Focus of rural eldercare on dignity and quality of life

Editor's note: China has pledged to improve the care system for seniors who are functionally impaired over the next five years. China Daily spoke to Nie Jianliang, executive director of the institute of social security studies at Northwest University, on building a care system for rural seniors with disabilities or cognitive impairments. Below are excerpts of the interview. The views don't necessarily represent those of China Daily.

The care for elderly people with disabilities or cognitive impairment in rural areas is a social issue worth policymakers' attention. The current rural care service systems face multiple challenges, including rudimentary needs assessment, homogeneous services, insufficient integration of resources and a shortage of professional personnel.

The care needs of rural elderly people are gradually evolving from basic survival-oriented demands toward developmental and quality-oriented expectations. However, the existing service provisions remain largely confined to basic daily assistance such as meal delivery and housekeeping, with a lack of differentiated and professional support tailored to varying degrees of disability and different stages of care.

Data show that the disability rate among the rural elderly is significantly higher than that of their urban counterparts, yet care resources are severely insufficient. Problems such as the separation between medical services and eldercare, bottlenecks in referral mechanisms and the heavy burden on family caregivers have become increasingly prominent. Building a care service system that is stratified by need, phased by care stage, precisely responsive and supported by multi-stakeholder collaboration has become essential for the high-quality development of rural eldercare services.

The core of such a care system is precise assessment, dynamic response and the integrated allocation of resources. By establishing localized and multidimensional comprehensive assessment mechanisms, elderly people in rural areas can be scientifically categorized as having mild, moderate or severe levels of disability or cognitive impairment. Correspondingly, dynamic whole-cycle services can be provided to seniors facing different situations, rather than adopting a one-size-fits-all approach.

Relying on coordination among families, communities and institutions, as well as the integration of county, township and village-level service networks, such a system can effectively address the long-standing problems of fragmented resources and obstructed referral mechanisms.

Long-term care insurance should play a dual role as both a strategic purchaser of services and an institutional lever within such a stratified and phased care system. It is therefore necessary to establish differentiated payment standards based on disability levels and care stages, and to design dynamic and modular service packages and explore value-based payment mechanisms.

These measures can help expand and improve the quality of underdeveloped services such as rehabilitation care and hospice care. Long-term care insurance should accelerate its extension to rural residents and work in coordination with basic medical insurance and social assistance programs to form a multi-tiered and sustainable care financing system.

Coordinated policy efforts are also required to achieve a transition from merely sustaining survival to enhancing the quality of life. These include accelerating the establishment of a comprehensive functional ability assessment system for rural seniors, building stratified and phased care service networks at the county, township and village levels, strengthening the training and development of care professionals, and encouraging localized service models such as home-based care beds and mutual-aid elderly care, alongside the application of smart care technologies.

Through systematic institutional innovation, resource integration and service upgrading, elderly people with disabilities or cognitive impairment in rural areas can enjoy a more dignified and higher-quality life. The establishment of a stratified and phased care service system is not only an important step in implementing the national strategy for actively responding to population aging, but also an essential requirement for promoting social equity and advancing common prosperity.