Abstract: Background　With the aging of China's population and the increasing care burden of functionally impaired older adults，the provision of home-based long-term care services by nursing institutions has become a general trend. However，numerous challenges persist in the development of these home-based service institutions，and their current service provision still fails to meet the existing demand. Objective　To conduct an in-depth investigation into the current state of long-term care services provided by nursing institutions，analyze the development challenges in providing home-based long-term care services，and propose corresponding recommendations. Method　On April 18，2024，a convenience sampling method was employed to select two designated nursing institutions in Shijingshan District，Beijing. Participants included two managers，three nursing aides，and one nurse. In-depth one-on-one interviews were conducted with the managers from each institution，while a focus group discussion was held with the remaining staff. Guided by the Structure-Process-Outcome（SPO）model，the analysis was framed across these three dimensions. The interview guide covered topics such as staffing，salary levels，and service scope. Result　Using the analytical framework，the current state of home-based long-term care services provided by nursing institutions in Shijingshan District was described from three dimensions. Several key issues were identified：uneven development among institutions，suboptimal structure of nursing teams，insufficient safeguards for caregivers' personal safety，inadequate training and evaluation systems，lack of clear policy standards for implementing long-term care services，and service content that fails to fully meet the needs of patients and their families. Conclusion　It is recommended to enhance the training and evaluation systems，create clear career advancement pathways to motivate nursing staff，strengthen care team building to comprehensively improve care capabilities，and introduce policies and regulations to establish institutional standards that promote the standardized development of nursing institutions.

Key words: Patient care, Long-term care, Disability, Elderly, SPO model, Nursing institution

摘要： 背景　随着我国老龄化程度加重，失能老人的照护负担加大，护理机构提供上门护理服务逐渐成为大势所趋，然而如今提供上门服务的护理机构发展中存在诸多困境，服务提供尚不能满足实际需求。目的　深入考察定点护理机构在开展长期照护服务中的具体情况，分析护理机构提供上门护理服务的发展困境，提出相应建议。方法　于2024年4月18日依据便利抽样的原则，选取北京市石景山区两家定点护理机构的2名管理人员、3名护理员以及1名护士作为访谈对象。对两家护理机构的管理人员分别进行一对一深入访谈，其余人员采用焦点小组访谈的方式；以SPO模型为指导构建框架，从结构、过程、结果三个维度进行分析，访谈提纲内容涉及人员配置、薪资水平、服务范围等方面。结果　运用分析框架从3个角度描述了石景山区护理机构实施上门长期照护服务现状。目前护理机构存在机构间发展状况参差不齐、护理员团队结构有待完善、护理员人身安全有待保障、培训培养以及评价体系不健全、机构实施长期照护服务缺乏可以参考的政策标准、服务内容尚不能满足患者及家属的需求等问题。结论　通过完善培养培训以及评价体系，打通职业上升渠道，为护理人员发展提供动力；加强护理团队建设，全方位提升照护能力；出台政策法规健全护理机构相关标准，迫使护理机构规范化发展。

关键词: 病人医疗护理, 长期照护, 失能, 老年人, SPO 模型, 护理机构