The Elderly Care Crisis in Aging China

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Source: NY Times
On the night of May 25, 2015, a fire broke out at the privately owned Kangleyuan Elderly Rehabilitation Center in China’s Henan province. Thirty-eight people were killed and another six were injured.

Authorities have blamed the incident on poor construction practices and non-adherence to safety measures. The State Administration of Work Safety reported that the walls were constructed of flammable materials and the majority of the building materials had low resistance to fire, allowing the building to rapidly ignite when there was an error in the outdated electrical system. This fatal disaster has sparked increased tension among the populace about how to provide adequate care for the country’s booming elderly population.

By the end of 2014, 212 million Chinese citizens were over the age of 60, comprising 15.5 percent of the total population. This cohort is expected to increase in size by 10 million each year. A report published by the Chinese Academy of Social Sciences predicts that by 2030 China will surpass Japan as the country with the largest proportion of its population above 65.[i] By 2050, China’s elderly population will likely comprise a quarter of its population.

The greying of China’s population can be attributed to three factors. Rapid economic growth over the past three decades has lead to higher life expectancy (68 in 1981 to 74 in 2013).[ii] Second, the generation of post-war baby boomers born during the 50s and 60s have joined the older population. Lastly, the family planning policy, more commonly referred to as the one-child policy, introduced in the 1980s has resulted in a low fertility rate, leading to an increase in the proportion of the older population.

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China’s population distribution resembles that of other developed countries. - Source: Wikimedia Commons

Among those surveyed in China’s first major study of the elderly, 38.1% had physical disabilities and 40% presented symptom of depression. The poverty rate was reported to be 22.9%. In comparison, 26% of elderly Americans had a disability with also significantly lower depression rates. The US Census Bureau reported that the poverty rate for Americans is only 8.7%.[iii] Furthermore, elderly Chinese lead less independent lives. The survey indicates that 88.7% rely on daily assistance from family members. 

Filial piety is a virtue of respect for one’s elders and central to Confucian role ethics. However, economic growth in urban areas has spurred the migration of young Chinese to cities in pursuit of higher wages, complicating traditional practices that require children to take care of their parents. In 2013, China implemented the widely mocked Law for the Protection of the Rights and Interests of the Elderly. It requires that adult children provide financial support, mental support, and life care to their elderly parents [iv]; but without any defined enforcement mechanism, most scholars view that law as aimed at advocacy.

Those that live apart from their children face a shortage of elderly care facilities. Most cities have few public nursing homes and expensive private sector options are unaffordable for most of the middle and lower class citizens. Nursing homes in Beijing and Shanghai can charge residents as much as 250,000 yuan (39,000 USD) a year.[v] These prices explain the high demand for existing public facilities – the current wait list for Beijing’s No. 1 Social Welfare Home is 100 years long.[vi] 

In response, the Chinese government has begun expanding its facilities and encouraging private sector solutions. Its policies advance a concept of “nine-seven-three” that aims to have 90% of the elderly living at home, 7% in government care, and 3% in private facilities.[vii] However, limited financial subsidies for construction and little oversight have led to substandard facilities. Researchers report that residents of private nursing homes tend to be sicker than those in government facilities.

Until the past half-century, nursing homes in the US were also largely unregulated. As the public grew increasingly aware of abuse, neglect, and inadequate care, however, it lobbied for legislation to regulate the industry culminating in the passage of the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987. The law established a Resident’s Bill of Rights and requires nursing homes to be in compliance with certain standards in order to receive Medicaid and Medicare payments.[viii]

Chinese citizens still hold a strong bias towards accessing health care in private settings.[ix] Private hospitals are among the worst offenders for peddling unnecessary diagnostic procedures and expensive pharmaceuticals as a means to generate revenue and maintain profitability. The negative reputation of private hospitals adds to the skepticism towards private senior care centers.[x] To reestablish consumer confidence in the expanding private medical sector, the Chinese government must pass legislation that holds them accountable to ethical practices. The existing system of care for the elderly is untenable and will require the government to continue investing in public facilities to accommodate its looming elderly problem.


References

[i] "China's Percentage of Elderly Highest in 2030." - People's Daily Online. September 12, 2010. Accessed September 16, 2015.
[ii] Huang, Yanzhong. "Population Aging in China: A Mixed Blessing." The Diplomat. November 10, 2013. Accessed September 17, 2015.
[iii] Orlik, Tom. "Aging Chinese Face a Bleak Picture." WSJ. May 31, 2013. Accessed September 18, 2015.
[iv] Pi, Xiaoqing. "China Filial Piety Law Draws First Blood." China Real Time Report RSS. July 2, 2013. Accessed September 18, 2015.
[v] Yan, Alice. "Silver Service: China's Elderly Seek out Upmarket Nursing Homes." South China Morning Post. May 15, 2015. Accessed September 18, 2015.
[vi] Moore, Malcolm. "China's Ageing Population: 100-year Waiting List for Beijing Nursing Home." The Telegraph. January 16, 2013. Accessed September 18, 2015.
[vii] Orenstein, David. "Nursing Home Boom in China Has Little Government Involvement." Nursing Home Boom in China Has Little Government Involvement. May 15, 2011. Accessed September 18, 2015.
[viii] Klauber, Martin. "The 1987 Nursing Home Reform Act - AARP." The 1987 Nursing Home Reform Act. February 1, 2001. Accessed September 18, 2015.
[ix] Orenstein, David. "Nursing Home Boom in China Has Little Government Involvement." Nursing Home Boom in China Has Little Government Involvement. May 15, 2011. Accessed September 18, 2015.
[x] Shobert, Benjamin. "Buyer Beware -- Chinese State Run Nursing Homes Available For Sale." Forbes. August 11, 2015. Accessed September 18, 2015.

David Shou is a graduate of Duke University and an NIH Academy Fellow at the National Institute of Health.