Aging in place

Focus for looking after the elderly now on home care supported by community services

According to the Seventh National Census, those residents aged 65 and above account for 13.5 percent of the Chinese mainland population, which means China will become an aged society around 2022, when the number of people aged 65 and above exceeds 14 percent, following the country's beginning of becoming an aging society in 2000, when those aged 65 and above exceeded 7 percent. With this development, eldercare services will have new opportunities for improvement.

During the 12th Five-Year Plan period (2011-15), China continued to increase the supply of beds in eldercare institutions, which partially eased the shortage of care resources, but triggered a structural imbalance between bed supply and demand. According to a survey conducted in 2015, the vacancy rate in eldercare institutions nationwide was as high as 48 percent; while placement was hard to come by in some areas, especially in densely populated urban centers where public nursing care beds are in severe shortage. Therefore, during the 14th Five-Year Plan period (2021-25), China will continue to increase bed supply while improving care services both in terms of structure and effectiveness. The plan is to boost the proportion of nursing care beds in eldercare institutions to 55 percent. China will also continue to develop and coordinate home-based care services, community care services, and services provided by institutions.

More than 90 percent of the elderly prefer home care supported by the community, while institutions are often the last choice only when professional care is needed. In the 1960s and 1970s, "aging in place "in a familiar community environment gained popularity in Western countries, since it reduced institutional dependency and enabled greater human dignity, autonomy, and more social support.

With increasing adoption of remote care terminals based on the internet and internet of things, smart care devices have been able to partially replace human care, and eldercare institutions have also been delivering professional care services to communities and families. Long-term care insurance has also begun to provide financial support for informal caregivers of families in some places. All these make home care supported by the community possible.

At present, China faces some problems in its provision of eldercare services, especially in home and community care, which hinders overall care efficiency.

First, the infrastructure is poor for senior care in the community in some areas. Old urban communities, in particular, can only provide limited services and have a shortage of venues for eldercare due to lack of planning in the early days.

Second, families don't have adequate capacity to offer long-term care for the disabled and elderly with dementia. The government has provided basic sustenance and support for these needy people, but long-term eldercare in average families has yet to be covered by basic public services for the aged. With the declining birthrate and further aging, families are shrinking in size and face difficulties: they are short of hands, money and professional care skills.

Third, private-sector service provision is not enough. In recent years, the eldercare service sector has been thriving due to local governments procuring more care services and the pilot programs for long-term care insurance in some cities, but the market is far from fully developed. There are few big brands offering standardized care services in cities due to the lack of incentives for private investors. The picture is even more bleak in rural areas.

Fourth, there is insufficient supply of professional caregivers. The caregivers available in the Chinese market are relatively small in number, and in general are not young, well-educated, or skilled. There is an even greater shortage of eldercare management professionals and social workers.

The shortcomings in senior care represents a major focus for China in relevant policymaking at present and going forward.

First, eldercare venues and amenities, the important infrastructure for home care in the community, must be created or secured in all possible ways. Old urban areas can do this through reorganization of land resources while newly built communities must reserve land for eldercare at the planning stage and implement standards on nursing facilities, in order to lay a good foundation for community-based care. For example, the Regulations of Shanghai Municipality on Eldercare Services, which entered into force in late March, stipulates that "the floor area for elderly care facilities shall be no less than 40 square meters per 1,000 permanent residents across the city".

Second, families should be offered more professional help. As an extension of professional services to communities and families by eldercare institutions, in-home nursing care beds will effectively relieve the pressure of family care. On-demand visits offered by nursing stations in the community, community adult day care centers, and training for caregivers offered by professional senior care institutions, are all effective ways to improve the community care network and build family care capacity.

Third, government subsidies should gradually transform from "subsidy to supply" to "subsidy to demand" or "subsidy to both supply and demand". Government subsidies play a positive role in attracting private investors to take part in and develop a market in the early days when supply is generally insufficient, but service providers may not meet governments' expected goals. To use fiscal funds more effectively and improve the quality of eldercare services, coupons and other forms of subsidies can be given directly to families, so that seniors can vote with their feet, incentivizing service providers to offer better services.

Finally, professional caregivers will grow in number with market incentives and supporting policies in place. Only when in-home eldercare becomes truly affordable and effective in meeting the needs of the elderly can the eldercare industry truly sustain its own development. Therefore, long-term care insurance and other related arrangements that offer continuous and stable payment flow are instrumental for the stable development of the professional care-giving industry. Cross-regional mobility of caregivers will be necessary for the development of eldercare services. Therefore, easy access to basic public services and social insurance is necessary.

The author is a professor of the School of Social Development and Public Policy at Fudan University. The author contributed this article to China Watch, a think tank powered by China Daily.

The views do not necessarily reflect those of China Daily.