Policy implementation deviation of government purchase of old age care services in Jiangsu, China: based on empirical and policy analysis.

BACKGROUND: Government purchase of social forces to participate in old age care services can release the burden of social care. Current research on performance evaluation in this field mainly focussed on the establishment of appropriate evaluation indices. However, discussion on the policy implementation deviation is scarce. This study aimed to evaluate the performance of China's local government purchase of old age care services, analyse the characteristics of related policies and explore their deviation. METHODS: The persons who participated in the Training of the Trainer (ToT) organized by the Red Cross Society were enrolled. The policy documents were obtained from the official websites. The K-means cluster was used to determine the project performance grades. We compared the project performance grades between service objects and undertakers with different characteristics utilizing the non-parametric test. Based on the framework of 'Collaborative Participation - Project Performance Objective', we analysed the content of relevant policy aiding by NVivo 12. RESULTS: Data of project performance were collected from 306 participants. The standardized mean score of the efficiency dimension was the lowest (0.70 ± 0.24). The projects were divided into four grades: poor (17.0%), average (27.5%), good (12.4%) and excellent (43.1%). There were statistically significant differences in project performance grades only between advanced ageing groups (Z = 2.429, P = 0.015). As well, the policy also mentioned that the services focus should be tilted towards the oldest old. The purchasers mainly involved the Ministry of Civil Affairs and Health management departments in the policy. Respite services were less mentioned in the responsibilities of the undertakers. The requirement for efficiency and effectiveness was mentioned in less than half of the policy documents. CONCLUSION: Policy attention is needed for the responsibilities and functions of the intermediate purchasing force, as well as more precise directions and responsibilities of undertakers. The purchasers and undertakers should improve management abilities and capacity of old age care services and focus on associated factors to achieve the best marginal benefit. In addition, the embedded performance evaluation needs to be updated periodically to bridge the deviation between policy implementation and policy formulation.

Retention of volunteers and factors influencing program performance of the Senior Care Volunteers Training Program in Jiangsu, China.

BACKGROUND: As the country with the largest aging population, China faces an enormous challenge with its elderly support and care. One of the proposed solutions is the development of volunteerism for elderly care. The Senior Care Volunteers Training Program (SCVTP) was initiated by the Red Cross Society of China with the purpose of training volunteers to care for community seniors. As one of the four pilot provinces, Jiangsu Province launched the program since 2017. AIMS: The present study was conducted to investigate the dropout rate of trained volunteer group leaders, the characteristics of the retained trained volunteer group leaders and the activities that their groups conducted. Additionally, the exploration of the factors influencing the SCVTP's performance was listed as another aim. METHODS: A cross-sectional study was designed. The study used purposive sampling to select participants who meet the criteria from all the trained volunteer group leaders (n = 623). Demographic questionnaire, volunteer role identity (VRI) scale, attitude toward helping others (AHO) scale, team climate and atmosphere (TCA) scale, and volunteer program performance evaluation (VPPE) questionnaire were used to collect the data online. Descriptive statistics were used to determine the dropout rate and general characteristics of the retained volunteers and the activities. A multiple linear regression equation was developed to study the factors that influence program performance. RESULTS: In total, 307 questionnaires were valid in the study. About 67.9%, 53.7%, and 30.0% of the trained volunteer group leaders dropped out of the program in the year of 2017, 2018, and 2019, respectively. The retained trained volunteer group leaders were more likely to be females (84.7%), those in excellent health (75.2%) and with a bachelor's degree or above (87.6%). Less attention has been paid to frailty care (n = 76) than other volunteer caring activities (e.g., safe care: n = 277, diet care: n = 250, drug management care: n = 226). VRI (ß = 0.118, p = 0.017), AHO (ß = 0.134, p = 0.021), TCA (ß = 0.459, p<0.001), and financial sustainability (ß = 0.179, p<0.001) affected the SCVTP's performance significantly (adjusted R2 = 0.356). CONCLUSION: High rate of trained volunteer group leaders' dropout should be brought to the policymaker's attention. The characteristics of the retained trained volunteer group leaders provide a useful reference for the recruitment of trainees in the future. Frailty care may need more training by the volunteer service provider. In order to enhance program performance, a better team climate and atmosphere, financial sustainability, and volunteers with appropriate attitude and role identity are also necessary for the volunteer program.