Aging population pressures existing elderly care system

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On Douban, a Chinese social media platform, over 50,000 people have been sharing their anxieties, hopelessness, pain, and even hatred of the burden caused by taking care of their aging parents. Those taking part in the discussion all have one thing in common: they don’t have any siblings to share the load.

The majority of those chatting on the message board were born after the 1990s and are made up of people from all walks of life, including employees at private companies, civil servants, university students, and authors. Almost all of them are from urban middle-class families and their parents are generally financially comfortable. Despite that, providing care for their parents still poses significant challenges to their life plans. For example, any intention to study abroad might conflict with taking care of sick parents.

According to data from the National Statistics Bureau, as of 2020, the number of only children in China has reached 200 million, but the number of senior citizens (aged 60 and above) has surpassed 250 million. With parents from the first generation of only children now approaching retirement, it is time for those born after the 1980s to care for their parents.

As many young people are unable to balance family and personal goals, more and more are taking the decision to place their parents in a nursing home. Yet multiple incidents in recent years have demonstrated that nursing homes are not necessarily an ideal solution.

One such incident was the death of 86-year-old Sun Hai, who suffocated to death in his nursing home in September 2020. Sun had been tied to a bed by his 70-year-old care worker Zhou Xianlin, in a bid to prevent him from falling off the bed.

In theory, care workers in nursing homes should be professionally trained. Yet, in reality, senior citizens who have not received any formal training are caring for people older than them, especially in smaller cities. The lack of modern basic facilities also poses a danger to many care home residents.

Opened in 2014, the nursing home where Sun died charges residents 2,100 yuan ($324) per month, with a 50 percent discount for seniors who don’t have any family members. Zhou, Sun’s care worker, had worked 24/7 at the home in return for meals and accommodation, earning a monthly base salary of just 2,800 yuan.

“Young professionals go for one-to-one care, and they can earn at least 5,000 yuan a month. If they are even younger, they can earn more working as maternity matrons,” commented Zhao Chan, the nursing home director, who acknowledged that a monthly salary of 3,000 yuan is anything but competitive in the existing market.

To promote the development of elderly care services in recent years, policies benefiting the industry have been frequently promoted. But for professionals working in elderly care services, many policies do not address the whole picture. The most significant pressure actually comes from training and professionalization, which policy changes have not adequately addressed.

“Current care workers are primarily females aged between 40 and 60. Their work can be very tiring and tedious, and they lack social recognition at the same time. Rarely do young people devote their efforts to frontline care professions,” claimed Gao Huajun, the deputy principal of the China Philanthropy Research Institute at Beijing Normal University.

In October 2020, the Ministry of Civil Affairs outlined new guidelines for ensuring the training of 10,000 directors for nursing homes, two million care workers for senior citizens, and more than 100,000 part-time social workers for elderly care before the end of 2022. Despite this, on the ground, it has proven unrealistic to facilitate the training of two million elderly care workers.

To tackle the issues in elderly care, aside from specifying the agenda in the Fourteenth Five-Year Plan, the government has strived to promote university education combined with short-term training to further develop the industry. According to a report in April 2020 from the China Education Daily, 56 new elderly service and management programs have been set up in vocational education institutions, reaching 278 programs across China.

The 2019 Statistics Report on the Development of Civil Affairs published by the Ministry of Civil Affairs shows that as of the end of 2019, there were 204,000 elderly care service institutions and facilities in China, with 7.75 million beds integrating elderly and medical care. Among them, registered elderly care service institutions accounted for 34,000, an increase of 19.9 percent compared to 2018. Community elderly care institutions and facilities accounted for 64,000, with 8,207 of them designated community elderly care institutions. Community elderly care based on mutual assistance accounted for 101,000, with 3.36 million beds.

Yet Gao discovered that based on the Thirteenth Five-Year Plan, the vast majority of elderly people – a stunning 90 percent — were still being cared for by their families, while systematic community and institutional elderly care services only accounted for 7 percent and 3 percent.