Graying China in dire need of senior care

BEIJING - Fu Daxin often dreams of being thrown back into prison, where he had "better food and less to worry about."

At 73, however, the peasant from central China's Hunan Province has neither the strength nor the courage to "play robber" the way he did four years back.

In 2008, Fu robbed a young woman at a Beijing railway station and got two years in jail. Struggling to provide for himself, the old bachelor begged the judges for a longer term, but failed.

Now he spends his days sitting on a bed at a shabby nursing home for elderly villagers in his hometown, remembering his "good life" in jail. Life behind bars was enlivened by no more than having buns, rice porridge and pork for meals, medication in times of illness and a few cigarettes a day. But it was still better than Fu's prospects as a free man.

At the end of his term, he was sent to the nursing home, living on a meager government subsidy averaging 10 yuan (1.6 U.S. dollars) a day.

Fu has to skip meals to save for cigarettes from time to time. So when a kitchen pipe broke and no one was around to fix it, he volunteered to help the chef carry water from the neighboring village, and got 2 yuan per bucket.

Fu is not the only person struggling to eke out a living in old age as China prepares to mark Tuesday's Double-Ninth Festival, a traditional occasion for showing respect for the elderly. This year, with an increasingly aged population, much of the attention is set to be on nursing home provisions.

As 14 percent of the Chinese population are aged 60 or above, inadequate care for elderly people has proven a real challenge for many rural and urban families.

China had 190 million people at or above the age of 60 at the end of last year, according to the China National Committee on Aging. It is estimated that the figure will top 200 million next year and by 2050, one third of the Chinese population will be aged over 60.

The 2,000-year-old Double-Ninth Festival was traditionally celebrated on the ninth day of the ninth lunar month for being auspicious for the elderly as the pronunciation of "nine" in Chinese is the same as the word for eternity.

Yet a growing need for better senior care services in recent years has caused clashes on traditional values and lifestyles, and confronted many families with the dilemma of "where to go in old age."

Nursing home dilemma

Many senior citizens, particularly parents of only children, are now ready to spend their retired life at nursing homes, an abrupt shift from traditional beliefs that living under the same roof with elderly parents was an essential part of filial piety.

While the change has been partly prompted by social progress and income rises, it is also a compromise between Chinese traditional lifestyles and the practical problems of the stressed-out "one-child" generation, who are having difficulties coping with work, children and ageing parents.

Yet finding a good nursing home is by no means easy.

When Wang Shufen moved to a privately run home in the suburbs of Beijing four years ago, she was determined to ease her children's burden. After several rounds of price hikes, however, her meager pension is not enough to cover even half of the charges.

Her monthly expenses at the home break down as follows: 2,800 yuan for room rate, 600 yuan for food, 2,500 yuan for nursing services and 200 for 500 ml of milk a day.

Despite the heavy cost, Wang says the food is horrible. "Everything is sloppy and watery so the toothless do not have to chew. It's disgusting for people like me."

So Wang, 84, spends her weekdays waiting for weekends, when her family visit and bring decent food. "I want to leave, to move into a government-funded nursing center or to hire someone to care for me at home," she laments.

Government-funded nursing centers, which provide good services but charge only about a third of the average market price for private institutions, are almost out of the question.

At Beijing's First Social Welfare Institution, one of the city's best nursing homes for senior citizens, more than 9,000 people are on the waiting list. The place, however, has only about 500 beds, which means the applicants may have to wait more than 10 years.

The majority of senior citizens who secure a room at the institution are retired intellectuals or government employees.

Zhang Minru, a former fine art teacher and deputy president of a Beijing-based paintings and calligraphy society, has lived there with his wife for seven years.

"The room is equipped with TV, computer, fridge, washing machine and broadband access. There's also a gym in the public area," he says.

On top of being well good facilities, the institution charges residents an average of less than 2,000 yuan, which is affordable for most retirees.

This cost-effectiveness is its biggest selling point. An old man who declined to be named says he waited for seven years to move in, adding, "I'd have waited much longer, but I found some connections and they did me a favor."

In sharp contrast, Beijing office worker Wang Xin pays more than 7,000 yuan a month for her bedridden mother at a privately run nursing center in eastern Beijing called Cuncaochunhui Home for the Aged.

"Despite the high price, my mother's room is never cleaned in time," she complains.

Wang Xiaolong, chief executive of the center, says they have 40 nurses serving about 100 senior citizens, at least of half of whom are bedridden. "The nurses always have their hands full providing daily health checks, massaging, bathing and cleaning services," Wang explains.

Cuncaochunhui Home for the Aged was inaugurated last year as the first community-based senior care center combining clinical services in the downtown Chaoyang District. But the high expenses, which Wang attributes to high operating costs, have turned away many families.

Figures provided by Beijing's Civil Affairs Bureau show the city's nursing homes have a total of 82,000 beds for senior citizens, but only about half of them are taken.

The openings are mostly available in remote suburbs, which are inconvenient for family members to visit.

Regardless of the openings, the bureau maintains Beijing's senior care still lags far behind demand, estimated to be for between 120,000 and 150,000 beds, or 2.8 for every 100 senior citizens aged at 60 or above.

Policy support demanded

"Senior care centers are ideal places for the elderly, the bedridden in particularly," says Beijing University Professor Mu Guangzong. "But many such institutions are either too expensive or lack the much-needed medical facilities."

While government-funded institutions are too few to meet the growing demand, private investors also lack enthusiasm in such businesses due to a lack of preferential policies and government support, points out Zhang Zhanxin, a researcher of demography and social security with the Chinese Academy of Social Sciences.

His point is echoed by Wang of the Cuncaochunhui Home for the Aged.

"Private businesses have no land, nor do we get government subsidies for land leases," he says. "The high rental fee is our heaviest burden."

Meanwhile, under the current "winner-take-all" rules, public institutions take the lion's share of the market and most privately run senior care centers have very small profit margins and little room for business expansion, he says.

"We also feel a shortage of employees, as we cannot pay our nurses well enough," according to Wang.

The government needs to encourage investment in social services and create a better policy environment for private businesses in this sector, urges Zhang.

"Preferential policies are important in drawing more investment and fostering privately run senior care centers," says the researcher. "That will make up for the lack of social services while making China's senior care services better regulated and more flexible."

Meanwhile, the government has an irreplaceable role to play in providing for the "empty-nesters," particularly for parents who have, for various reasons, been deprived of their only offspring, according to Ma Li, director of the Research Center for Chinese Population and Development.

Improving senior care was taken into the Beijing government's agenda in 2009, when the civil affairs bureau said it would ensure accommodation at senior care centers for 4 percent of the city's senior citizens by 2020.

By then, an additional 6 percent of the elderly population will get government subsidies for senior care services extended by their communities.

Meanwhile, the government has promised adequate social services, including community-based food rationing and medication services, so that 90 percent of senior citizens can be better cared for while living in retirement at home.

"There's still a long way to go," summarizes Prof. Du Peng, a sociologist with China Renmin University. "As a first step, it's important to build more senior care centers and improve government supervision of their prices and services to protect senior citizens' rights."