Elderly care in spotlight as population aging grows #Oriental Outlook#-Sino-US

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Elderly care in spotlight as population aging grows #Oriental Outlook#
China turned into an aging society in 1999, when more than 10 percent of its population reached over 60 years of age. In the past two decades, the country saw a rapid growth in the aging population and has the largest senior population in the world now.
Official data shows that by the end of 2017, people aged over 60 has amounted to 240 million, 17.3 percent of China’s total population, and people aged over 65 reached 158 million, 11.4 percent of the total.
A large population of senior citizens would show China’s improvements in people’s living standards, but it would also bring problems and challenges for the largest developing country which has not grown rich before getting old.
The aging population would surely influence the country’s economic and social structure and functions. Concerns might include who would support them and where and how they would spend the twilight years.
The Chinese government has paid attention to the aging population, and taken efforts to ease the potential problems, and focus more on providing services to the senior citizens.
In the 11th issue of 2018, the Oriental Outlook magazine under the Xinhua News Agency ran a cover story on a comprehensive service system for the elderly that is pushed ahead by the government by letting private sector play a more important role.
Below is an excerpt of the article.
China will have about 255 million people aged over 60 by 2020, and senior citizens living alone and empty nesters will reach 118 million, according to an estimate from a State Council plan.
Following the social and economic development, Chinese parents have fewer children and families have become smaller, and thus a family’s ability to provide elderly care is weakening.
With the growth of aged people and the deepening of the population aging, elderly care has become a hot social topic. “Who will support the elderly”, “who will take care of them” and “where will they live” have become core concerns.
The country’s top leadership has laid out requirements for accelerating the building of elderly care service system and developing the elderly care service industry.
In February 2016, President Xi Jinping highlighted the importance of coping with the aging population as crucial for development and people’s well-being. He called for a top-down design based on the current situation and improved policies. 
In the report to the 19th CPC National Congress in November, Xi called for providing integrated elderly care and medical services, and accelerating the development of elderly care programs and industries.
On March 5, Premier Li Keqiang said in the government work report to the National People’s Congress this year that people still have some complaints about the elderly care.
Li said the government will take proactive measures to tackle population aging, developing at-home, community-based and mutual-aid elderly care, promoting integrated medical and elderly care services.
In the past years, the government has launched a series of policies to support the development of the elderly care industry, said Zhu Yaoyin, deputy director of the general office of the National Working Commission on Aging.
According to the Ministry of Civil Affairs, China had 144,600 elderly care institutions by September 2017, a 226-percent increase from 2012, and more than 7.3 million beds for senior citizens, by the end of 2016. 
The central government has invested 3 billion yuan from 2013 to 2015 to support the construction of 100,000 rural well-being homes. It has planned to invest 1 billion yuan annually between 2016 to 2020 for at-home and community-based elderly care. 
Besides that, the Ministry of Civil Affairs will also arrange part of the welfare lottery fund to support the elderly care system, and the amount allocated in 2017 was 1.3 billion yuan.
According to a report from the National Working Commission on Aging, the number of elderly care institutions run by nongovernmental sectors has increased quickly and by the end of 2015, it accounted for 41.5 percent of the total.
Zhu Yaoyin said that the rapid growth was due to the demands of the country’s increasing aged people and their increasing expenditures, and the government’s support policies, such as offering subsidies in building and running the facilities.
The State Council issued opinions on accelerating the development of the elderly care industry in September 2013 and opinions on fully opening the elderly care market to improve the service quality in December 2016.
These opinions have garnered strong responses from the society, attracting lots of nongovernmental forces to join in elderly care industry, Zhu said.
He said that a comprehensive and full coverage system will be built based on the country’s situation, and the government will provide basic services for the elderly, and private-run institutions will provide diversified services.
Government-backed institutions
Since the foundation of the People’s Republic of China, the government has established nursing homes for the elderly in both rural and urban areas, helping poor people getting out of a vagrant life. 
Along with the population aging, the central government has released a number of policies, regulations and measures to promote the development of the elderly care industry.
In 2000, the State Council issued opinions on accelerating the socialization of social welfare, putting forward requirements on investors, consumers and service providers.
In 2006, the State Council issued the opinions on accelerating the development of the elderly care industry, encouraging public and private institutions to cooperate with each other and private institutions independently to provide services.
The Social Welfare Institute of Wuhan Jianghan District continued to provide services to people in need and built a new nursing home in 2006 to be run like a private institution where workers were all contracted.
Senior citizens going to the new nursing home would receive different services from the old one at the SWIWJD, and they have to pay for the services due to market rules.
Zhou Chunfang, president of the SWIWJD, said that this practice would secure the services to the elderly in need, and also provide different services according to different needs of the senior citizens.
The practice of the government building nursing homes and private institutions running them has been promoted across the country, and by September 2016, more than 1,100 public institutions joined the initiative.
Li Bing, professor from the Beijing Administration Institute, said that during the reform, preventing profiteering by the private institutions is a problem the public institutions have to face.
