho y td trong giai d o ^ 2011-2015 tdng qua cac ndm vdi ty Id tdng cao hon so vdi miic tdng chi NSNN (trir ndm 2011 cd miic tdng trudng am sau khi trir di ty Id giam phdt GDP).
Qua trinh do thi hda dang dien ra khd manh md d Viet Nam. Ty le dan eu dd thi dd tdng tir 19,2% ndm 1979 ddn 19,4% ndm 1989, 23,7% ndm 1999, 29,6% nam 2009 vd 35,1% nam 2017 (Tdng cue Thdng kd, 2017a). Cd nhfing khdc bidt quan trpng giua dan cu dd thi va ndng thdn. Trudc het do la ve miic sdng, the hidn ro ret vd didu ki|n nha d va cdc ti$n nghi sinh hoat nhu dien, nudc s^ch. Hgc van va trinh dp chuydn mdn cdng vifc eiia ngudi ddn ciing cao hon d khu vyc dd thj. Tat ca nhung ydu td do da gdp phan tao ra ldi sdng khac biet giiia dan cu dd thi va ndng thdn (Nguyen Hiiu Minh, 2000; Nguyen Thanh Lidm vd Nguyen Hiru Minh, 2011). Sy phd bien ciia gia dinh hat nhdn, mdi quan he ddng hg giam di, su da dang cua hoat dgng kinh te tao thu nhap ngoai gia dinh va hge vdn cao hon d cac viing dd thi da dnh hudng den each nghT cita cu dan thanh thi vd gia dinh ndi chung, trong dd cd vide cham sdc ngudi cao tudi. Su phat trien cua cac dich vu giiip vi?c gia dinh t^o thuan Ipi cho ddn cu trong viec cham sdc thanh vien gia dinh.
Nhidu ngudi hign song xa cha me, hp cd thu nhdp cao hon va it con hon, vi thd vide cd ngudi giiip vide chdm sdc cha me gid ciing thudn lpi hon ddi vdi hp.
Vdn dl di cu ciing dnh hudng ddn hoJit d^ng chdm sdc ngudi cao tu6i. Trong thdp ky qua, di cu dd tdng len nhanh ehdng. Dan sd di cu giua cdc tinh tdng tir 2 trieu ngudi ndm 1999 ddn 3,4 trieu ngudi nam 2009 va 2,6 tri?u ngudi nam 2014 (Tdng cue Thdng ke, 2015). Xu hudng nu hda di cu the hign rd rang. Phu nfi chidm hon mgt mia ddn sd di eu d gdn nhu cac loai hinh di cu va di eu ndng thdn-dd thi. Phdn tich co cau tudi ciia cac ddng di cu qua 3 ky tdng didu tra dan sd (1989-2009) va Didu tra di eu ngi dia 2015 ciing cho thay ngudi di cu, dac bidt la nfi, cd xu hudng tre hon. Didu dd ham y rdng khu vyc nhan di cu cd them nhidu lao ddng Ire, trong khi dd khu vuc gui ngay cang phai ddi mat vdi hien tupng gia hda dan sd va nhung nhu cau ddt ra ciia nhdm tuoi nay (Tong cyc Thdng kd, 2011b; TCTK va UNFPA, 2016). Diiu nay tao ra nhung khd khdn cho h?
thdng eham sdc ngudi cao tudi va tre em vdn truyen thong dugc dap ling bdi phy nfi.
Mpt chieu canh khdc ciia di cu la xudt khau lao dgng qudc te. Tir ndm 1990 dSn 2009 cd khodng 500.000 ngudi di lao ddng xudt khau d hon 40 nudc va vung ldnh thd,
48 Cham soc ngucri cao tudi a Viet Nam hien nay...
ttong dd cd 1/3 la lao ddng nit (Cue Quan ly lao dpng ngoai nude - Din theo Phan Luong Cir, 2010). Trong 9 thang diu nam 2017 Chinh phu da dua gin 93 nghin ngudi di lao ddng nudc ngoai (Chinh phu Viet Nam, 2017). Dilu do t?lo ra tinh ttang phan ly ciia cac gia dinh. NhOng ngudi cd site lao ddng cua gia dinh ddu phai ra di, nen d nhieu lang, xS chi cdn lai dng ba gia va tre nhd.
