NEW YORK, NY / MarketWatch / News / September 6, 2010
Future starts to age: China's elderly
A bulging need for nursing home services has appeared with the effects of China's one-child policy and changes in multi-generational living arrangements
By Lan Fang in Beijing
A 92-year-old nursing-home resident in Beijing slumps in his wheelchair. Immobile and suffering from severe dementia, he requires daily care from nurses. Next to him, there are dozens more elderly patients, sitting in wheelchairs, awaiting a scheduled activity or meal.
These are the very fortunate. In cities across China, millions of elderly are facing a growing shortage of residential facilities and nursing services for senior citizens.
Current social safety nets cannot accommodate the situation.
"A disabled senior citizen places a burden on the entire family," said Yang Tuan, deputy director of the Social Policies Research Center from Chinese Academy of Social Sciences.
Moreover, with family sizes decreasing over the years, and empty nests -- aging parents separated from children who migrated to cities -- becoming more common, traditional family support is overburdened.
In the views of many social scholars, a substantial increase in investment for elderly-care infrastructure and services is an urgent priority. This year, for the first time, the establishment of a basic elderly-care system was included in China's 12th Five-Year Plan, although experts have already begun to deride the system's feasibility on poor statistics.
The change in family demography is a major reason behind the growing need for elder care. China has adopted the one-child policy for 30 years. Parents of first-generation only-children are in their later years now. One couple caring for four elders and one child is becoming common, meaning the family burden has become very heavy for each young person.
Meanwhile, urbanization, migration and smaller families place additional pressures on the multi-generational upbringing function of the family. There are 49.7% "empty nests" among urban seniors. Growing "empty nest" families and decreasing family size greatly reduce the families' support for the elderly. Unfortunately, some senior citizens suffer from abandonment.
Internationally, elderly-care institutions in developed countries have 50 to 70 beds for every 1,000 people. In China, there are 23.5 beds for every 1,000 people over the age of 65. This makes for bed shortage amounting to roughly 3 million. Professional nurses are in even greater shortage. There are only around 200,000 nurses in the entire country for senior care and only 1/10th of them have nursing licenses.
In traditional Chinese society, the family carries the burden of elderly care, but several factors have eroded this structure. The families now have to rely on social institutions and services, which exacerbates the problem.
Li Baoku, president of the China Aging Development Foundation, said: "The suicide rate among the elderly in rural areas of China is four to five times higher than the world average. Many elderly choose to quietly finish their days in these cabins on a barren hillside, forest or stream, in order to avoid becoming a burden to their children."
Beyond material necessities
With the lack of family care, as well as the weakening of the family support function, the need for external social support has become urgent.
Most senior citizens can't afford the monthly costs of 2,000 to 3,000 yuan ($295-$440) at a nursing home. The national average retirement pension is about 1,200 yuan per month. In rural areas, 90% of the elderly have no retirement pension at all. Due to gaps in the current pension system, nearly 70% of senior citizens rely primarily on their children and grandchildren for economic support.
A scholar at the Chinese Academy of Social Sciences, Sun Bingyao, says that the demand for elderly services has grown with the increase in the average lifespan. However, "the design of our elderly care system is concerned with the basic material life. We didn't take the care services into consideration."
Sun further explained that the impoverished conditions of China's senior citizens imply that the effective demand in China's elderly-care market is insufficient, resulting in slow development in this market. Many lower- and middle-income families face the dilemma of high-quality care being out of their financial grasp, the limited places in nursing homes and possible maltreatment of elderly in nursing homes.
The government should bear the responsibility as the last line of defense, if the market and third parties can't provide services for the elderly, said Yan Qingchun, deputy director of the China National Aging Work Committee.
Many scholars believe that the government's policy on social welfare has been incoherent as the economy continues to develop, making it impossible to provide affordable social services to those in need as a "socialist state." There is a lagging political impetus to stimulate supply from third parties such as non-governmental organizations or private nursing homes.
"China's per capita [gross domestic product] has already passed the $3,000 mark -- it's a middle-income country," said Wang Zhenyao, the head of the Public Welfare Research Institute at Beijing Normal University and a former official at the Ministry of Civil Affairs.
With greater economic development, Wang said, the country has a duty to find a solution for elderly care by increasing investment in social welfare services
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