Theoretical Basis Demographic data show that the world's population has been aging and there are more and more elderly people who need health and social care. The same situation is in our country. Every person lives his/her life in a unique way. With aging changes occur in physical, mental and social aspects. To cope with them requires help, tolerance, respect and patience shown by other people. The current forms of care for seniors are carried out in health facilities, social facilities as well as families. The changes bring about the need to find a new way of life. The most frequent changes occur in self-care which results in increased demands on the care of other people. Some seniors do not need almost any services and some are dependent on permanent comprehensive care. Definitely, the best way for seniors is living at home with the support of their families and the cooperation with home care agencies when health care is necessary. Everyday nursing care for seniors depends on the degree of their self-sufficiency and is extremely challenging. Caring for seniors is often complicated by changes in the behavior of seniors in communication, aggressiveness, disorientation caused by today's relentlessness and memory disorders. Caring for immobile seniors also places an enormous physical strain on nurses. Aims of the Study In this thesis, one goal was set, that is to survey the activities of nurses in nursing care for seniors in selected health care facilities, home care agencies and nursing homes. Methods Used in the Study In the empirical part of this thesis the qualitative research method of observation was used to conduct the research survey. The research survey was conducted through observation, in which the frequency of nursing activities was observed, and the time consumption of selected nursing activities (recording nursing documentation, intramuscular injection administration, subcutaneous injection administration, insulin administration with an insulin pen, capillary blood collection, venous blood collection, a planet urinary catheter insertion in women, blood pressure taking, blood sugar levels testing using a glucometer and colostomy care) were recorded into pre-prepared observation sheets (Appendix 2) and (Appendix 3) in the Home care Agency in České Budějovice from May 1 to July 5, 2013, in the Home for Seniors in České Budějovice from July 8 to July 12, 2013 and in České Budějovice Hospital, plc, in the Aftercare department from July 22 to July 26, 2013. The data sheet with activities when time measurements were carried out was compiled based on a preliminary research, when all the mentioned facilities were visited beforehand to find out which activities were carried out in all the facilities where the research study was conducted. A digital stopwatch was used for measurements. The time measurements are stated in units of time rounded up to the nearest minute. Each nursing activity was measured from its preparation through implementation to completion. Observations were carried out eight hours a day, 5 days a week in each facility. Overall, 160 hours for 3 weeks. Observations were conducted during regular operating hours in the facilities; every day one nurse treating fifteen seniors in each facility was observed. The frequency of nursing activities and the measured values were statistically processed - summed, averaged, and standard deviations were calculated. Results of the Thesis The analysis of the data implies differences in nursing activities carried out by nurses in particular facilities and the time measurements show time differences between particular facilities in nursing activities performance. The goals of this thesis were achieved after the research investigation and the research questions were answered.

Diploma thesis is focused on the individualization in providing diets in three homes for the elderly in the South Bohemian region. The main goal of the qualitative research was to uncover what the options of the homes in providing the diets are, where the boundaries and the limits of the individualized care are and what the clients' attitude toward individualization is. Results of the research show that the homes for the elderly can accommodate just to the basic requirements of the client, such as replacing unpopular dish or side dish for another one. Medical restrictions of the clients in preparation and serving their food are taken into account. The homes don't have the capacity for greater individualization. Another problem is the lack of staff. The homes are limited by legislation rather than by their financial budget. Clients' conservative and conformal attitudes are not empowering managers to expand some options or to change the system. The concept of the individualization is interpreted by the homes for the elderly in different ways. In practice, they rather just try to individualize the diets, than truly doing it. It turned out that individualization is a complex phenomenon and the extend of its fulfillment depends mainly on organizations' overall approach to the clients and on the clients'...