Cimg vdi su phat triln kinh tl, trinh dp hpc vin cua dan cu khdng ngimg tang len.
Nam 2009, ty le bilt chit cua nam gidi la 96% va cua phv nil la 92%, sa vdi ty le tuong ling eua nam 1989 la 93%> va 84%. Nhin chung bit binh ding gidi vl giao due ea ban da gin dupc triet tieu. Nam 2014, ttong sd dan so til 5 tu& ttd len cd 24,5% hoan thinh trung hoc co sd va 25,4% hoan thanh trung hpc phd thong ttd len. Sd lieu tuong ling cho nam 2016 la 24,8% va 26,4%. Hpc vin cua dan eu do thi cao hon d ndng thdn (Ban chi dao TDTDS, 2010; Tdng cue Thdng ke, 1991; 2015; 2017b). Hpc vin tang len giiip cho dan cu ndi chung cd co hpi tilp can nhilu hon vdi kien thiic eham sdc sire khde, nhat la cham sdc ngudi cao mdi.
Cac CO hdi viee lam ngoai ndng nghiep cung ngay eang phat trien, tao dieu kien thuan loi cho cu d ^ ttong tim kilm vide lam ngoai gia dinh, nhat la ddi vdi phu nii 6 ndng thdn. Nlu nam 2009 cd 76,5% dan sd tir 15 tudi ttd len tham gia vao l\rc lupng lao ddng, vdi 81,8% nam gidi va 71,4% nii gidi, 80,6% ddi vdi dan cu ndng thdn va 67,1%
vdi dan cu dd thi thi biic ttanh tham gia lao ddng nam 2014 la: 78% tdng dan s6 15 tuoi trd len; 82,6% vdi nam gidi va 73,6% vdi phu nii; 81,7% vdi dan eu ndng thdn va 70,5%
vdi dan eu dd thi (Tdng cue Thdng ke, 2014). Sir tham gia ngay cang nhieu cua phy nii vao luc luong lao ddng cd anh hudng hai mat den van de cham sdc ngudi cao tudi. M?!
mat, su tham gia lao dpng c6 thu nhap se giiip tang ngudn tich luy tai chinh ciia gia dinh va ban than phu nir, tir dd cd dieu kien vat ehat tdt hon eham sde ngudi cao tu6i hien nay ciing nhu bao dam an sinh cho hp khi ve gia mai sau. Tir khia canh khae, hd thdng cham sdc gia dinh d Viet Nam truyen thdng vdn dua vao phu nii, ttong bdi canh mdi, viec hg di lam ben ngoai khien cho hd th6rtg cham sdc ngudi eao tudi gap khd khan vi chua kip thich ling.
4. MQt so van de chinh sdch can quan tam
Vipc cham sdc ngudi cao tudi chiu tac dpng eua nhilu ylu td khac nhau. Theo Ochiai (2009), hoat dpng cham sdc cua ngudi cao tudi cd lien quan din su van hanh cua 4 thilt chi (md hinh kim cucmg), dd la Nha nuoc, C0ng dong, Gia dinh va hp hang, va Thj trudng. Tac ddng cua yeu td Nha nudc thd hien qua nhiing chinh sdch va luat phap ddi vdi viee cham sdc ngudi cao mdi ciing nhu cac phong ttao va ho?it ddng cu thi td chiic ddi sdng ngudi cao tudi. Viec nang cao miic sdng vi ttinh dp hpc van ciia ngudi dan, dd thj hda va md rdng co h$i viec lam ngoai pham vi gia dinh nhu li mpt phin kit qui ho?t ddng cua nha nudc ciing cd anh hudng dang kl din each thiic va mirc dp cham sdc ngudi cao tudi. Tit gdc dp xa hpi va cdng ddng la cic hoat dpng do cpng ddng td chiic, ching ban viee td chiic cac cau lac bp, cac nhdm vui chai giai tri, cac hinh thiic cham sdc khac do cpng ddng va xa hpi thue hipn. Vl ylu td thi trudng ed hai hinh thiic cham sdc pho bien dd la nudi dudng tap trung ngudi cao tudi ttong cac nha dudng lao vi chSm soc
Nguyen HOu Minh 49
ngudi cao tudi d nhd. Hinh thiic eham sdc cudi cimg chinh Id tu gia dinh vdi cac hoat ddng chdm sdc vat chdt va tinh thdn.
