Scholars dissect how new guidelines aid Healthy Aging
A member of staff helps a senior do rehab exercises at a rehab and medical center for the elderly in Hengshui, Hebei Province. Photo: XINHUA
By 2022 and 2030, the percentage of the elderly with disabilities aged between 65 and 74 is expected to decline, as is the growth rate of the prevalence of dementia among people aged 65 years and older, according to the new guidelines.
“China finds it tough to cope with the issue of elderly health, represented by a real lack of health services for seniors,” said Wang Haidong, director of the Department of Aging and Health at the National Health Commission. He pointed out that the country has a scarcity of institutions for medical treatment, rehabilitation and care. Many institutions are short-handed and unable to offer high-quality services.
Families are having fewer members and more and more children live far from their parents. “At present, adults have both parents and young children to support and take care of. They will face a great deal of pressure if there is a senior with disabilities in the family,” Wang said, noting that a permanent care system for these seniors is yet to be established.
Medical care services are the elderly’s most urgent need, which is demonstrated by the crowds of seniors in hospitals. According to media reports, in order to obtain better medical and nursing services, many elderly inpatients refuse to leave hospitals when their illnesses are healed. Hospitals thus become no different from nursing homes.
“The sick older adults regard hospitals as their homes, causing a serious waste of medical resources,” said Chi Fulin, director of the China Institute for Reform and Development, who has long been concerned about elderly care. China’s elderly care services do not separate medical treatment and daily care. As a result, the structural contradiction caused by a supply shortage is intensifying.
In recent years, China has strived to combine medical treatment and health care by integrating these two forms of services. This work targets the seniors who spend their twilight years at home, in community organizations or in nursing homes, supplying them with medical treatment based in daily care. Roughly estimated, nearly 4,000 institutions are working on this goal and they have formed more than 20,000 partnerships for elderly care as April 2019, according to the National Health Commission.
Chi, however, is not optimistic about many institutions that claim to offer both medical and health services. “It is not just about the combination. The point lies in a better form of such a combination,” he said, emphasizing that medical treatment and health care should complement and promote each other.
“At present, many elderly care projects target hospitals, which increases medical costs and doesn’t favor elderly care’s own development,” Chi said. He suggested using more resources to tackle minor illness and improve health care, requiring a proper separation of medical treatment and health care. At the same time, we can straighten out the elderly care system with the support of professional medical institutions. For example, health checks, hospice care and other services can be added so that older adults can stay at home or live collectively in their communities.
Regardless of the forms of elderly care, each senior needs someone with basic medical knowledge by their side. For example, this person should know how to prevent pneumonia that can arise after a senior chokes while being fed, said Fan Li, director of the Chinese Geriatrics Society.
After recovery, seniors’ refusal of hospital discharge sometimes is their last resort. Many elderly people told Fan that what they needed most was not a doctor but a caregiver. In 2018, an international training for management faculty held in Jiangsu Province estimated that by 2030, China will need a total of 68 million elderly caregivers.
Wang Haitao, deputy director of the Department of Aging Strategy at China Research Center for Aging, said that the shortage of elderly care practitioners is attributed to a lack of professionalism and specialization. “The income from elderly care is not as high as a nurse’s salary in a hospital. Moreover, nurses have clear career prospects, such as becoming head nurses, while elderly caregivers have no such career planning and promotion channels,” he added.
Senior care providers, an occupation different from doctors and nurses, shouldn’t be underestimated. Some experts held that caregivers act as nurses because they must master basic medical and care skills. They work as physical therapists who can teach the elderly how to use training devices, care robots and wearable devices. They also serve as social workers with an understanding of relevant regulations and policies, insurance products, and service organizations, formulating feasible plans and matching social resources based on individual circumstances. Care providers also design sports and recreational programs for the elderly and teach them skills such as cooking and art.
This may be an idealistic goal, because the basic requirement of performing the responsibilities of nurses and nannies is not easy. Fan said that being an elderly caregiver should be treated as a professional occupation with clear promotion channels and career development. She suggested adding senior care as a major into the Chinese educational system and encouraging professionalization. Graduates can obtain university degrees. In addition, it behooves the country to implement top-level design concerning elderly care and to specify standards in terms of subjects, locations and methods.
To train professional talent, technical colleges last year opened majors regarding aging services, health services and their management. Currently, efforts are being made to set up majors in elderly care services. In the future, accreditation for elderly care professionals will be available, according to the Ministry of Human Resources and Social Security.
Wang said that China will introduce policies on an elderly health service system, covering the construction of medical services for seniors, care for the elderly with disabilities and on-site services. This year, pilot projects will be carried out to assess elderly with disabilities and supply health services.
When there is a caregiver, there is a call for care insurance. Talking about the insufficient services for the seniors with disabilities, Wang pointed out a major cause in that a stable payment mechanism is yet to be set up. Many Chinese people get old before becoming rich. With long-term care insurance, older adults can afford and receive necessary care services.
Long-term care insurance refers to a mechanism that compensates the insureds’ expenses incurred by long-term care services. Supported by the insurance principles of risk sharing and universal benefits, it mainly covers the elderly with disabilities. In 2016, China issued the “Guiding Opinions on Piloting the Long-Term Care Insurance System” and implemented the insurance in 15 cities. The 2019 Government Work Report proposed to expand the pilot program of long-term care insurance.
This insurance is a type of social security mechanism for socially vulnerable groups. It is crucial to identify and assist the elderly in need of medical and daily care. Jin Weigang, director of the Chinese Academy of Labor and Social Security, suggested we should identify the scope of long-term care insurance with a priority on supporting the daily care expenses of the seniors unable to live alone due to disabilities or mental issues. Medical care payment is secondary.
In terms of applicants, it is urgent to identify whether and what they need for long-term care. The criteria to evaluate disabilities and mental issues in the pilot areas have shown inconsistency. Some criteria are developed by the local authorities, and some are introduced from foreign countries. Jin called for speeding up the study and making national standards for the grading of disability and care, as well as for the cost of long-term care insurance.
In the long run, a source of funds must also be determined to secure stable implementation. At present, most pilot areas have transferred a portion of health insurance funds to operating long-term care insurance. Such a method of fundraising is considered unstable and unsustainable, as health insurance funds are shrinking.
Jin suggested finding independent financing channels to no longer rely on the country’s health insurance funds. The government should support long-term care insurance by creating a moderate and stable financial input mechanism. Apart from the mechanism, individual contributions, financial subsidies and social donations are all practical approaches to fundraising.
This article was edited and translated from Guangming Daily.
edited by MA YUHONG