Review
Nursing Homes in China

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China will face a dramatic transition from a young to an aged society in the coming 30 to 40 years. In 2000, there were 88,110,000 persons aged 65 years and older, which represented 7% of the population. This percentage is projected to increase to 23% in 2050. Regarding health and long-term care for older adults, the current challenge is to build a comprehensive system of care for older adults. Nursing home care is an inevitable care model for frail older adults in China, which is largely sponsored by the government of China with contributions from some nongovernment organizations and private investors. China is a large country. Within the country, long-term care varies greatly between rural and urban areas, and among the different economic developing areas. In urban and better-developed areas, the range of services exists; however, in rural and less-developed areas, the range of services is limited. The “Star Light Program” and “Beloved Care Engineering” were recent government initiatives to improve aged care. They were launched in 2001 and have dramatically increased the number of both senior centers and nursing homes for older adults. While the quantity of nursing homes is still inadequate with an additional mismatch problem between the supply and demand, the quality of care in most nursing homes is suboptimal. At present, most administrative and frontline workers in nursing homes have received little training in elder care. There is a need for good-quality structured training in long-term care for all types of staff. Moreover, quality standard for care, including standard setting, assessment, and monitoring, is an important issue and needs substantial improvement for nursing homes in China. Currently, 1.5% of older people live in nursing homes and apartments for older people. Because of the peculiar 4–2–1 family structure in China, we expect the prevalence of nursing home placement of older adults will increase in the coming years. The government of China has realized that it is financially not sustainable to expand in this area using only the government's resources. The current policy is to encourage private and foreign investors to participate in the nursing home business in China.

Section snippets

Policy Toward Aging in Mainland China

Officially, the basic principle in China's aging support policy is to maintain sustainable development by setting up a partnership support system involving the state, the community, the family, and the individual. The priority in meeting the challenge of population aging in China is to develop China's economy, set up an old-age security system, speed up the establishment of the community-based aged care system, set up a legislative system to protect the rights of older adults (ie, the Law of

Decline in Family Care and the Rise in Nursing Homes for Older Adults in China

The Chinese tradition of caregiving for elders is to rely on family members to support all aspects of elder care. This is a reflection of the traditional Chinese values of “filial piety.” In the Chinese Constitution, it is stated that “Children who come of age have the duty to support and assist their parents.”13, 14 As formal aged care services are quite limited, many older persons would mainly rely on their family members to support them. This is particularly true in rural areas. The

Community Social Support Services for Older Adults in China

According to the Chinese National Committee on Aging, China has limited resources to set up comprehensive facilities and services to meet the increasing needs of older adults. However, community care and services are now recognized as being attractive ways to complement the family in caregiving. Over the past decade, there has been a great development in community service. By 1997, there were 930,000 community service facilities (located in urban areas with comprehensive service), 5055

Nursing Homes in China: The Past and the Present

Aging of the population, a decrease in family size, declining practice of “filial piety,” moving of young adult family members away from their parents (“empty-nest elders”), increased number of childless older adults, and low financial income of many older adults have led to an increased development of institutional care and nursing homes in China. However, comprehensive data are not available regarding the number and distribution in the past. In 1992, the White Paper on the Development of

Eligibility Criteria for Admission Into State-Owned, Government-Sponsored Nursing Homes

The government-owned or -sponsored nursing homes are mainly for elders who have lost their ability to work and have no income source, no legal guardian, or guardians with poor financial ability. In practice, the eligibility criteria under these nursing homes are quite strict and they are called the “5 nil elders” criteria, which are (1) no child, (2) no regular income, (5) living alone, (4) widowed, or (5) never married.19, 21 Furthermore, under the “Star Light Program,” the admission criteria

Work Force in Nursing Homes

In general, staff of nursing homes can be classified as administrative staff and frontline workers (ie, personal care staff). Administrative staff of government-owned or -sponsored nursing homes are employed by the street committees or local civil affairs bureau. Overall, these administrators usually have only a general educational background but no specialized training in social work, nursing, geriatrics or other related fields. This was illustrated by a survey of the educational background of

Quality of Nursing Home Care: Assessment and Monitoring Standards

In general, the central and local governments determine the regulations of the management of nursing homes in China. The Ministry of Civil Affairs oversees the administrative aspects of nursing homes. The Ministry of Civil Affairs of the People's Republic of China has announced a national guideline on “Basic Rules on Social Welfare Organizations for the Elderly.”19, 27, 28 The fees and charges of government-owned or -sponsored nursing homes are determined and set by the respective local

Private and Foreign Investments in Nursing Homes in China: The Future Trend

In the past, the state government built most nursing homes in China. Realizing the size of the problem and the huge financial impact to build and operate a sufficient number of good-quality nursing homes, the government now encourages private companies, overseas corporations, and nongovernment charity organizations (NGOs) to build and operate nursing homes. This will be the policy direction in the future. For example, Beijing has adopted new measures to encourage NGOs and private sectors to

Alternatives to Nursing Home Care: Home and Community Day Care Services for Older Adults

In view of the huge financial implication of building and running all nursing homes by government sponsorship in the coming years, the present policy emphasis is on community and home care, which has been greatly expanded in the “Star Light Program” from 2001 to 2004. Moreover, most Chinese older adults prefer living in their own homes to nursing homes. Hence, good home care services may decrease the need for older adults to live in nursing homes in China. Nevertheless, nursing home care will

Conclusions

China will face a dramatic transition from a young to an aged society in the coming 30 to 40 years. The current challenge is to build a comprehensive system of care for frail older adults. The Chinese government has recognized the impact of the emerging needs of older adults and in 2001 implemented the “Star Light Program” and “Beloved and Care Engineering,” which has dramatically increased the number of senior centers and nursing homes for older adults. However, China is a big country. Within

Acknowledgment

The authors thank Shengming Yan and Pearl Chan for their assistance in retrieving some of the reference information and Chinese articles.

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