Nha nu&c
Vd mat nhd nudc, trong thdi ky Ddi mdi (tCt ndm 1986), nhd nudc dd ban hanh nhieu chinh sach lien quan ddn ngudi eao tudi nhdm gidi quydt nhirng thach thiic cila tinh trang ddn sd gia, chang han nang cao vai trd ciia gia dinh trong vide chdm sdc ngudi cao tudi, phat huy vai trd cua ngudi cao tudi, nang cao siic khde va hanh phiic cua ngudi cao tudi va bdo ddm mdt mdi trudng thudn loi cho ngudi cao tudi^. Gan day nhdt, Dd an chdm sde siic khde ngudi cao tudi giai doan 2017-2025 do Bg trudng Bd Y td ky quyet dinh ban hdnh ngdy 30/12/2016, da dett ra muc tidu dap ling nhu cdu cham sdc siic khde ngudi cao tudi thich ling vdi giai d o ^ gid hda ddn s6, vdi nhi^u boat ddng thiet thyc tir phia nha nudc, cgng ddng, gia dinh vd thi trudng. Tuy nhidn, cdc chinh sdch hien tgi ddi vdi ngudi cao tudi mdi chi t$p trung vdo vide hd tro cho mdt bg phdn nhd cua ngudi cao tudi ddc bidt khd khan, chdng han nhihig ngudi cao tudi cd don, ngheo, khdng noi nuong tya hay nhung ngudi khdng cd ngudn thu nhap. Cdc chinh sdch do van chua vuon tdi dugc tdt ca nhiing ngudi cao tudi trong toan qudc ma nhieu ngudi trong sd hg dang ddi dien vdi cac khd khan do tudi gia va bat binh dang xa hgi. Phan ldn ngudi cao tudi Viet Nam van cdn phdi sdng chu ydu bdng lao ddng cua chinh hp hodc dua vdo giiip dd ciia gia dinh, hp hdng, con chau.
Chinh sdch vd bao hiem y td cung cdn nhidu han chd. Theo kdt qua cua Dieu tra Qudc gia vd ngudi cao tudi 2011, ngudi cao tudi d Vidt Nam thidu cdc co hgi tidp can cdc dich vy siic khde. Ty Id ngudi cao tudi sii dyng bao hiem y td la thap. 26,1% ngudi cao tudi khdng cd hinh thirc bao hiem y te ndo; 51,1% ngudi cao tudi khdng the ty chi trd cho cdc didu tri y td. Ty le ngudi eao tudi khdm benh dupc chi trd bdi bao hidm y td chi cd khodng 15% (Hdi Lien hiep Phu nu Viet Nam va cpng su, 2012).
Kdt qua nghidn ciiu cua Didu tra Qudc gia ve ngudi cao tudi 2011 cung chi ra rang, nhidu ngudi cao tudi khdng hd ndm dupc ve quyen eua hp. Hon 50% nhiing ngudi cao tudi duoc phdng vdn ehi bidt vd quydn dugc tro cap va eac chuong trinh mimg thp. Sy hidu bidt vd cdc loi ich khac nhu quydn dupc uu tidn trong cac dich vu y te, gidm gia dich vu cdng, trp giiip phap ly, mien thud thu nhap, vay vdn vdi ldi suat thdp, v.v. cdn rat h ^ che (Giang Thanh Long va Bill Dai Thy, 2012).
