Remember ME - You Me and Dementia

June 9, 2011

CHINA: All of us intend to live longer lives, and next year we'll all be one year older

BEIJING / Global Times / Special Report / June 9, 2011

Age old issues
By Xuyang Jingjing

It was 4 am when the sadistic caregiver was caught on video forcing 79-year-old Shi Qingchen to drink his own urine.

When the old man refused he was hit with a slipper and whipped with strips of cloth that were also used to tie him to his bed.

A local television news crew shot the scene on May 30 through a window of the Changleyuan Seniors Home in Zhengzhou, Henan Province.

Authorities later found numerous residents of the nursing home were suffering from dementia. Staff at the 30-plus-bed extended care facility often tied residents to their beds.

Local police arrested Zheng Huanming, the nightshift orderly caught on camera, who confessed he often woke residents in the early hours so he could get off work earlier.

"What they did was very bad. This rest home will have its license revoked," an official surnamed Duan from the Zhengzhou civil affairs bureau told the Global Times.

"We are contacting the families of the residents and other facilities. We will make sure they are taken good care of," she said.

"Most publicly funded rest homes are well managed, some private homes need to improve services," said Duan.

"As the supervising agency, we should better regulate these facilities," said Duan. "But it's complicated."

Reports of neglect and abuse

Reported cases of abuse and neglect at nursing homes are not uncommon. The media have reported on a nursing home in Hubei Province that forced elderly residents to do manual labor but didn't pay them. In Heilongjiang Province, an elderly man was left uncared for at a nursing home and developed massive bedsores. An orderly in Suzhou, Jiangsu Province was caught on video slapping an elderly woman across the face.

Feng Zhanlian (left), an associate professor at Brown University in Providence, Rhode Island, whose research focuses on institutional long-term elder care in China, said the amount of abuse and neglect at nursing homes is hard to estimate as many cases go unreported.

Heavy workloads, poor pay and few benefits at nursing homes lead to high staff turnover, Feng said, adding that some staff lack necessary training to look after the weak and frail, who are difficult to care for.

"All these unfortunate circumstances make institutionalized elders prone to abuse and neglect," Feng told the Global Times.

"It's not just nursing homes; you see a lot of cases where elderly parents are abused or abandoned by their adult children," said Zhai Zhenwu (right), a demographer from Renmin University of China.

"The whole family structure is weakening," Zhai told the Global Times. "The traditional values of filial piety are losing ground."

Changing family dynamics

Experts say the requirements of modern life are responsible for diminishing China's centuries-old family values, which dictated that adult children must provide their parents with grace and dignity as they grow old.

Nowadays busy, working sons and daughters are far less centered on the ancestral tradition and there are fewer of them in households that can often include four aging family members.

All these factors will require significant attention and resources from governments as China's aging issue becomes exponentially more severe.

People over 60 years old now account for about 13.3 percent of the population, compared to 10.3 percent in 2000, according to the sixth national population census which was taken in 2010. Demographer Zhai predicts that the number of people over 60 will account for fully one third of the population within the next 30 years.

Meanwhile the percentage of young people under 14 is declining and the annual population growth between 2000 and 2010 was just 0.57 percent.

As the baby boomers born in the 1950s and 1960s begin to retire, the country seems ill prepared to meet their needs. The rapidly aging population and changing family dynamics are sure to challenge the country's elder care system, which lags behind international standards.

"The traditional function of families as elder care providers is weakening as a result of urbanization and the increasing mobility of the population," said Zhai.

As more people leave the countryside for work in cities, statistics show 40 million aging adults have been left behind in rural areas.

In cities, where most families rely on double incomes, the one-child family policy has resulted in just 3.1 people per household, according to the recent census.

"It means people are no longer living with their elders, and therefore the family is no longer the chief source of care for the elderly," said Zhai.
According to the National Committee on Aging under the State Council, half of all older people will be living by themselves by 2015.

This will undoubtedly cause great concern for families and society as the elderly approach the last stages of life and lose their ability to care for themselves.

The Committee reported that in 2010 there were 33 million seniors who were unable to live independently and their numbers are expected to reach 40 million by 2015.

China has more than 38,000 facilities for seniors containing 2.66 million beds, enough to accommodate just 1.6 percent of the elderly population, stats from the Ministry of Civil Affairs show. Internationally about 5 percent of the population is provided with nursing home care.

Trained help hard to find

For 72-year-old Wang Hongwei, money is a primary concern. "Going to a nursing home would be a last resort," she said, adding that someday she may have to live in one. "I won't always be able to take care of myself, and my son is often away at work. Who's going to look after me?"

Over the past decades, the government has encouraged private-sector development of nursing homes in order to meet the growing demand.

In Beijing, the number of homes for seniors more than doubled between 2000 and 2009 to more than 300, with a majority of them privately owned, according to Feng's research.

By the end of 2010, Beijing had 386 facilities for seniors, according to the Municipal Civil Affairs Bureau.

Feng's study found that migrant workers account for 55 percent of direct-care staff in most facilities and few of the homes employ clinical professionals. This lack of qualified, skilled caregivers is one of the most urgent problems facing nursing homes, experts believe.

Yan Shikai hired about 20 migrant workers for his nursing home in Huilongguan, in suburban Beijing. The average age of the caregivers is 45 and none of them is professional.

"We couldn't find professional caregivers, so we have to train them ourselves," Yan told the Global Times.

Yan opened his nursing home five years ago but it will soon be torn down to make way for a new development.

Yan, who is in his 40s, has been left disillusioned by his experience. He told the Global Times he wouldn't send his own parents to most nursing homes.

He is not planning to relocate his elder care facility. "It's too exhausting and there's no money in it," he said.
Private facilities in a pickle

Public nursing homes are overcrowded, and private nursing homes are either too expensive or provide bad service, said Yan.

Beijing No. 4 Welfare Institute, a public nursing home, has a waiting list of over 100 people. Some people who are not yet retired have already registered with the home.

Sijiqing, a township-sponsored nursing home in Beijing, has a waiting list of more than 2,000 people.

"For private facilities, if the price is too high, people can't afford it; if the price is low the service quality is suspect and people won't go," said Guan Xinping, a professor of sociology and demography at Nankai University in Tianjin.

"Financial support from the central and local governments is insufficient, which means these private facilities are unable to provide inexpensive, quality services," he told the Global Times.

Guan believes the government should give more support to private nursing homes in order to ensure better quality care.

Governments at different levels have announced support for non-profit, private nursing homes, but many managers complain that the subsidy is not enough. Beijing provides just 100 to 200 yuan per month per resident and an 8,000 yuan subsidy for the construction of each patient unit.

"That's too little. The government said they would raise the standard five years ago but it hasn't happened," said Yan, the former nursing home owner.

China has been promoting community-based elder care since 2008, and many experts believe this is the right track. "When older people still live in their own homes they can receive daily care, medical care and other services that are provided by the community," said demographer Zhai. "It's a better way to address the issue of aging."

The issues surrounding China's aging population are complex and many solutions are being studied and implemented. "It entails building of an information infrastructure to track developments and enhance quality monitoring on a regular basis," said Feng.

While demographers study and provide estimates on the future impact of an aging population, they are absolutely certain of two facts of life that make aging issues important to everyone: All of us intend to live longer lives and next year will all be one year older.

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