Take proper care of elders and betters

Much of the debate on aging society in China has focused on the material challenges faced by senior citizens-the level and fairness of pensions, the cost of healthcare and the financial support that should be provided by their children. Not much has been said about the challenges of emotional and social care faced by a society that within the space of two generations has changed from one in which the elderly enjoyed an honoured status in extended families to one where the number of "empty nests" is growing by the millions every year.

Needless to say, the annual sessions of the National People's Congress and Chinese People's Political Consultative Conference should thoroughly discuss the increasingly acute social problem and come up with plans to solve it.

Recent media reports of pensioners in Luzhou (Sichuan province), Qingdao (Shandong province) and Wuhan (Hubei province) found dead alone have awakened people to an impending social crisis that China must confront head on.

Seven years ago I was at a EU-China Round Table Conference in Berlin where there was a fierce debate between European and Chinese representatives on whether European people cared for the elderly in the way that the Chinese did, especially whether eldercare institutions in Europe could provide the personal care and love that children have for their parents and grandparents. But because of urbanization, migration and the strict family planning policy, Chinese today face the same issues that have been troubling their European counterparts for half a century or more-and there is rich experience to learn both good and bad.

Provisions of institutional care-"old peoples homes"-proved to be a big mistake in China. Although it seemed a good idea at the time, bringing people of similar age and interests together in old people's homes was like condemning them to an early death. Eighteen months was the average stay of senior citizens in old people's homes.

Deprived of their familiar surroundings, often their old friends and most of all losing a sense of independence to do what they liked, many senior citizens simply lost the will to live, even if the physical environment and care were relatively good. My experience of such an institution was in Chengdu, Sichuan province, in 2007 and made me feel that the old people in pyjamas were bored to death and waiting to die. It was not a place you would want your parents to go to, however kind the nurses were.

In the 1980s and 1990s, the policy shifted to caring for the elderly in communities. This meant supporting elderly people to stay in their own homes, either living on their own or with relatives. This could mean support for daily tasks like washing, cooking or house cleaning or getting some exercise and entertainment in day care centers where they could also socialize or enjoy watching TV.

Working out individual packages of care isn't cheap; they cost a lot to implement and administer but their impact on the quality of life and longevity of senior citizens is dramatic. Residential care will always be required for the most dependent such as those suffering from Alzheimer's disease, but for most elderly, community care is the best.

In some respects, China is well positioned to provide community care. It has a strong tradition of socializing among the elderly. Visit any park and you will find groups of pensioners exercising, playing cards or singing. Over the last few years, many local pension bureaus have set up day centres. And Chinese cities have the potential army of comparatively fit and active 60-plus pensioners willing to work for a little extra or even just for the company they would get, which could extend their own lives.

But on other fronts, China has a lot of work to do. Most local governments have not yet realized eldercare to be a fundamental challenge. And in places that have eldercare plans, the main concern of officials is building eldercare facilities from the perspective of employment and economics rather than to exclusively help senior citizens. Thousands of senior citizens are still confined to hospital beds because there isn't enough support or funding to look after them at home. However, the thousands of apartments that remain vacant, with some relatively low-cost adaptation (bathrooms with pull handles and call buttons, for instance) and some high-quality "people support", could be transformed into viable social housing for the elderly.

Most importantly, the State still has to bear almost the entire burden of eldercare and social welfare because of lack of small NGOs, charities and community service organizations, which have proved so useful in Europe.

The Chinese leadership needs to address these challenges by allocating funds for specific eldercare projects. Social care (including eldercare) is expensive, and targeted funding is essential for developing social care training, stimulating the development of NGOs and community service organizations and earmarking housing units for the elderly. Besides, the health- and social-care challenge needs to be tackled across the institutional divide of health, civil affairs and social insurance bureau.

Death is certain. But what really matters for the elderly is the quality of life they lead before dying.

The author, based in Kuala Lumpur, is an international financial consultant and former fund management expert on the EU-China Social Security Project.

(China Daily 03/11/2014 page10)