BEIJING — On a muggy July afternoon, 91-year-old Zhao Zhuxian sat quietly in an outdoor courtyard at the Laowulao Elder Care Facility, the largest senior citizens home in Beijing’s Fengtai district.
“I don’t want to live here at all,” she told Caixin Global while resting in a rock garden. “I was kicked out by my kids.”
Madam Zhao was forced to leave her family’s three-bedroom apartment to make room for a newly-married grandchild and spouse. “I don’t have any other choices,” she said. “Living at home is way better than living here.”
Mdm Zhao’s predicament points to one of the many reasons why demand for elder-care is rapidly increasing in China, and why efforts to meet that demand are incredibly challenging for care providers, policymakers, and seniors alike.
As the nation’s population of 1.4 billion ages and urbanises, the number of people living in elder-care facilities is steadily climbing. Demand is also rising for senior citizen medical care services.
As demand for elder-care grows, new opportunities are emerging for businesses offering services and products in this area. According to the China Research Centre on Ageing, the value of the nation’s market for elderly consumers is projected to jump to 106 trillion yuan (S$21.66 trillion) in 2050, up more than 100 times from 4 trillion yuan in 2014.
Playing a key role in the market are senior citizen homes, which in 2016 numbered nearly 140,000 nationwide, up nearly 21 per cent from the year before, according to the Ministry of Civil Affairs.
But will the flurry of new construction keep pace with the booming demand for elder-care facilities?
More than 230 million Chinese are now aged 60 or over, and that number is expected to swell to about 400 million by 2050, according to the World Bank.
Low fertility rates since the 1960s and improving life expectancies are main factors contributing to the increase in the seniors segment of the nation’s population.
The World Bank said that China’s fertility rate in 2015 had plummeted to 1.6 births from six births per woman in 1965 as a result of the one-child policy. And according to the World Health Organization, the average life span in China is rising: Life expectancy for Chinese was 76.1 years in 2015, while the world average was 71.4.
Complicating efforts to house seniors is the fact that many elderly in China suffer from poor health. The National Committee on Ageing said China was home to more than 40.6 million disabled or partly disabled senior citizens last year, accounting for 18.3 per cent of the elderly population. Eye disease, malignant tumours and cardiovascular disease are common.
Demand for housing and healthcare are thus key areas of concern for China.
The supply of skilled manpower poses another challenge, as nationwide demand for workers trained to care for seniors currently far exceeds supply.
Mr Chai Yuyang, an elder-care industry analyst at Beijing Normal University, said that about 10 million workers will be needed to supplement the current labour supply, which numbers only a few hundred thousand.lifting elder care worker certification requirements. The Ministry of Human Resources and Social Security cancelled certification rules for these workers in 2015.
EMPTY BEDS
The most sought-after homes are the public nursing ones because they are relatively cheap. But special eligibility criteria means only a small percentage of seniors are allowed to live in such facilities. For example, some facilities take only seniors with no income or who have no close relatives.
Also in demand are homes in accessible urban areas serving clients who are relatively well-resourced. Most senior-care homes, however, are located in relatively hard-to-reach areas, such as distant suburbs.
Therefore, bed vacancy rates are higher in facilities in suburban and rural parts of China than in urban districts. For instance, suburban Beijing’s Laowulao reported a 55 per cent bed vacancy rate last year.
A senior housing industry analysis by the consultancy Deloitte found that most elder-care facilities are designed to serve middle- to high-income brackets. In contrast, most of China’s elderly citizens are poorer and live in rural areas.
But there is nonetheless a lot of unmet demand for building senior-care homes. A 2010 nationwide census said that only about 44 per cent of people aged 65 and over were living in cities or towns, with the rest in rural areas.
The government is thus encouraging an expansion of the labour pool for elder-care services by, for example,
Therefore, it is possible that some senior care homes are always full, while others struggle with high vacancy rates.
One reason is that the elderly are selective about where they want to live, said a report by Singapore bank DBS. They also have the financial resources to afford a more pleasant environment.
It said this is despite the fact that China is building more living space for senior citizens. The government counted 7.3 million beds at elder care facilities nationwide last year, up 8.6 per cent from the year before.
Another factor curtailing the use of such homes is cost, although elder care in China is less expensive than elsewhere. A bed at a private elder-care facility in Beijing can cost thousands of yuan per month, according to Dr Chen He, who works for School of Public Health, Peking University. He said this is more costly than government-run facilities.
Finally, there continues to be cultural barriers to the use of senior-care homes. Fear prevents some elderly Chinese from choosing to live in a nursing home because they do not want neighbours to think they have been abandoned by their grown-up children.
MEDICAL SERVICES
At the moment, most elder-care facilities provide only basic living and care services, such as assistance with bathing and eating. Medical services are rarely part of the package, not to mention educational programmes, recreation and entertainment.
High-end facilities that include medical services along with educational and entertainment opportunities are usually full, as clients are always looking for engaging activities and medical services in senior homes. For instance, every bed is taken at an upscale home called Gongheyuan, in Beijing, for example, which charges between 9,800 yuan and 30,000 yuan per month. The home’s waiting list recently had more than 50 names.
