Chen Weihao

28/10/2023

Promote residential care services in China:Difficulties and response policies

Introduction

China has the largest elderly population in the world today. Chinese people have a

tradition of filial piety, but huge changes in population and social economy have made

it increasingly difficult for the elderly to receive care and support from their adult

children. The demand for residential care is constantly rising in China, and it is

foreseeable that this demand will continue to expand. Therefore, we should be

prepared for the possibility that a large number of elderly people will choose

residential care services in the future. We need to understand the needs of China's

elderly, what are the difficulties in promoting residential care services on a large scale,

and what the government should do. This article sorts out the needs of Chinese elderly

for residential care and predicts some problems that residential care may encounter in

its future development. And by comparing the situation in Australia, some policy

suggestions were put forward for the Chinese government. By analyzing the data, it

can be concluded that China is not fully prepared for the huge demand for residential

care services that may arise in an aging society. Therefore, the government needs to

increase investment in this area, not only in terms of funds but also in terms of special

policies. This includes investing in the research and development of elderly care

technology and encouraging more people to engage in the nursing industry.

Literature review
 It can be seen from the past literature that there have been many studies on

Chinese elderly. These include China's population structure, population aging,

retirement system, how to provide for the elderly and other aspects. Among them, the

most closely related to people's lives is the research on how to provide for the elderly.

A research survey on the attitudes and preferences of China's future elders towards

future retirement care shows that a considerable number of people are considering

relocating to a residential care facility when they grow old. "Access to residential care

in Beijing, China" reveals how elders and their families made the decision to move to

a residential care facility. Under this circumstance, it is natural to conclude that China

should promote the construction of residential care service infrastructure. However,

past literature only proves that China's elderly need more residential care institutions.

In fact, there is a lack of research on possible problems and specific solutions in

building and promoting residential care services. This article sorts out the needs of

Chinese elderly for residential care and predicts some problems that residential care

may encounter in its future development. And by comparing the situation in Australia,

some policy suggestions were put forward for the Chinese government.

Data

No original data were collected for this article. This article will use secondary

sources of data to explain the needs of Chinese elderly for residential care services,

the current situation of residential care in China and Australia, government capital

investment, etc. Specific data sources will be listed on the reference page.

Analysis
First of all, all problems are based on the two premises that China has a large
number of elderly people (a high proportion of the total population) and a huge

demand for residential care. If either of these two premises does not exist, the

remainder of this article will be meaningless. Therefore, it is necessary to clarify these

two premises in the first part. Judging from data released by the Chinese government,

as of the end of 2021, China's elderly population aged 60 and above accounted for

18.9% of the total population, and those aged 65 and above accounted for 14.2% of

the total population (National Health Commission, 2022). Given that China's

population is as high as 1.4 billion, which means there are approximately 270 million

elderly people. At the same time, it can be expected that the number and proportion of

China's elderly population will further increase in the next few decades. Therefore,

China has and will have more and more elderly people. China has a long history of

filial piety culture and tradition. Children have a moral and even legal obligation to

care for their elderly parents. China's constitution clearly stipulates that adult children

have the obligation to support their parents. Therefore, for a long time, the elderly in

China mainly lived with their children and received care in their families and

communities. Traditional filial piety values influence the willingness of family

members and the elderly themselves to choose residential care. Sending the elderly to

residential care facilities is considered unfilial. The stigma of residential care pervades

the public perception. However, as social and economic structures have changed

dramatically over the past few decades, the elderly care situation has also changed.

Adult children are the main providers of family care, and housewives in particular

bear the vast majority of responsibilities. The increasing number of women working
full-time, the increase in adult children migrating or working away from home, and

the shrinking of family sizes (primarily due to the one-child policy) have reduced the

resources available for traditional long-term home care in China. Because there are

fewer providers. Due to the increase in life expectancy and the postponement of the

average childbearing age, more and more middle-aged people are expected to have

one or more surviving parents or parents-in-law while still needing to raise minor

children. In many cases, families prioritize care of minor children.“an increase in the

number of younger grandchildren has a negative impact on the care provided to older

parents/parents-in-law." （ Falkingham 2019 ） Based on above, China's social status

and trends are causing more and more families to choose residential care services.

Another factor that cannot be ignored is that the life course experiences of China's

next generation of elderly people (currently those aged 40-55) are very different from

those of their predecessors. They may not want to rely on family support in their later

years and therefore proactively choose to receive long-term residential care. “around

a quarter of Chinese mid-life women living in urban areas and with just one adult

child are actively considering the option of institutional care for their own old age”

(Qin, p285, 2020) There are many reasons for this phenomenon, such as the gradual

improvement of the environment and services in nursing homes, media publicity that

makes people's concepts gradually change, the increase in income levels, etc. In

summary, China has a large, next-generation elderly population who wish to receive

long-term residential care. The Chinese government should and must promote the

construction of residential care service infrastructure.

