Source of materials: 【I saw the current situation and future of elderly care in China from a nursing home in a county】
Notes#
Elderly care models are mainly divided into home care, community care, and institutional care. Nursing homes belong to institutional care, which currently accounts for a very small proportion. Nursing homes are divided into public and private. Public facilities have more investment and lower fees, making it "hard to find a bed."
The elderly admitted to nursing homes fall into two categories: fully self-sufficient and those needing passive care. Different nursing homes have varying admission criteria. Some accept "active seniors" who can take care of themselves, while others accept those who require care. The sources of admission for nursing homes are primarily elderly individuals and middle-aged people suffering from "elderly diseases." The industry principle is not to admit those with infectious diseases or mental illnesses. The normal admission targets show a clear polarization trend, which may hint at modern people's life expectancy and future elderly life, observable through the current situation of the middle-aged and elderly population.
Currently, elderly individuals in China who can take care of themselves prefer home care, partly due to economic reasons, such as having a small retirement pension or the financial difficulties of their children in paying for care. There are indeed cases where children stop paying for care. On the other hand, there is a lack of trust in nursing homes, such as fears of abuse. Some elderly people resist moving into nursing homes after a lifetime of hard work, feeling "abandoned" by family and society. Some would rather go to the hospital than stay in a nursing home that combines medical care and elderly care, fearing they might not return home.
Currently, the demand for elderly care and the supply of services are imbalanced. It is said that nursing homes are a sunrise industry, but the industry is not mature, with many nursing homes having low occupancy rates, unbalanced income and expenditure, and a lack of transparency; society generally does not recognize it, and practitioners' professional identity is often seen as "having no future," making it hard to find people willing to work long-term in this field. There is a need to improve the public image of nursing homes and enhance public confidence in institutional care.
To evaluate the service effectiveness of a nursing home, one must look beyond hardware facilities to the quality of human service. The quality of human service reflects on the service recipients, particularly the mental state of the elderly. If they appear dull and close to despair, lacking hope and longing for life, that is not good. Smiling service and joyful service are the requirements for good nursing home services. A nursing home is essentially a small society where elderly people should have collective activities, participate together, and engage their interests and hobbies to bring joy.
The future elderly care service model needs to be diversified, which is a historical trend. Community care needs to enter the homes of the elderly, especially for empty-nest seniors!
For many, as they age, their children provide a sense of security, as they can help them in times of need. Many parents hope their children will have a home, "so that someone is there to accompany them during holidays." Conversely, some elderly people who lack family companionship may have suicidal thoughts during family reunion holidays. The need for "accompanying care" also arises from the spatial and temporal separation between parents and children.
In nursing homes, there are elderly individuals who suffer from serious illnesses or pass away, and there is palliative care (including end-of-life care; helping patients pass away comfortably, peacefully, and with dignity, ultimately achieving tranquility for the deceased, peace for the living, and calm for the observers). When an elderly person passes away, it is the relatives and survivors who suffer. End-of-life care focuses more on the psychological support for family members, including avoiding moral accusations of "unfilial behavior" and guiding their grief.
Traditional filial piety concepts can impose varying degrees of constraints on children, such as giving up opportunities to work in big cities or even abroad. Should children live their ideal lives or stay close to care for their parents? This depends on parents' expectations of their children. Historically, loyalty and filial piety have been difficult to balance. In modern society, we should not measure and bind children with past concepts.
Perhaps, in matters of love, marriage, and elderly care, our worries about things that have not yet happened are unnecessary. Some children do not want to settle for a relationship or marriage. Some children completely refuse to marry or even date. In the future, perspectives may suddenly change, or society may adapt to the public's thoughts.
During collective activities for the elderly, someone sings:
"To speak from the heart, I also have a home..."
"The songs cannot express the suffering of the world..."
"The sunset over the western mountains glows red..."
"Follow Chairman Mao, hi! Follow the Communist Party, hi..."
Extended Discussion#
China's elderly care issue is closely related to love and marriage issues.
The traditional concept of elderly care in China is "raising children to prevent aging." Due to the large population and the accumulation of social wealth, this can mitigate the problem of losing the ability to work and having no stable income in old age. Currently, the retirement pensions and social security of private enterprise employees are unlikely to support an elderly person living independently and having a surplus to deal with emergencies.
The traditional view of filial piety can be seen in "Mencius, Book of Li Lou": "There are three forms of unfilial behavior, and having no descendants is the greatest. Shun did not announce his marriage because he had no descendants, and a gentleman considers it as still announcing."
"Three forms of filial piety" refer to "The Book of Rites, Sacrificial Rites": "Filial piety has three forms: the greatest is to respect parents, the next is to avoid disgrace, and the least is to provide for them."
In marriage, there is an emphasis on "matching families," "talented men and beautiful women," and "establishing a family and career."
Of course, many contemporary young people have already freed themselves from the constraints of traditional concepts and actively choose not to date, not to marry, or not to have children, or they may choose all three. The social trends among these young groups are actually the result of various social factors, including unequal distribution of social wealth and high costs of married life. Each person's social situation varies, leading to diverse views and practices regarding these issues.
In the future, reliance on "raising children to prevent aging" will no longer be feasible, and China is not an immigrant country like the United States. Young people who are only children face immense pressure. National policies and the distribution of social resources will inevitably need to lean towards socialized and market-based solutions. Relying solely on state power or family strength cannot solve the elderly care problem. The issue of elderly care is a challenge that society as a whole must face, and different social groups—mainly the lower three income quintiles—must work together to weave a social mutual aid network for elderly care, using collective strength to address collective issues. The elderly care problems of the wealthy are not within the public's view and do not need to be discussed; they have their own means due to their advantages in political and economic relations.