INTEGRATING DIFFERENT NEEDS
Demand for senior medical care has also outstripped supply. A National Committee on Ageing report in 2014, found that only 10 per cent of all elder care facilities provided healthcare and rehabilitation services.
To address the problem, government agencies, including the National Health and Family Planning Commission and the Ministry of Civil Affairs, have encouraged elder-care facility operators to cooperate with hospitals or provide in-house medical services.
The ministry is also working with hospitals to build a comprehensive health-care system for seniors by 2020. The ideal elder-care model under the ministry’s plan would take into account that 90 per cent of seniors can care for themselves or get family help in their own homes, while about 6 per cent can benefit from in-home doctor visits and community hospitals, and no more than 4 per cent need professional medical care in elder care facilities.
Last year, authorities launched a project through which 50 areas nationwide were chosen to host pilot facilities that provide elder-care and senior medical services. The pilot was later expanded to 90 areas.
The government has also encouraged the transformation of public hospitals to care for senior health-care needs.
One city that’s successfully integrated elder and medical care is Nanjing, on the central east coast. Mr Zhou Chunhua, director of the city’s civil affairs bureau, told a local newspaper that the integration push has included “most nursing homes” in the area. And in the north-eastern city of Shenyang, according to the Liaoning Daily newspaper, 61 per cent of the city’s nursing homes now offer medical services.
The Laowulao facility in Beijing has expanded into the health-care arena by buying a private hospital last year. One beneficiary is Mdm Xiong Qianchu, 77, who lived at the facility with her husband. Both are retired engineers.
“My husband has been sick for five years. He has cerebral infarction, so it’s extremely hard for me to take care of him by myself,” said Mdm Xiong. “My children are too busy to take care of us. One day, I read an advertisement about the elder-care facility in a newspaper.” The price for two was 6,800 yuan a month and the couple receives 10,000 yuan monthly in pension payouts.
“We decided to live here,” said Mdm Xiong. “Living here is really convenient, and we can afford it.”
Dr Chen He at the School of Public Health, Peking University, said senior medical care can be delivered through community-based and facility-based services. The former option is challenging, though, given doctors’ tight schedules and lack of financial incentives to offer senior care.
A better option, in Dr Chen’s view, is for hospitals to operate elder-care facilities.
“Considering costs, it’s easier for a hospital to run an elder-care facility than for a facility to build or buy a hospital,” she said.
Promoting a different perspective is Mr Lu Zhongying, deputy chief at the Beijing No 4 Social Welfare Institute. He favours elder-care facilities with doctors who specialise in caring for the aged rather than getting hospitals to run senior homes.
“Doctors in hospitals or community medical centres are not elder-care doctors,” he said. “Their skills may be good, but they aren’t familiar with old people.
“At a state-backed facility such as ours,” added Mr Lu, “experienced doctors spend decades treating senior patients. We can even tell a senior patient’s health condition by looking at his face.”
Beijing No 4 was one of the first public nursing homes in China to provide residents with medical care in-house and a hospital through an agreement with the hospital’s operator. A bed at the home costs only 1,500 yuan a month.
INVESTOR INTEREST
Mr Lu is also one of many elder-care experts who thinks more private companies should get involved in elder-care by operating facilities that target seniors who do not have serious health conditions.
Real estate developers and insurers have heard the call. More than 30 Chinese property developers are now in the market for elder-care facilities, and more than 80 others have expressed a willingness to invest in the industry, according to a Deloitte report.
For instance, developer Poly Real Estate has launched projects in Beijing and Shanghai. The Beijing facility in Hexi Hui has 200 rooms and 400 beds, and is equipped with a clinic, ambulance station, and physical rehabilitation centre.
The insurance company Taikang Life built the Taikang Elder Care Community in Beijing with a park, school, rehabilitation hospital and other facilities.
Local governments have been earmarking some of the land they routinely sell to developers for senior housing since 2014. Beijing, Shanghai, Shenzhen, Zhejiang province and Fujian province have sponsored sales of “senior housing land”.
But Mr Chai, the Beijing Normal University analyst, suggests the government should do more by drafting strategic land plans and encouraging construction of elder care facilities.
Integrating the medical and elder care systems in China is obviously a work in progress.
One appreciative resident of the current elder care system is 89-year-old Chen Yujuan. She has received long-term medical services while living at a Beijing elder-care facility and rehabilitation centre that has been converted from a hospital.
Longfu Hospital was renovated and reopened in 2000 as a geriatric hospital. It is now a full-service, geriatric care and rehabilitation facility. More recently, it opened satellite centres in the city’s Tiantongyuan and Beiyuan areas, and signed cooperation agreements with 12 nursing homes in the Dongcheng district.
Mdm Chen recently suffered a stroke and fell. A hospital refused to treat her, saying there were no available beds. Another hospital accepted Mdm Chen and gave her a month of treatment before asking her to leave. But paralysis made even minor tasks such as brushing teeth impossible.
Fortunately, a bed at Longfu was available, and Mdm Chen found a new home. She said she now feels “lucky and grateful” – a feeling that proponents of elder care development in China are working hard to spread nationwide. CAIXIN ONLINE