The diploma thesis deals with issues of vaccination of workers in social services against seasonal influenza in homes for the elderly. Furthermore, this diploma thesis deals with possible ethical dilemmas in connection with cancellation of mandatory vaccination against seasonal influenza as a result of the change of legislation in 2010. The thesis is divided into a theoretical and a practical part. The theoretical part summarizes the basic information concerning seasonal influenza, its impact and prevention, and also provides an overview of long stay services focused on homes for the elderly. In the theoretical part there are also described the basic aspects relating to ensuring the quality of the service provided. Results of the quantitative research carried out in six homes for the elderly are presented and evaluated in the practical part of the thesis. The main goal of the diploma thesis is to map trends concerning the immunization coverage of workers in social services against seasonal influenza, opinions of these workers, their attitudes towards and motivation for such vaccination. Survey research shows that the cancellation of mandatory vaccination against seasonal influenza had a negative impact on immunization coverage of the workers in social services and that in the past the most common reason for vaccination was the duty laid down by law. Moreover, it follows from the results of the research that currently the main reason for refusal of vaccination lies in distrust in efficiency of vaccination. The research has also shown the importance of practising physicians' recommendations for vaccination and their irreplaceable part in provision of information about influenza. The secondary aim of the thesis was to discover how the workers in homes for the elderly perceive the impact of sickness rate of workers in social services caused by seasonal influenza on functioning of the organisation and on the quality of the services provided. As the research has shown, the workers do not believe that incapacity for work due to influenza has an impact on the functioning and quality of the services provided. Another secondary aim of this thesis was to obtain an overview of possible motivation of the workers in homes for the elderly for increase in immunization coverage against seasonal influenza. It follows from the results of the research in question that the strongest motivation for the workers would be represented by reintroduction of mandatory vaccination. The third secondary aim of the thesis was to identify possible ethical dilemmas with respect to change in duty of vaccination against seasonal influenza. These dilemmas are defined in the conclusion of the practical part of the thesis. The results may be utilized as resource materials for motivation of both the senior employees and other employees of the homes for the elderly for vaccination against seasonal influenza with respect to protection of their clients.

Abstract The society has become increasingly interested in the issue of seniors at present. Considering the increasing age of seniors, a situation when they are not able to take care of themselves and need help of another person may occur. The assistance secured by health and social services may be provided to seniors in their homes or in housing facilities. Human needs are changing and developing with age and form an integral part of the personality of an individual. The theoretical part of the thesis addressed the terms of aging, old age, needs and health and social services. The data were collected using the qualitative research strategy, the method of questioning and the technique of interviews, involved observation and technical literature analysing. While interviewing the respondents, their anonymity was respected. The objective of the thesis was to ascertain whether needs of seniors are satisfied in relation with the offered health and social services. In the research, the main research question was set out. In order to answer the question, five research sub-questions associated with the interview structure were used. The research was conducted in retirement home Hvízdal České Budějovice, p.o. (organization co-funded by the state budget). The main research question led to confirmation of the thesis objective. The obtained information may be used for improvement of quality of the services provided in the facility where the research was conducted.

