Senior Concerns
As China’s population is rapidly aging, how can the struggling senior care sector step up to meet the increasingly complex needs of the elderly and their families?
After suffering from a number of strokes over the years, 83-year-old widow Cheng Yuqin became more and more forgetful. Although her daughter, Xu Hong, would leave notes on the stove to remind her to switch off the gas after she finished cooking, she often forgot. When Cheng's doctor warned she could no longer live alone due to the risks caused by her forgetfulness, Xu employed a caregiver for her mother, only to find the carer couldn't stop Cheng from getting into risky situations, on top of which, the two just couldn't get along.
It was a big problem for Beijing-based Xu, Cheng's only child at home – as a photographer, she makes frequent, long trips on business, and if she took too much time off, it would definitely impact her work.
“I couldn't deal with it, really, though I wished I could,” she said. Xu finally admitted Cheng to a local nursing home. It may be the only choice for thousands of families in a similar situation – according to statistics from the Ministry of Civil Affairs (MCA), China was home to more than 230 million people aged 60 or above at the end of 2016, 16.7 percent of the total population. The United Nations predicted in 2015 that China's gray population will exceed 500 million by the middle of the 21st century, more than the entire population of the US.
Yet, China's elder care system lags far behind the burgeoning aging population. According to a 2015 report on the development of Chinese families released by the National Health and Family Planning Commission (NHFPC), most Chinese seniors take care of themselves or are supported by their families, with one-quarter of those who are unable to care for themselves left untended. The report found that suffering from multiple health issues, being incapable of looking after themselves and being left untended during illness are the top three difficulties seniors in China face. However, neither China's medical care system nor the elder care system is well set up to solve these difficulties.
Barriers to Medical Services
It was the two experiences of taking Cheng to hospital that made Xu determined to send her mother to a nursing home. One time, Cheng strained her back and couldn't move, but the nearby community hospital refused to admit her due to her age. As Cheng could not bend down to sit in a taxi, Xu had to carry her to the bus stop on her back. After they struggled to their destination, they were told that the hospital had no beds left. Xu finally carried her mother back without any treatment.
Another time, Cheng suddenly had stomach ache. The emergency doctor suggested going for tests in a bigger hospital, but Xu only managed to make an appointment for two weeks later, and by this time, Cheng's symptoms had disappeared.
“We're lucky that my mother was later diagnosed as having chronic gastritis. If she suffered from a serious disease, I couldn't imagine the consequence [of delayed treatment],” she told Newschina.
In March 2016, the Renmin University of China issued a report on China's senior society, warning that more people are suffering chronic diseases at an earlier age. “More than 75 percent of seniors suffer chronic diseases like high blood pressure and heart disease, 10.54 percent have small-to-medium problems taking care of themselves, and 23.8 percent are in obvious cognitive decline,” the report said.
Such figures indicate that seniors' medical demands are rising with the growth in their population, while Chinese hospitals – especially large, first-tier ones – are already overloaded.
Turned Away
Xu did not rest until Cheng was admitted to Cuncaochunhui Home for the Aged, a professional nursing home in Beijing's Chaoyang District near their home which specializes in seniors who are unable to care for themselves and those with dementia. Equipped with an internal clinic that offers necessary services and medical staff providing round-the-clock nursing care, the facility has relieved Cheng from the troubles of going to see a doctor.
Not all seniors are as lucky as Cheng. Li Ying, research director in the elder care system at the Peking University Health Science Center and director of the National Association of Health Industry and
Enterprises Management under the NHFPC, told Newschina that a former classmate, who has been paralyzed for years, still had to shuttle back and forth between the hospital and her nursing home after a wound recently got infected, since the home couldn't deal with it.
“If even such a high-end, expensive nursing home can't provide a necessary [medical] service, then what about the smaller ones?” Li asked.
Li's worries were proved in a survey by the Beijing Municipal Committee of the Chinese People's Political Consultative Conference, which showed that among the 386 nursing homes for seniors in Beijing, only 103 have a clinic, half of which are not certified by medical authorities. Four out of five are not covered by China's social medical insurance. Besides, 38 percent of nursing homes neither have a clinic nor have they signed agreements with nearby hospitals.