^ Ching han, Khoan 3, Diiu 37, Hien phip nam 2013 cua Nhi nudc Cpng h6a Xa hgi chu nghia Vi?t Nam chi r6: "Ngucri cao tuoi dugc Nhi nirdc, gia dinh vi xa hOi ton trpng, chim soc vi phit huy vai tr6 trong s\r nghiip xay dung vi bao v? T6 qu6c" (Qu6c hOi Vi?t Napi 2013, Khoin 3, Diiu 37); Lu^it H6n nhan vi Gia dinh nam 2000 va 2014 (Qu6c hpi Vi?t Nam, 2000a va 2014) da c6 nhOng quy dinh cy the ve vi|c chim soc ngu6i cao tu6i; Luat Hinh s\f 2009 (Qu6c hoi Vi^t Nam, 2009a) xic djnh t$i ngupc dii hojc hinh ha ong bi, cha m?, vg chdng, con, chiu, nguiri c6 cong nu6i du&ng minh, vi dieu 152 xic dinh tpi ttr choi hoac trfin tranh nghia vy cap duSng doi vdi ngufri mi minh c6 nghia vy cdp dudng theo quy djnh cua phip luSt;
Lu^t Nguiri cao tuoi 2009 (Quoc h^i Vi$t Nam, 2009b) di xic djnh cic bien phip mi Nhi nudc vi xa hpi cdn lim di t^o ra nhihig dieu ki?n thuSn lpi cho ngufri cao tu6i hpc tip, nghign ciiu vi tham gia vio cic ho^t dpng vSn h6a, thi dye vi the thao, giii tri, du lich.v.v.
50 Chdm soc ngudi cao tuoi a Viet Nam hi^nnay...
Cpng dong
Qudn triet nhiing quan di8m chi dao ciia Dang vd ehinh saeh ciia nha nudc, d cdp dp cdng ddng dd tridn khai thyc hidn nhidu hogt dgng cham sdc ngudi cao tudi. Phong trdo xay dyng "Gia dinh van hda" vdi cac tidu chi nhu: Gia dinh am no, hda thuan, tien bd, khde manh va hgnh phiic, thuc hien tdt nghta vy cdng dan xdy dyng gia dinh van hoa, lang van hod; xdy dung cac cau lac bd gia dinh hanh phiic, cau lac bd ngudi ldn mdu muc, tre em cham ngoan, cau lac bp phat tridn kinh tg gia dinh, cau lac bd phy nii khdng sinh con thir ba; nhidu hinh thiic van ddng, tuydn tmydn phong phu, thiet thyc nhu phdt ddng cac phong trao "ong ba, cha me mdu muc, con chdu thdo hien", "'thap sdng tinh yeu thuang trong mdi gia dinh", "vi mgt mdi dm gia dinh khong co bao luc"; v.v... dupc td chiic rpng khdp d cae dia phuong da cd ddng gdp khdng nhd vao vide cung cd gia dinh va eham sdc ngudi cao tudi.
Cac td chiic d cdng ddng nhu cac nhdm hda giai va Hdi ngudi cao tudi cung ddng vai trd quan trpng trong viec cham sdc ngudi cao tudi. Cdc td chiic cdng ddng ndy dd can thiep kip thdi vao cac xung dot gia dinh dd bao v? quyen cua ngudi cao tuoi eiing nhu giir gin su thdng nhdt, doan kSt trong moi gia dinh. Ddng thdi, cdc td chiic cgng ddng cung co nhidu sang kidn de bao vd ngudi cao tudi tdt hon. Ben canh nhiing hinh ihiic cau lae bg, cdc td chiic nay cd nhiing sang kidn nhu hinh thdnh nhimg ngdi nha cpng ddng eho ngudi cao tudi den sinh hoat giai tri trong ban ngdy va hg cd the ve nhd buoi tdi.
