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Home comforts


Community-based care for the elderly is shifting from quantitative growth to high-quality development

To tackle the challenges of an aging population, China needs to build up an old-age support system based on home and community-level elderly care services that suits its social and economic development level and demographic structure.

By the end of 2021, the country had more than 8 million beds offering nursing services to senior citizens, 29,000 community healthcare centers, and 470,000 community health stations. According to a plan released by the State Council, China's Cabinet, more high-quality community nursing services for the elderly will be available by 2025. In recent years, China has accelerated the development of community-level elderly care services, with various services and programs rolled out. However, some problems still exist.

The availability of smart elderly care services, which enable senior citizens to enjoy the conveniences brought by the internet, are low because of the relatively high costs involved.

A survey conducted in a residential community in Xi'an, capital of Northwest China's Shaanxi province, in July 2021 shows that while 80 percent of the elderly people had smartphones, they used it mostly for chatting on the instant messaging app WeChat. Only a small percentage of them used their smartphones for making payments, shopping online or surfing the internet. And only 13.7 percent had heard of smart elderly care services, with one-third expressing willingness to enjoy these services and two-thirds holding a wait-and-see attitude or even being opposed to them.

The coverage of community-based nursing services is limited. The current community-level elderly care services, which are limited to providing basic food and recreational activities, are unable to meet the nursing needs of senior citizens who live alone or are unable to care for themselves, or the healthy senior citizens' diversified needs for recreation and other services. The survey in Xi'an shows that the elderly are expecting more platforms and activities at the community level where they can communicate with others and seek emotional comfort. Only 37 percent of the elderly surveyed were satisfied with the community nursing services, with the satisfaction rate for daily care services far higher than that for recreational and sports activities.

So far, community elderly care is not fully integrated with the healthcare services system. However, a community-based elderly care system that combines medical care and nursing care is expected to be established in the post-COVID-19 pandemic era. Under this system, senior citizens will be able to access services such as disease prevention, management of chronic diseases, rehabilitation, and nursing in the community. The elderly values services such as disease prevention and first aid--some of the most needed services include blood pressure and heart rate monitoring, health knowledge promotion, and guidance on drug use for chronic diseases and psychological support.

Home-based elderly care services play an important role in meeting the challenges of the rapidly aging population. To cater to the growing demand of senior citizens for a better life, the eldercare system should not only safeguard their physical and mental health, but also help them enjoy an active social life. China's community-based nursing service system is shifting from the stage of quantitative growth to that of high-quality development. More needs to be done though.

The smart eldercare industry should take into account the local conditions for its development. Sites should be created where leading eldercare providers can demonstrate their smart elderly care services with the aim of cultivating a batch of eldercare brands. Local governments should enhance publicity and attract elderly care service providers with favorable subsidies and tax breaks to reduce the costs of nursing services. For example, the civil affairs bureau of Lianhu district in Xi'an has built a "virtual nursing home". Through integrating the eldercare and housekeeping services provided by 915 companies and the means of the internet, icloud and big data, the "virtual nursing home "is able to, through a registration system, bring the senior citizens who live separately across the district under its information management system. By doing so, the service center is able to provide tailor-made and personalized care services to senior citizens in accordance with their actual needs and conditions. This has greatly improved the life quality of the elderly people in the district.

After retirement, elderly people tend to experience dramatic changes in their social roles, as well as family and community connections, and be more vulnerable to social isolation and associated depression. As they grow old, their physical abilities and immune system weaken, and their capacities to endure mental stress decline. To address the problem, the government could introduce paid leave to encourage young people to take care of their parents, and build a "time bank", a mechanism which would allow people to amass credits for assisting the elderly and use them later in life to get services for themselves. Moreover, recreational and sports facilities for seniors should be promoted in communities.

As the elderly population is more likely to suffer from chronic diseases and dementia. Disease prevention and health management services are vital to reduce the incidence of chronic diseases and control the risks of sudden illnesses and complications caused by chronic conditions, thus improving the life quality of the elderly. In addition, a family doctor system can be an important part of the modern old-age care system to expand the provision of timely, tailored health services, such as medical checkups, nursing and rehabilitation services.

Hu Han is an assistant professor at the School of Public Policy and Administration at Xi'an Jiaotong University. Jiang Quanbao is a professor at the Institute for Population and Development Studies at Xi'an Jiaotong University.

Contact the editor at editor@chinawatch.cn