An Industry in the Making: The Emergence of Institutional Elder Care in Urban China

Abstract

Demographic shifts in China pose unprecedented challenges in the care of a rapidly growing older population. Sporadic reports suggest the recent emergence of institutional elder care in China, but little is currently known about this phenomenon. This study documents the growth, ownership, financing, staffing, and resident characteristics of elder care institutions using survey data collected in 2009 from Nanjing, China, supplemented with government registry data from seven additional major Chinese cities. Between one-half and two-thirds of facilities operating in these cities were founded in the last decade, primarily in the non-government sector. In Nanjing, government ownership dominated homes built before 1990 (96%) but was increasingly rare in the 1990s (60%) and in the 2000s (23%), a pattern observed in the other seven cities as well. In Nanjing, the average home now draws more than 80% of its daily operating revenues from private-pay or other non-government sources, and this share increases sharply with the recency of facility establishment. The majority (85%) of non-government-owned homes are receiving ongoing per-bed subsidies from the government. The lack of clinical staff characterizes the majority of study facilities; most care staff are rural migratory workers. There is considerable variability across facilities in the case-mix of residents in terms of functional dependence and acuity levels. These findings portray the emergence and rapid growth of a nascent industry of institutional long-term care in urban China and a fundamental shift in institutional ownership, financing, and clientele.

Staff characteristics and care in Chinese nursing homes: A systematic literature review

“…Wu and Caro [9] also reported regional differences of staff training, in which few staff in Hubei had received any training, while some staff in Shanghai in participating NHs received training and working certificates. Feng et al [10] found that less than one-third of the participating 140 NHs in Nanjing employed professional nurses or physicians. Despite this widespread lack of training, some evidence suggests that staff welcome more care knowledge and skills; one study found that 96% of enrolled staff were willing to participate in training and desired training in basic knowledge about common diseases among older adults, and knowledge about psychological care and daily care [25].…”

“…None of the 10 surveyed NHs in Chengdu had a nutritionist to design individualized diet plans for residents [5]. Also, less than one third of all NHs in the city of Nanjing employed nurses or physicians [10]. Nonetheless, Li and Buechel [31] found that family members i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 1 ( 2 0 1 4 ) 4 2 3 e4 3 6 had a high level of overall satisfaction towards residents' life in Chinese NHs, in terms of accessibility of nurses and quality of care, even higher than that in the U.S. NHs.…”

“…Also, the eight studies provided data on staff training levels of both Government-owned and private-owned NHs, as well as NHs in both urban and rural China. However, articles reviewed on training levels were mainly limited to direct caregivers; only one study mentioned the extreme lack of medical and nursing professionals in NHs [10].…”

“…These findings among studies likely result from inclusion of diverse types of NHs (e.g., geriatric hospital versus apartment for elderly) or inclusion of NH staff with different job titles. In terms of sources of NH staff, most direct caregivers in urban areas were migratory workers from rural area [3,5,10,26]. In rural areas, direct caregivers were from local areas, which were very likely the same village or community with residents [3,9].…”

Chinese one-child families in the age of migration: middle-class transnational mobility, ageing parents, and the changing role of filial piety

“…Apart from families and communities, the state has promoted the traditional family contract through legislation on children's responsibility of parental care 1 and minimising the state's role in long-term care for the elderly (Feng et al 2011;Zhan et al 2008). To date, there is no functioning elderly care system in China.…”