 At present, the phenomenon of population aging has appeared in many countries

in the world. Developed countries entered the aging society one after another before

1960, and from the 1970s to the late 1990s, they entered the deep aging society one

after another, including Australia. If you want to know what problems China may

encounter in the future, comparing and learning from the social conditions and

government policies of these developed countries will be of great help to China's

future development. The first is China’s insufficient financial investment in

residential care. In Australia, “In 2019–2020, AU$21.5 billion was spent on aged

care services: ~63 per cent on residential aged care; ~31 per cent on home care and

support services; and ~5 per cent on community care services." (Lovarini, 2023) It

can be seen that the vast majority of funds are provided for residential care. China's

investment obviously cannot reach such a proportion, and more funds are used in

home care. Insufficient funding will have some negative impacts, such as serious

aging of facilities and low wages for nursing staff, which will further promote the

shortage of nursing staff and reduce service quality. The second serious problem is

that the growth in the number of beds cannot keep up with the growth rate of China's

elderly population. Although the Chinese government has recently been encouraging

local governments and private companies to enter the residential elderly care industry,

the per capita bed level is still not as good as Australia's. After the 13th Five-Year

Plan, China has achieved a supply of 35 to 40 beds per 1,000 elderlies in social care

institutions. However, Australia has more than 70 residential care beds for every 1,000

people aged 70 and above.(Meagher, 2022) The aging of China's population is still
accelerating, and China's residential care resources must be increased as soon as

possible. In addition, China has yet to establish specialized government departments

and organizations to supervise residential care institutions. At present, the main

entities that supervise elderly care institutions are the civil affairs department for

industry supervision and industry social organizations for industry autonomy. Others

include some social media and the public for supervision of them. However, in

Australia “evidence of poor-quality care in some services prompted the

establishment of the Royal Commission into Aged Care Quality and Safety in late

2018.” (Meagher, 2022) For any industry, the lack of effective regulation will be

disastrous. Especially once China's residential care services grow rapidly, it is

temporarily doubtful whether the government will have sufficient ability to regulate.

For the Chinese government, aging is definitely the most serious challenge the

country will face in the next fifty years. Therefore, the government should further

increase the construction and investment in elderly care service facilities and improve

the supply capacity and coverage of elderly care services. One of the key points is that

more state-owned residential care facilities should be established. The current policy

of the Chinese government is exactly the opposite. In the 13th Five-Year Plan, the

government proposed to reduce the share of state-run beds in eldercare facilities

below 50%. However, according to Australian research, “For-profit nursing homes

tend to have better financial performance, but worse results with regard to employee

well-being and client well-being, compared to not-for-profit sector homes” (Meagher,

2022) Generally speaking, this phenomenon occurs in developed countries with more
complete laws and more complete regulatory systems. As a developing country, China

is more likely to see private residential care facilities ignore the interests of the elderly

in pursuit of profits. Therefore, it is necessary for the Chinese government to rethink

its original plan. Assess the need for additional state-owned residential care facilities.

On the other hand, it is necessary to immediately establish effective regulatory

systems and institutions, just like those in Australia, which will become the basis for

promoting residential care services. After all, if the quality of services cannot be

guaranteed, how can the public trust it? Secondly, from a practical perspective, it is

impossible to obtain a large number of residential care service resources in a short

period of time. Since supply cannot be increased, one can start by reducing demand. If

resources for home care could be increased and costs reduced, the overall need for

residential care might be slightly lower. The Australian government has set an

example on this point, “Commonwealth Home Support Program (CHSP): 75 per

cent government subsidy for those aged 65 years and over requiring entry-level

support services, including meals delivered, cleaning services, home

maintenance/modifications, basic aids/equipment (for example, shower chair, bed

hoist, walking aids) and community transport" (Lovarini, 2023) The Chinese

government can follow Australia and make some investments in home care. Let some

elderly people who can still take care of themselves live a better quality of life at

home and in the community, and delay their entry into residential care institutions.

incident. Because a major problem with increasing residential care facilities is the

shortage of nursing staff. Training and increasing nursing staff takes a long time, and
subsidizing some families can have an immediate effect. Therefore, if residential

nursing services begin to be in short supply in China , the government should activate

some backup plans to reduce public demand for them.

Conclusion

Due to the intensification of aging and the huge society and economy changes in

China, more and more elderly people want to choose residential care services.

Therefore, it is urgent for the Chinese government to promote residential care services

and increase elderly care resources. However, at present, China has insufficient

investment in this area and the number of beds per 1000 people is low. At the same

time, special regulatory departments and institutions have not yet been established. In

order to deal with these problems, China first needs to increase investment in this area

and improve the legal and regulatory system. Finally, if demand is much greater than

the supply of residential care, approaches such as subsidizing home care can be used

to balance supply and demand.

Reference

1.2021 National Bulletin on the Development of Aging Care National Health

Commission, 2022

http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?

id=e09f046ab8f14967b19c3cb5c1d934b5

2.Access to residential care in Beijing,China: making the decision to relocate

to a residential care facility YANG CHENG, MARK W. ROSENBERG, WUYI

WANG,LINSHENG YANG and HAIRONG LI Ageing & Society32 2012, p1277-

1299

3.Attitudes and preferences towards future oldage support amongst tomorrow’s

elders in China Min Qin, Jane Falkingham, Maria Evandrou and Athina Vlachantoni

Demographic Research , JULY - DECEMBER 2020, Vol. 43 (JULY - DECEMBER

2020), pp. 285-314

https://www.jstor.org/stable/26967808?seq=1&cid=pdf-

reference#references_tab_contents

4.Making a profitable social service market: The evolution of the private

nursing home sector Gabrielle Meagher and Richard Baldwin 2022

https://www.jstor.org/stable/j.ctv2xc67nm.15

5: Technology to support ageing in place in Australia Meryl Lovarini, Kate

O’Loughlin and Lindy Clemson 2023

https://www.jstor.org/stable/jj.3102549.9