Tuy nhien, hidn nay sy can thiep tir ben ngoai gia dinh ddi vdi vdn dd mau thuan, xung dot vd dac bidt la bao lyc ddi vdi ngudi cao tudi cdn gap nhidu trd ngai, nhat la tit nhan thiic eua ehinh edng ddng. Dii hg hang, chinh quyen va cac td chiic doan the nhu td hda gidi. Mat tran Td qudc, Hdi Phu nfi cd tim each khuyen giai con cai va giiip do ngudi cao tudi nhung trong mgt sd trudng hpp, khi con cdi khdng lam theo, hp ciing khdng the cd each ndo giiip dd dugc nan nhdn vi hp van cd tdm ly e de vd eoi day la viec rieng cua gia dinh. Dilu nay cd thd lam han che kha nang can thiep cira xa hpi nhdm trg giiip cac nan nhdn ngudi cao tudi.
Gia dinh
Vd mdi quan he gia dinh vd hp hang, cac bang chiing thyc nghi?m xac nhan mdi quan he chat che gifta ngudi cao tudi va con chau hg trong cac gia dinh (Ld Nggc Lan, 2017). Ngudi cao tudi tidp tuc giu vai trd va dia vi quan trpng trong gia dinh va gia dinh cung cd vi tri dac bidt quan trpng ddi vdi ngudi cao tudi. Didu nay duoc thd hidn trong su hd trg ldn nhau giua dng bd, cha m? va con chdu ca tir khia canh vdt chdt va tinh thdn, sy giiip do va cham sdc khi ngudi cao tudi bi dm, chia se ganh nang cdng vide nhd va chdm sdc cdc chdu. Trong giai dogn hidn nay cdc gia dinh dang cd gdng hoan thanh trdch nhiem cua hp trong vide hd trg va chdm sdc ngudi cao tudi va duy tri mdi quan he hai hda gifia ngudi cao tudi va con chdu hg. Bihu dd ciing cd nghia la mdt ty Id dang kd ngudi cao tudi khdng cdn sy lya chgn ndo khdc ngoai vide phu thudc vdo con chau khi hg khdng thd tilp tuc tu cham sdc hoac khdng the ty h-ang h-ai cac khodn chi phi cua vi?c chdm sdc sure khde va dich vu y td.
Nguyin Hiru Minh 51
Tuy nhien, bdn than cudc sdng cua gia dinh cac con chau ciing cdn nhidu vat vd.
Theo sd lieu Didu tra Gia dinh Viet Nam (2006), cd khoang 1/3 sd hp cd ngudi cao tudi la hd ngheo, vi vdy viec chdm sde, phung dudng cha me gia trong .ho la thuc sy khd khdn, trong didu kidn cac chinh sdch hd trg ciia nha nudc cdn it (Bd Vdn hda, Th§ thao va Du lich va cac co quan khac, 2008). Ngodi ra, mOt bp phdn con chau mdi chi quan tam den ddi sdng vat chdt cua cac cu, cdn cudc sdng tinh thdn thi bd be. Ly do chinh Id con chau thidu thdi gian, khdng san sang ldng nghe vd gifia hai bdn thidu sy quan tdm chung (Vign Nghidn ciiu Gia dinh va Gidi, 2012).
Cung can nhdn mgnh Id, trong bdi cdnh eua tidn trinh cdng nghidp hda, hign dai hda vd nhat la dudi su tdc dgng ciia toan cdu hda, hg gid tri gia dinh d Viet Nam dang cd sy bidn ddi rat ldn. Ben canh nhiing gia tri cd truyen nhu "kinh tren, nhudng dudi",
"trgng xi" (tdn trpng ngudi cao tudi), thi nhfing gia tri mdi nhu coi trpng "quyen tu do ca nhan", "binh dang gidi", "quydn tre em" ciing ngay cdng dupc khdng djnh. Sy bidn ddi ndy, trong mdt chimg muc nhdt dinh, da lam cho mdi quan he dng bd-cha me-con chau khdng thuan chidu nhu trudc day va lam tang nhiing mau thuan va xung dot the he.
Didu tra Gia dinh Viet Nam (2006) cho biet, cd khoang 1/10 sd y kidn tu cdc hd gia dinh cd 3 the he chung sdng thira nhdn cd su khdng thong nhdt trong cdc vdn dd vd le ldi sinh hogt, each quan ly tidn va tidu tien, each thiic lam dn va phat tridn kinh te gia dinh, ciing nhu vd phuong phdp giao due con chau (Bg Van hda, Thd thao va Du Ijch va cac co quan khac, 2008).