隨著政府職能的改變，面對財政壓力，引進民間企業的活力和專業創新的能力，委外經營模式成為政府推動各項為民服務業務的主要策略，而以「公設民營」的方式，結合民間資源共同推動老人福利服務工作。 「高齡化」是當今世界各國共同現象與趨勢，近年台灣人口老化迅速，在工商社會變遷與晚婚少子化下更形突顯。為因應「老人照顧」多元化的發展，以何種「老人安居住宅」的型態，達成融入「社區」、「在地老化」的政策目標，引發了研究者之研究動機。 本研究係採質化研究，以文獻分析，問卷調查深入訪談法等方式進行探討，由高齡社會學、公共選擇理論、社會資源整合等理論為分析導引，探討老人安居住宅需求重要性、老人照顧需求層面內涵、公設民營發展、政府及國內學者專家對老人住宅政策規劃方向，最後再結合個案入住老人、社區住民、公民營專家深入訪談，歸納並提供適合社區老人安居住宅之公設民營建議與結論。 本研究發現「毗鄰居住」的社區老人安居住宅，適合台灣傳統家庭的維繫；而公設民營模式可適合老人社會普遍性需求，以全政府照顧弱勢的社會責任。最後，本研究研擬幾項建議如下： 一、 硬體設施：政府擇定設置示範老人安居住宅，委由民間專業團隊經營，建立有效的監督機制與評鑑規範、以公設民營模式建構老人連續照顧體制的初級系統。 二、 醫療支援：政府應整合社會醫療資源，規劃多元醫療體制；及早實施長期照護保險政策；提供老人連續性服務之多功能窗口。 三、 在地老化：政府應推廣社區老人安居住宅概念，落實社區照顧，儘量讓老人在自己熟悉環境中在地老化。 四、 居住安養：運用居住空間「通用設計」概念，建構設置社區公設民營老人安居住宅，以使有限資源運用效益最大化。 五、 資源整合：政府應整合社會福利、現行老人補貼等相關政策資源，以發揮整體效益。 / To cope with the change of the functions and financial pressure, the government conveys the works to private sectors to make good use of their innovative and professional ability, or adopts outsourcing model to promote the social services. Therefore, the strategy of “government owned and private sector operated,” combined with non-governmental resources are provided jointly to promote the welfare of the elderly services. "Aging" is a common phenomenon and trends in today's world. In recent years, as Taiwan's population is aging rapidly, the birthrate is declining and late marriage is prevailing highlighted the need for reform. In response to development of "elderly care", my main question is to investigate what kind of "residential homes for the elderly" to attain the policy objectives of integrating with the "community", "aging in place". This study reviews the literature concerning the sociology of aging, public choice theory, theory of social resources and adopts qualitative research method, such as questionnaire and in-depth interviews to examine the importance of housing demand for the elderly care needs, development of public-private partnership, government policy planning directions for the elderly housing. Finally we work through the case study with the data collected from the elderly, community residents, public and private experts, and draw conclusions for providing the elderly suitable community-dwelling homes and the strategy of “government owned and private sector operated.” This study finds that adjacent to the community residential homes for the elderly, is suitable for maintaining the traditional family ties; and the government owned and private sector operated mode is suitable for the elderly needs. By doing so, the government can fulfill the social responsibility to take care of the disadvantaged. We make some suggestions for further efforts: 1. Hardware facilities provided The government selects the model residential homes for the elderly, and run by non-governmental professional team, and sets up effective monitoring mechanisms and evaluation standards in order to help civil organizations to run the elderly care system continuously. 2. Medical care support The government should integrate social and medical resources, planning pluralistic health care system; early implementation of long-term care insurance policies to provide multi-functional window for services of the elderly. 3. Aging in place The government should promote the concept of community-dwelling for the elderly, the implementation of community-based care as much as possible so the elderly can be aging in familiar environment. 4. Nursing homes provided in the neighborhood To use concept of "universal design" for living space, and build the “government owned and private sector operated” housing in nearby community in order to maximize the benefits of using limited resources. 5. Resource Integration The government should integrate social welfare resources, the current subsidies for the elderly and other related policy resources in order to increase the overall efficiency.

