发展基于社区的老年人长期护理服务：蒙古试点项目的经验教训（英）

DEVELOPINGCOMMUNITY-BASEDLONG-TERM CARESERVICES FOROLDER ADULTSLESSONS FROMA PILOT PROJECTIN MONGOLIA Like most countries in Asia and the Pacific,Mongolia is facing the aging of its population.Decades of increases in the country’s overallstandard of living, and improvements in thehealth system, have led to longer life-spans,and, at the same time, a decline in fertility. CONTENTS Figures and Boxiv A Vast Country withan Aging Population Existing Long-TermCare in Mongolia PilotImplementation8 A Community-BasedCare Pilot Pilot Components10 17 Profile of PeopleServed Under the Pilot 25 How the Project Changed theActive Aging Hub Pilot Sites Outcomesfrom the Pilot 27 Areas for FutureDevelopment Recommendations forReplication and Expansion This case study was developed under the regional technical assistance forDeveloping InnovativeCommunity-Based Long-Term Care Systems and Services, financed by the High-Level Technology Fund,Japan Fund for Prosperous and Resilient Asia and the Pacific, Japan Special Fund, and ADB’s TechnicalAssistance Special Fund-6. The document was peer-reviewed by Altantuya Jigjidsuren and ItgelLonjid, principal social sector officers at the ADB Mongolia Resident Mission. In this publication, “$” refers to United States dollars and “MNT” refers to Mongolian togrog.On the back cover: Population aging in Asia and the Pacific creates an urgency to develop long-termcare systems for older people (photo by ADB). © 2025 ADB. The CC license does not apply to non-ADB copyright materials in this publication.https://www.adb.org/terms-use#openaccesshttp://www.adb.org/publications/corrigendaPublication Stock No. ARM250368-2pubsmarketing@adb.org Figures and Box FIGURES 1Age and Gender Distribution of Mongolia’s 60-Plus Population,32020–20502The Active Aging Hub Model73Active Aging Hub Service Providers94Case Management Flow for Active Aging Hubs115Care Foci and Interin Interdisciplinary 2024 (based on actual data18by pilot active aging hubs) BOX Care Foci and Interdisciplinary Care Protocols14 Abbreviations AAH–active aging hubADB–Asian Development BankDMC–developing member countriesEDC–elder development centerLTC–long-term careMFLSP–Ministry of Family, Labour and Social ProtectionNGO–nongovernment organization DEVELOPING ACOMPREHENSIVELONG-TERM CARESYSTEM FOROLDER ADULTS MONGOLIA VISION The vision of Mongolia’s National Operational Plan for Long-TermCare (2022–2024) was to improve the quality of life of the Mongolianpopulation by developing a comprehensive integrated long-termcare system, emphasizing active aging and enhanced by supportiveenvironments. In line with this vision, and with technical assistancefrom the Asian Development Bank in 2021, a pilot program developedthree active aging hubs (AAHs) to test innovative and sustainablecommunity-based long-term care service models that can deliver qualityand affordable services and have potential for replication. The pilot worked with three different types of service providers:•a nongovernment organization-run residential care home •a state-owned Elder Development Center, and•a public general hospital in three different-sized communities in urbanand rural Mongolia. The AAH program aims to offer coordinated care, with assessment, casemanagement, and provision of in-home visits by caregivers and medicalstaff; facilitate access to active aging services; and provide information andreferral services based on three distinct levels of need. The services aredelivered either by the dedicated service providers or through coordinationand linkages with existing services in the community. The pilot equipped the AAHs with clinical guidelines andoperational and program manuals to support a comprehensivecase management system, to find and screen cases; assess andprioritize according to risk; develop and implement a tailored care plan; andinstitute effective, digital record keeping. The evaluation of the pilot verified that it increasedthe coherence of the AAH service offerings and ledto cross-sectoral integration of services and improvedoutcomes for participating older adults and their families.It highlighted the complexity of support required for olderadults beyond health services and financial assistanceto a wide range of services tailored to level of need,and especially for older adults who are homebound. The pilot also influenced policy. In 2024, the Elderly Law in Mongolia wasrevised to incorporate assessment and case management services andincrease the budget available for home-based services. The budgetfor this was increased approximately twenty-fold, from$85,600(MNT300 million)to$1,566,000 (MNT5.4 billion)and the Ministryof Family, Labour and Social Protection (MFLSP) is working on doublingthat figure. The AAHs will provide these services on a contract basis. NEXT STEPS For future development, the evaluation highlightedseveral needs, including providing further respite andsupport services to family caregivers, increasing thenum