Trong thdi gian tdi, ty le eiia ngudi cao tudi sdng vdi con chau cd thd gidm di do su thay ddi vd vide lam, thay ddi vd quan nidm vd each suy nghT ciia cac the hg tre hon va ciia chinh thd he ngudi cao tudi trong vide sdp xdp cudc sdng ciia hp khi ve gia. Didu do cimg cd nghia la ngudi cao tudi cd thd gap phdi nhidu khd khdn hon trong viec ty cung cdp va cham sdc siic khde riSng cua hp, vd vi thd cdn thdm su giiip dd va ho trg tir phia chinh quydn, cdng ddng vd cdc to chiic xd hdi.
Chdm sdc ngudi cao tudi va tang cudng cdc gid tri trong mdi quan hg gifia ngudi cao tudi vdi con ehau trong cac gia dinh phu thugc phan ldn vao vigc ndng cao nhgn thiic cua cdc cd nhdn (con chau va ngudi cao tudi) vd long hieu thao. Vi the, vigc duy tri va md rdng eac co hgi gido due nhdm chi ra nhimg thay ddi ve mdi quan hg gia dinh trong qud trinh cdng nghiep hda, cung nhu xdc Igp cac mdi quan he gia dinh dan chu, tidn bd va hanh phiic ngay cang trd ndn cdp bach.
Thi trirdng
Tir cdch tiep can thi trudng, vide xay dyng cac trung tam cham sdc ngudi cao tudi danh cho nhieu nhdm ddi tupng la rat quan trgng. Sy phat tridn ciia cdc logi hinh dich vu chdm sdc ngudi cao tudi tai c0ng ddng dang trd thdnh xu hudng, hinh thiic mdi nhdm chia se ganh ndng, trach nhiem ciia nhd nudc, gia dinh. Cac trung tam tu nhdn chdm sdc ngudi cao tudi xudt hidn tir gan 2 thap nien nay va phat trien vdi tdc dp nhanh trong thdi gian gdn day nhd miic sdng tdng ldn va nhu cau ngay cang cao. Cdc trung tam nudi dudng nay chii yeu la tai cac vimg dd thi vd phuc vu chu ydu doi tupng cd miic sdng khd. Ngoai vide
52 Chdm soc nguai cao tuoi a Viet Nam hijnnay...
chdm sdc dn udng, cac co sd nudi dudng ngudi cao tudi cdn cd nhidu hoat dOng phong phii khac dd phuc vu ngudi cao tudi nhu vd cham sde y tk, ddi sdng tmh than, phuc hdi chiie nang va tri lidu. Didm mgnh chu ylu ciia cac trung tam nay la ed mOt dOi ngu cdc nhdn vien dugc dao tao kha bai ban cham sdc ngudi cao tudi. Tuy nhidn, hgn che ciia eac trung tdm cham sdc ngudi cao tudi la chi phi dich vu tuong ddi cao ddi vdi nhieu ngudi.
Bdo eao tir mgt sd tnmg tdm cham sdc ngudi cao tuoi d Ha Ndi (nhu Thien Diic, Nhan Ai) cho bidt chi phi chdm sdc ngudi cao tudi tgi trung tdm vdi mdt sd ddi tupng cd tieu chudn cao dao ddng tir 10 trieu ddn 15 trieu ddng/thang, cao hon rdt nhidu so vdi thu nhgp cua nhiing ngudi cd mirc song trung binh.
Ngodi ra, ngudi giiip vide cung cd vai trd quan trpng trong vide cham sdc ngudi cao tudi. Cd nhidu logi hinh giiip vide chdm sdc ngudi cao tudi tgi nha, ngudi giup vide chdm sdc benh nhdn tai benh vien, v.v. Nhung loai hinh chdm sdc nay cd uu diem la chi phi thudng thdp hon so vdi ehi phi dich vu tgi trung tdm cham sdc ngudi eao tudi. Tuy nhien, nhupc dilm cua logi hinh chdm sdc nay la nhfing ngudi giiip vide thudng khdng dupc dao tao bdi bdn trong vide cham sdc ngudi cao tudi (Bd Lao dgng-Thuong binh va Xd hgi va cdc CO quan khac, 2012).