In this thesis an explorative study was undertaken with the aim to study how a number of private care providers, as well as politicians and officials from councils in and around the Stockholm and Uppsala counties, think about the future of the Swedish elderly care from a property perspective, i.e. homes for the elderly. The analysis shows that there is a demand for capacity in 6 out of 16 municipalities, and that the property is an important part of this capacity, and the fulfillment of it. This was mainly due to the cost of capital, but also because of several other factors such as lack of land, a wish to guide the design, ideology, and in many cases a wish to use the property as an instrument of domination to control private health care providers. Also, the property was show to be connected to economic competition, to freedom of choice, and to quality. The problems related to the property in the market for elderly care still remains to be solved. The writer of this thesis suggests that, among other things, patients should be treated as customers to a larger extent and problems that counter competition must be solved. Lastly, the writer has analyzed the situation in the Swedish market for elderly care from a value creation perspective. It is suggested that value can be created in both the network and within the company, even if the companies are competing, and thus ought to compete and not cooperate. / I denna uppsats har en explorativ studie företagits med målsättningen att undersöka hur ett antal privata vårdföretag samt politiker och tjänstemän från ett antal kommuner i och runt Stockholms- och Uppsala län tänker kring framtiden för den svenska äldrevården. Utgångspunkten har tagits ur ett fastighetsperspektiv, närmare bestämt vårdboenden. Bakgrunden ligger i det stora behovet av äldrevård som växer fram i Sverige och som beräknas nå sitt maximum kring 2035. Genom intervjuer har respondenterna fått svara på frågor om fastighetsbehovet, om konkurrens samt om, och i så fall hur, fastigheten kunde kopplas till kvalitet, valfrihet och konkurrens. Analysen visade att behov förekom i 6 av 16 kommuner, och att det påverkades av bland annat deras inställning till ägande och privata vårdgivare. Vidare visade sig fastigheten vara en viktig del i behovet och lösningen utav det samma, främst på grund av kapitalkostnaden, men också på grund av faktorer så som markbrist, en vilja att styra utformningen, ideologi och i flera fall en vilja att använda fastigheten som ett domineringsinstrument för att kontrollera privata vårdgivare. Konkurrensen sågs till viss del som ett utbyte framför en tävling. Slutligen framkom att fastigheten, om än som en underordnad komponent, kunde kopplas till konkurrens som nyss nämnda instrument, till valfrihet genom attraktivitet i läge och utseende, och till kvalitet som möjliggörare av effektiv vård och med rätt utformning. Fastighetsproblematiken i stort för vårdmarknaden, speciellt kopplat till LOV, återstår att lösa och författaren föreslår bland annat att vårdtagarna bör ses som kunder i större utsträckning och att konkurrenshämmande problem skall åtgärdas. Avslutningsvis har författaren analyserat situationen på den svenska vårdmarknaden ur ett värdeskapande perspektiv, kopplat till Porters, Stabell och Fjeldstads teorier om värdekedjor. En problematisk situation, sett till konkurrenskrafter på marknaden, iakttogs som orsak till att de privata vårdföretagen tycks medvetet eller omedvetet skapar värde tillsammans genom värdeskapande i nätverk parallellt med verksamhet enligt den traditionella värdekedjan, trots att detta motverkar ökad konkurrens. En möjlig förklaring är en kombination av oplanerat resursinterberoende och att det är ett slags relationsbyggande mellan företagen, orsakat av en imperfekt marknad.

Master thesis aims to evaluate the accessibility of social services in Karlovarsky region. The thesis is focused on the demographics of seniors and social services intended for them, specifically retirement homes. In addition to analyzing the accessibility of social services is elaborated demographic projection of region's population over the next 50 years. In the theoretical part is described the definition of social policy and the fundamental theoretical principles, types and functions. This part also describes the legislative framework of social policy in the Czech Republic. In relation to social policy are presented issues of community planning as a tool for the implementation of social policy in the Karlovarsky region. The conclusion of theoretical part is devoted to the theory of demographic projections and describes the basic projection methods. The practical part in the introduction focuses on general and demographic characteristics of the Karlovarsky region and the current state of social services for the elderly, specifically homes for the elderly. The second half of the practical part presents a demographic projection of region's population over the next 50 years and is focusing on senior component whose proportion in the population will increase. This projection is calculated by the component method without migration. The conclusion of the practical part is comparing the initial state of social services and the anticipated development of seniors. It also describes community plan in the Karlovarsky region with emphasis on the development of social services for seniors. Documents drawn up by the Karlovarsky region on issues of social services and conclusions of this thesis suggest that there is no need to increase capacity, but rather to focus on the change in the structure of users and ensure that these services are provided to people whose health condition really requires this kind of complex social care.