He said the attempts in the reform should not change the public welfare feature of the institutions, and they should secure the services to especially impoverished group.
The government has paid more and more attention to the elderly with advanced age, disability and financial difficulties, who are a priority for receiving basic services from government-run institutions. 
Beijing First Social Welfare Institute (BFSWI), founded in 1988, had to only receive special age groups, such as senior citizens aged over 70 or in poverty, from 2015 according to a regulation from the Beijing municipal government.
The Beijing Fifth Social Welfare Institute under the BFSWI, in 2016, became the country’s first institution specially for receiving senior citizens who have difficulties after they followed the country’s family planning policy.
Chang Hua, president of the BFSWI, said that the practice was being piloted, and the results of the pilot will determine whether or not it will be further promoted, but the demands will increase in the future. 
Li Banghua, an official from the Ministry of Civil Affairs, said that these public-backed institutions also have the function to promote experiences and standards in the industry.
The elderly care service industry has high degree of professionalism, and service providers have to focus on the physiological and psychological characteristics of the seniors, Li said.
Private-run special ‘communities’
In 2013, the State Council issued the opinions on accelerating the development of the elderly care industry, focusing on fully exerting the market role in placing the resources to gradually form the social forces as a majority in the industry.
Li banghua said that it was a milestone document in forming a new conception of the elderly care industry and the industry would enter a great development period.
Following some pioneers, real estate developers including China Vanke and Sino-Ocean Group, and insurance companies including Foresea Life Insurance and Taikang Insurance Group have started to build projects for elderly care.
Private companies in other fields, such as medicare, IT and services, as well as foreign companies have also entered the elderly care industry.
Beijing Sun City Group was a pioneer in building the first elderly care community in China in 2000. Zhu Fengbo, the company’s chairman, went to Hong Kong, Japan, Europe and the US to learn their experiences.
“Many aspects of these places, including concepts, consumption capacity, subsidies, insurance and low-interest loans were better than home,” Zhu said. “We could not learn everything from them, but have to find our own way.”
Zhu led his team to survey about 8,000 senior citizens on weekends in 10 months, and based on the survey results, they made out their plans to provide small bedrooms, but large spaces for recreation, in the community.
Wang Yufeng, general manager of the Shenzhen-based Renda Pension Industrial Group, another pioneer in creating an elderly care service community in 2008, said that he agreed with Zhu’s opinion in providing unique services on demand.
“We allow seniors to decorate some home style settings in their rooms, and such personalized services the public institutions could not provide,” Wang said. “It seems the seniors move their homes to the community.”
The huge investment in the early stage put strains on the company’s ability to gain benefits and control operation costs, and the company usually encountered a tight financial situation, said Wang.
Zhu Fengbo said that his company also met with the problem, since banks have no low-interest products to support the private companies in the elderly care industry, and the company had to finance itself.
The elderly care service industry needs huge investment but creates benefits very slowly, and companies expect the government to take more concrete measures to support the development of the private-run communities.
In February 2017, the State Council issued the plan on the elderly care system, putting forward the mechanism of integrating elderly care and medical services and supporting the elderly care institutions to provide medical services.
Seniors are vulnerable to diseases, and the integration of elderly care and medical services is very important, said Li Banghua. It has become an important factor for seniors to decide an institution.
Wang Yufeng said that his company opened a clinic at the community and also cooperated with large hospitals in Shenzhen to provide seniors with 24-hour medical services through “green channel.”
There are many entities who want to cooperate with hospitals to provide medical services.
Centers for at-home seniors
Official data showed that by the end of 2017, Beijing had 380 such service centers in communities, serving seniors living 3 kilometers around them.
Yu Jufen, 86, lives at the Ganyu community in Beijing’s Dongcheng district. She would like to visit the service center near her home to meet with other seniors or seek help.
“The life is vibrant. I can chat with other seniors there, do exercises, watch movies and sometimes make some handicrafts,” Yu said. She has treated the service center as her second home.
In 2012, the Beijing municipal government issued regulations on building the service centers in communities to service seniors at home after the State Council issued a plan on the socialization of the elderly care service system.
When service centers were established in the beginning, the effects were not ideal, because the centers operated by local authorities could not provide professional services. 
Lin Junyu, an assistant to the general manager of a company running a service center at Songyu Xili community, said that his company signed a contract with the local authorities to run the center under the backdrop in 2014.
Lin said that his company mainly offers daily service to seniors and also provides some special services to seniors who live in the centers. “From the contacts with the center, seniors trust us deeply and rely on our daily services,” Lin said.
Data from Lin’s company showed that 90 percent of seniors sought basic domestic services from the center in 2016, and in 2017, about 30 percent demanded more professional services, such as rehabilitation nursing.
Providing elderly care at home is the norm in the current system, Li Banghua said. When the family’s role in the elderly care weakens because of smaller modern families, and the service centers provide professional services for seniors at home.
Other cities including Shanghai and Shenzhen also have similar service centers in the communities. The government provides free venues and professional companies provide daily care services for seniors.

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