Worse still, although seniors with dementia or those who can no longer take care of themselves need elder care facilities the most, many Chinese nursing homes won't admit them. “Nursing homes prefer active seniors to those who are physically or mentally disabled, as they require less care. So although we have 6.7 million nursing care beds for seniors nationwide, less than 20 percent are accessible to seniors who have a mental or physical disability,” Wu Danxing, a member of the expert committee for the senior care industry under the MCA and also director of the Seniors' Health Care Society under the China Science and Technology Industry Association, told Newschina.
“For the sake of reducing costs and mitigating potential risks, many nursing homes have shut the door to such people, despite the high demand. This is a misallocated market,” she added.
According to The Fourth Sample Survey on the Life of Rural and Urban Chinese Seniors, conducted by the National Commission for Seniors' Affairs in 2016, China was home to 40.63 million seniors who need care, 18.3 percent of the total gray population. However, according to the MCA, only around 20 percent of China's current 40,000 elder care homes are qualified to provide medical care.
A recent survey by Ciconsulting, a leading Chinese industrial development and strategy researcher, supported the data: China has around 18.77 million seniors who cannot care for themselves, and this figure will increase to 20 million by 2020. However, China's current elder care facilities can only accommodate 15.9 percent of those in need.
The shortage is so great that many seniors use hospitals as a nursing home and refuse to be discharged. Guangdong-based newspaper the Southern Metropolis Daily revealed in 2015 that a local elderly man with senile dementia, who was admitted to hospital due to high blood pressure and diabetes, had been there for 12 years. His family would rather pay the hospital 2,000 yuan (US$307) each month for his care than take him home.
Shortage of Facilities
For almost 10 years, Chinese society has followed a so-called “9073” senior care pattern which was reportedly started by the Shanghai government. It suggests that 90 percent of seniors should take care of themselves or be taken care of by family at home, seven percent by their community, and the remaining three percent in nursing homes. However, as the aging population is rapidly enlarging and as China's three-decade-old “one-child” policy means Chinese families are smaller than ever, the idea is increasingly challenged by experts.
The government is trying to remedy the situation. In September 2013, the Chinese State Council issued two documents, encouraging various medical institutions to cooperate with elder care facilities. Two years later, nine ministries, including the MCA and the NHFPC, jointly issued a document that required these institutions to set up a priority channel for quick access and simplified formalities for seniors and care facilities to provide various medical services for their residents.
The documents, according to He Zhaohua, the NHFPC'S deputy family development director, aim to “incorporate medical services into the senior care system.”
“The new policy will help lighten the load on big hospitals by transferring some seniors to nursing homes and communities,” he said. “We hope the new policy will form a new medical pattern – the big hospitals take charge of treating serious disease, and community clin-
ics and nursing homes are for basic medical services and daily care.”
According to the documents, medical services include disease treatment, healthcare consulting and physical examinations, and nursing care includes daily care, psychological consulting and cultural activities. The government hopes that the use of social resources will be optimized and maximized when the two are effectively incorporated.
The new policy was hailed by many experts. Li Ying said it could be a solution to the negative impact caused by some of the medical contradictions in Chinese society.
“Since medical services became marketized following China's medical care reforms [in the 1990s which required most public hospitals to become self-financing], many hospitals have concentrated on highend, advanced services for more profit. But seniors mostly need general practitioners and nurses who offer basic medical services and daily care,” she said.
Wu Danxing agreed. “The new policy mainly targets those with dementia and those who can't take care of themselves,” she told News- China. “Under the policy, medical institutions will put more effort into the chronic diseases that seniors are more vulnerable to, and care facilities will put more into admitting and caring for physically and mentally disabled seniors.”
Du Peng, director of the Gerontics Institution at Renmin University, said the new policy will bear results for both seniors and care providers. “It will enable seniors to enjoy higher-quality services at lower costs, and the policy will give nursing homes a new profit point if they seize the chance to provide more medical services. Hospital beds will get rotated more quickly which means their medical resources will be used more efficiently,” he noted.