“Would you wash the underwear of your elderly mother who has Alzheimer’s?” is the title of a recent Chinese-language article by Japanese writer Moro Miya. It describes a single Japanese man of 53 who struggled to care for his mother, who has Alzheimer’s, for two-and-a-half years before he finally sent her into care. It’s based on a Japanese book written by the carer himself. Chinese readers were moved by the son’s depiction of the physical, psychological and economic pressures he faced. Given China’s elder care system lags far behind Japan’s, many of the comments on Chinese social media expressed deep concerns about how the users themselves would fare in old age.
In recent years, thinking about life in old age has gone from a topic of discussion only among the elderly, to one shared by the whole community, as China transforms into an aging society it is ill-prepared to provide for. The official solution has been to combine medical and care services for seniors, who often need both at once.
Academic, industrial and government institutions have combined to research and develop the policy. A center for the study of integrating medical and care services for seniors was established at Peking University’s Health Science Center in April 2017. A year earlier, the National Association of Health Industry and Enterprise Management, under the National Health and Family Planning Commission, established a branch specializing in elder care.
As chief of both organizations, Li Ying has plenty of academic and empirical research on the subject under her belt. In an exclusive interview with NewsChina, she shared her observations and insights on the purpose and progress of the policy.
NewsChina: Why has China officially adopted a policy of combining medical and nursing services for seniors? What problems are the policy supposed to solve?
Li Ying: Combining medical and care services for seniors has been adopted as a national policy in the context of China having better living standards and longer life expectancy than ever before. It is necessary to provide professional medical and care services for the significantly aging population. Indeed, there is a long tradition of offering such services for the aged in China. Since the Tang Dynasty (618–907CE), there have been records of various institutions taking care of groups in need, including the old, sick and disabled. The idea of combining medical and nursing services is not a new concept in China.
Between the founding of the People’s Republic of China in 1949 up to the beginning of the reform period of the late 1970s, nursing homes and healthcare organizations operated independently of each other with different roles under the same planning system. Hospitals became part of the market economy after health system reforms in 1985, while nursing homes remained part of the social safety net under the government department for civil affairs. Over the years, the healthcare system has become increasingly market-oriented, and publicly funded nursing homes have continued in the same way as in the time of the planned economy.
Private companies have already entered the elder care market to cater to growing demand due to China’s changing demographics. However, this has not solved the problem of the deconsolidation of medical and care services for the most elderly [those over 80 years old in China]. Combining medical and care services is the proposed solution.
Conventional nursing homes are not equipped with professional medical expertise, while healthcare organizations cannot provide ongoing care for seniors. As China faces a rapidly aging society, the question is how these two different tracks, with different roles and values, can be integrated into the same area of elder care.
Life expectancy in China has reached 76.5. An elderly person will often be living with multiple chronic diseases and needs professional care. The policy of combining nursing and medical services is designed to give such people dignity and quality of life.
It is misleading to focus only on adjusting responsibilities across government agencies or a new growth point for the economy. We should focus on the human life cycle, and find solutions for the last leg of life.
In his report at the 19th CPC National Congress in October, General Secretary Xi Jinping called for a policy system and social environment which supports and respects seniors and promotes combining medical and care services. It’s about carrying on and upholding China’s traditional philosophy of care and respect for the elderly. It also means opportunities to develop a supply chain for the aging society in the future.
NC: How has implementing the policy of incorporating medical services into elder’s care gone in the past few years? What are the problems yet to be addressed? What should government agencies do differently?
LY: The policy is based on an excellent idea. However, understanding of this idea varies among people. I always stress that the issue of elder care involves an awareness of demographic changes and social development, as well as the physical and psychological status of seniors influenced by their life experience, cultural customs and income level. Government agencies have already adopted many implementation policies. The question is whether these policies are built on sound empirical research, how to tackle any problems that emerge in their practical implementation and who is responsible, as well as the cooperation between different government agencies.
I would reject the idea that the policy should be regarded merely as an indicator of government performance or an economic growth point. We have to keep in mind that the policy is designed to prepare China for an aging society. Its fundamental purpose is to build a system that will serve elderly people for the rest of their lives. It is all about quality of life.
Different government agencies have to work together to implement the policy. In reality, departments of civil affairs and healthcare and other relevant institutions have diverged based on their own considerations and interests.
In our field of research, we regularly saw local offices of ministries of civil affairs and healthcare implement policies issued by their own ministries [that in fact conflict with each other]. If this problem cannot be resolved, policy implementation and the quality of services will be compromised.
I have visited some projects that integrate care and medical services for elderly people. They have different standards of development. The national policy needs to specify what kind of services should be included, and what standards they should be held to.
NC: There has long been a skills shortage in the elder care sector. Will this need to be solved before the plan can progress?
LY: It is necessary to think about what seniors need in the first place. Of the people over 60 years old, some live with chronic diseases that do not affect their standard of living very much. They have limited demands for medical and nursing services.
However, those who suffer from dementia or disability to some extent can barely survive without them. Further triaging of demands can take place for the two groups to analyze what expertise and skills are needed.
There are lessons in Japan’s systematized training of talent. I visited Shuto Iko, a vocational medical school in Tokyo. It focuses on training talent to serve society as soon as they graduate. Courses include clinical medicine, nursing, rehabilitation and sports therapy. We should set up our own special vocational schools, add courses in elder medicine, rehabilitation and care to existing vocational schools, or restructure our existing medical education resources to develop a training system to meet the skills shortage.
Again this training system will not exist without coordination between different government agencies. And the treatment of employees in the elder care sector has to be considered by policymakers.
NC: Do other countries have similar systems to that which China is trying to build? What can China learn from them?
LY: In recent years, I have researched elder care services in Japan, as well as in the US and Europe. Those places have developed cultural, economic and systematic conditions that provide medical services to elderly people in nursing homes. They do not face the challenge of how to integrate medical services into care for the aged. For example, Chiba Prefecture in Japan has a hospital that extends its services to nursing homes, rehabilitation houses and communities around it. The proposed Chinese model is very similar to that.
Japan became an ‘aging society’ three decades before China. So there is a lot to learn from Japan’s experience in building an elder care system, including about funding, long-term care, insurance and nursing. I think the best option for China is to build a well-structured system based on Japan’s experience and China’s conditions. Without planning, merely pouring resources into the sector will result in waste.
Take the nursing home beds for example. It is wrong to have as many beds as possible in a nursing home. The decision on how many beds to have should be based on data analysis. When my colleagues and I visited Tokyo, an official with an elder care institution there said an institution operating more than 100 beds faces heavy cost pressures which could affect the quality of care. Safety deserves special attention.
How will elderly people evacuate in the case of a fire? The design of such institutions has to consider this. That’s why elder care institutions with more than 1,000 beds are rare in Japan. In China, their construction will need to take into account local conditions, including the stage of aging and economic development.
There is a lot for us to learn from other countries to cater to the diversity of demands from Chinese seniors. We can integrate their experiences into Chinese culture to come up with our own solutions for combined medical and w services in China.
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