标准化与人性化之间：居家养老服务递送的实践困境

Between Standardization and Humanization: The Practical Dilemma of Home Care Service Delivery

摘要: 社区居家养老服务覆盖面不断扩大，但存在服务指标完成好、老人实际满意度低的问题，本文聚焦服务递送过程，分析标准化流程与老人个性化需求的矛盾。在政府购买养老服务时，会将照护需求拆分为量化条目并计时计量考核，虽强化了监督，却忽略了老人需求的情感性、多样性和动态性，导致标准化照护难以适配实际需求。而一线照护者面临“按表操作”与“看人服务”的双重期待，严格考核压缩了其裁量空间，使得服务趋于形式化，老人的实际需求未得到解决。这一困境的根源是制度逻辑与照护逻辑的冲突，前者追求可量化、可考核和程序规范，后者则注重关系性、持续性和需求回应。据此，本文建议改革单一量化考核方式，在服务评估体系中加入弹性时间机制，兼顾程序规范与人性化照护。

Abstract: The coverage of community home-based care services is expanding, but there are problems such as good service indicators and low actual satisfaction of the elderly. This paper focuses on the service delivery process and analyzes the contradiction between the standardized process and the individual needs of the elderly. When the government purchases pension services, it will split the care needs into quantitative items and timing measurement assessment. Although it strengthens the supervision, it ignores the emotional, diversity and dynamics of the needs of the elderly, resulting in standardized care difficult to adapt to the actual needs. The first-line caregivers are faced with the dual expectations of “operation according to the table” and “service to see people”. Strict assessment compresses their discretion space, makes the service tend to be formalized, and the actual needs of the elderly are not solved. The root of this dilemma is the conflict between institutional logic and care logic. The former pursues quantifiable, assessable and procedural norms, while the latter focuses on relationship, continuity and demand response. Based on this, this paper proposes to reform the single quantitative assessment method, add a flexible time mechanism to the service evaluation system, and take into account the procedural norms and humanized care.