(By Pan Gaofeng, Jiang Yuezhong and Xu Yiru. Xinmin Wanbao (新民晚报, Xinmin Evening News), Jan. 15, 2012, p. A02. Complete text:) The statistics that advisers quoted during this year’s National People’s Congress and Chinese People’s Political Consultative Conference are unsettling.
Sixteen percent – more than 2 million people – of [Shanghai’s] registered population is over the age of 65, while 18.1% of the elderly population – 600,000 people – is over the age of 80.
The city has 3.5 million one-child families, which account for 68.6% of all family households; and the city’s 7 million parents of one-child families account for 49.6% of the registered population. By 2013, the percentage of elderly people – those over the age of 60 – who are parents of one-child families is forecasted to reach 80%.
Seventy percent of the very elderly have partially lost the ability to look after themselves, and 30% have completely lost that ability. In Shanghai in 2010, approximately 420,000 elderly people needed comprehensive care and 180,000 elderly people needed professional nursing, but there are only 20,000 certified professional nurses nationwide – and there are certainly even fewer in Shanghai.
Chinese People’s Political Consultative Conference members are concerned about the data and contemplating how to care for Shanghai’s elderly. How should we generate more societal interest in providing elderly care? What is our answer to one-child families facing the double dilemma of lacking familial resources and social services to care for the elderly? How can we concurrently develop elderly care and housing security? CPPCC members have made a number of proposals.
Status quo: Elderly care institutions have unknown risks.
Countermeasure: Establish a risk-sharing mechanism.
In recent years, personal-injury accidents suffered by elderly people in nursing homes have increasingly made headlines. Due to a lack of scientific evidence and a reasonable risk-sharing mechanism, disputes about accidents regularly occur between nursing homes and their elderly clients and those clients’ families.
According to a survey by the Shanghai Municipal Committee of the Chinese Peasants’ and Workers’ Democratic Party, about 60.7% of elderly people currently in nursing homes have cerebral thrombosis, cataracts, arthritis, diabetic complications and other geriatric diseases, and quite a number of them suffer from several of those conditions at once. Under those circumstances, the probability of suffering a bone fracture in nursing homes is as high as 80%. Bone fracture is the most common risk facing elderly people in nursing homes.
To protect themselves, individual nursing homes have to take extreme measures to secretly restrict certain freedoms, but accidents still happen. Some nursing homes have strengthened general examination requirements and even refuse to admit elderly people who have disabilities and dementia. That hinders the development of elderly care and proves a deterrent for potential private investors.
Jin Ruyin, a CPPCC member and deputy chairman of the Peasants’ and Workers’ Municipal Party Committee, said that other countries – for instance, Japan, whose society entered an aging period before China – have adopted government-purchased accident insurance for the elderly. She suggested that China study how the Municipal Federation of Trade Unions provides “mutual assistance to workers who have serious illnesses.” In this way, according to actual circumstances, China should draft mandatory provisions for nursing homes to buy accident insurance to cover their risks.
Certain subsidies could be given to those who buy insurance for “health support services.” Insurance premiums could be split three ways: among the insured, nursing homes and a special municipal public welfare fund.
Status quo: One-child families carry a heavy burden to support the elderly.
Countermeasure: Establish an elderly care insurance system.
Shanghai took the lead in family planning in the 1960s and now, parents of one-child families have entered old age. A survey by the Municipal Committee of the China Democratic League reveals four characteristics of life for elderly parents of one-child families:
1) They have a low dependency ratio; their occupations and incomes are stable and economic conditions good.
2) They have diverse requirements for retirement and seek retired lives of high quality with a richness of experiences.
3) The family support function has weakened, and their dependence on society and the community has increased.
4) The phenomenon of one child studying abroad or studying or working in other places has increased. The family empty-nest period has shifted from old age to middle age.
Fang Rong, a municipal CPPCC member and deputy chairman of the Municipal Committee of the China Democratic League, believes that there are two difficult points regarding providing for the elderly. The first is elderly care, and the second is spiritual comfort. He proposed borrowing ideas from the overseas elderly care insurance systems – starting at age 40, the next generation of parents of an only child would begin to pay fees so that at 70 or in the case of serious illness, they can tap into nursing insurance money.
In addition, to satisfy the elderly’s requirement of spiritual comfort, policies and guidance can be created to encourage those families hosting their elderly or living close to them. “For example, adult children living with elderly parents over the age of 70 or living near them could get a reduction in their individual income tax contributions, or receive preferences to buy affordable housing or live in low-rent housing. They could receive five to seven extra days off work every year to provide elderly care; they could also receive commuting allowances or, for those families with special economic difficulties, financial subsidies.
Status quo: Housing security and elderly care are separate.
Countermeasure: Institute advanced planning of elderly communities.
“At present, elderly care is primarily home-based. Existing housing systems and housing security policies in China are separate from old-age security services,” said CPPCC member Hu Suyun, who believes elderly care services should be instituted in the housing security system as early as possible.
According to Hu Suyun, in some developed countries, housing for the elderly has been a primary component of community care. Home-based elderly care is combined with remodeling and maintenance of housing facilities for the elderly. Governments coordinate social support services such as family welfare and emergency call services.
For example, in France and Germany, small-scale nursing homes are generally integrated into their respective communities. There’s been a shift from standardized services to individualized services. In Singapore, special institutions have been set up for elderly people and children who are uncared for in a “three-in-one family center” that integrates nursing homes and nurseries – thus caring for the elderly and for children.
She suggested that as various kinds of public housing are built in Shanghai – whether relocation or low-rent housing, or some other option – that a proportion of each project’s consideration should be given to elderly people’s residential needs – for example, space for elderly care organizations and community care centers equipped with the proper facilities.
In addition, public funding and urban planning should take elderly care requirements into account.
Status quo: There is a shortage of professional nursing personnel for the elderly.
Countermeasure: The nursing profession for the elderly should be supplemented.
Municipal CPPCC member Gao Xiangdong pointed out that historically, care services, especially for the elderly, were basically provided by the family, with spouses and children serving as primary care providers. Today however, due to the rapid aging of the population, longer lifespans and smaller and less cohesive families, meeting the demands associated with elderly care has proven difficult.
“It is frustrating; professional nursing resources for the elderly are very inadequate these days. Less than 50,000 people are training [to be nurses] in Shanghai and even fewer have obtained their professional nursing certificate,” says Gao Xiangdong. He proposed that geriatrics and relevant disciplines be incorporated into medical college curriculum to increase the number of highly skilled doctors and advanced health care professionals who can provide elderly care. Meanwhile, the government should enhance elderly care training: “A set of reasonable training programs could be developed. Teaching material and textbooks on how to care for the elderly, on elderly health and elderly care could be published.”
Gao Xiangdong also proposed that hospitals set up geriatric medical centers. To better prepare them to handle pathological problems, geriatric doctors and nurses should be specially trained and experienced in providing long-term treatment for elderly patients.