5. Ket luan
Biln ddi kinh td-xd hdi trong may thgp nien qua da tgo ra nhfing didu kidn thugn lgi cho viec eham sde ngudi cao tudi, ddng thdi dgt ra nhiing thdch thiic mdi. Hpc van va miic sdng dupc ndng cao va co hdi vigc lam dugc md rgng hon, nhung didu nay cho phep cac gia dinh cung cdp chdm sdc tdt hon. Cdng nghiep hda va dd thi hda da lam thay ddi nhan thiic va hdnh vi cham sdc, chang hgn, viet thu, email va gpi dign thoai thay vi thdm tryc tidp dd thd hign sy cham sdc tinh cam. Cac ddng di cu tim kidm vide 1dm ngdy cang mgnh mpt mat giiip nang cao miic sdng dan cu, tir do tgo di^u kidn cho vide chdm soc ve ddi sdng vat chdt day dii hon. Nhung d mat khae, dieu do ciing 1dm giam di cac giao tidp tryc tiep vdn la mdt phan ciia ddi sdng tinh cdm. Xu hudng nii hda trong di cu lam cho mdt bd phan ddng dao phu nu, vdn la ngudi thudng lam cdng vide chdm sdc, phdi rdi nha di tim kidm thu nhgp, de lai ngudi cao tudi va tre em noi que nhd. Thay vi dugre chdm sdc, nhieu ngudi cao tudi lgi trd thanh ngudi chiu trdch nhigm chinh eho vide cham sdc chdu.
Quy md gia dinh nhd hon cd thd tao nen thuan lpi eho vide eham sdc tre em nhung lai gay khd khan cho vide chdm sdc ngudi cao tudi. Xa hpi Viet Nam dang trong qua trinh gia hda dan sd, nhu edu vl chdm sdc ngudi cao tudi tdng len trong khi cdc dich vy xa h^i vl vdn dd ndy cdn han chd va gia dinh tiep tuc la thidt chd chinh trong vide chdm sdc ngudi cao tudi.
Trong nhfing ndm gan day, luat phap vd chinh sach Nha nudc da dd ra nhung giai phap cu thd nhdm bao dam chdm sdc ngudi cao tudi. Tuy nhien, kdt qua thyc hign cac chinh sach chua tao ra dupe nhung thay ddi co bdn vd tinh chdt va hinh thiic chdm sdc d Viet Nam. Cdn thidt phai cd nhfing nghien ciiu sau hon vd hg thdng bao trg xd hpi va bao hidm huu tri, bao hidm y td ddi vdi ngudi cao tudi va khuydn khich cac don vi sii dung lao dpng tao vide lam va mdi trudng lam vide phu hgp vdi nang lyc va siic khde ngudi cao tudi. Trong khi do, cdc thidt chd cdng ddng, gia dinh va ydu td thi trudng da ddng gdp tich
Nguyen HOu Minh 53
cyc vao hd thdng cham sdc ngudi cao tuoi, va vai trd ciia cdc thiet che nay ngdy cdng trd nen quan trgng. Didu do ddi hdi cdn phdi phdt huy sy ddng gdp ciia cac thilt che nay nhidu hon nfia.
Dudi tdc dgng tdng hgp cua cdc ydu td van hda, kinh tl, xa h§i va chfnh sach dd ndu ra d trdn, sd cdn nhidu biln ddi trong hg thong chdm sdc ngudi eao tudi d Vigt Nam trong thdi gian tdi. Mdt su hieu bilt day du ve bdi canh kinh te-xa hOi-vdn hda va h^ thong chinh sdch da neu d trdn se la co sd dd phdn tich sau hon khudn mau cham sdc ngudi cao tudi hien nay.
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