Endowment in China

With the continuous development of the Chinese society, the aging process speeds up. Due in especial to the family planning policy, the young population fail to meet up with the aging speed. With the pass of time, the proportion of old people in the Chinese population is still on the rise. Therefore, the improvement of the endowment insurance system is a quite urgent topic more than ever.

However, during the implementation process of the endowment insurance, many problems emerge. Nursing institutions for old people or nursing homes, as the major part of the social endowment service system, are experiencing profound changes. Therefore, this article, focusing on the stories of three old people who live in nursing homes, discusses the existing problems of and people's attitudes towards the nursing homes with the population aging tendency.

The stories of three old people

"Living here makes me forget all my anxieties, and all my troubles seem to have disappeared. I feel great to live here."says Wang, an 84-year-old man, who is now living in a private nursing home with his wife in Zhengzhou, near the Yellow River in central China. 

When Wang first came to the nursing home two years ago, his children strongly protested his decision to live there. Sending aged parents to nursing home is actually a new-emerging phenomenon in China. People used to hold negative attitudes to it. Most of the elderly people refused to live in nursing homes in the past. It is deep rooted in Chinese culture that young people should be "xiao"(which means filial )to their parents.Therefore, people consider it unethical to let their old parents stay in nursing homes instead of supporting and caring for them in the family. Years passed, China's urban aged population has become more tolerant and open minded to it.

According to Wang, when he took his children to the nursing home, they were shocked by the advanced facilities and living environment there. He said, "They finally decided to respect me". Since then, Wang moved in and his children visited him every weekend and also during holidays.

Far from the fast-paced and noisy downtown area of Zhengzhou City, the nursing home was a quiet and relaxing place for Wang. He said,"It provides me a quiet and secure place where I can do whatever I like."

Another 89-year-old old man, Sun Chuanrong, is in the similar condition with Wang.

Another 89-year-old old man, Sun Chuanrong, is in the similar condition with Wang. She had already lived in the Zhengzhou Nursing Home for seven years. She chose to live here because her husband passed away at that time, which made her worrying that more divergences and quarrels would happen between her and her family. Therefore, she moved to the nursing home which gave her much freedom. "I feel happy and free here, people here are all very nice." said Sun

Different from the two old people before, an 89-year-old woman, Li Zezhuang decided to live in the nursing home for the lack of care from her family.

"My child is overseas. Unlike other people, I cannot often see them. Every time I see some young people come to visit their parents, I feel solitary and lonely, really." said Li, she had lived in the same nursing home with Sun for twelve years.

Mrs Li, a young woman from Suzhou, moved from south China to the north because her husband worked in Zhengzhou. After the death of her husband, Li's daughter went to America to accompany her granddaughter who was studying in America at that time. Li could not follow her daughter to the US because of her poor physical condition. During these years, her daughter only returned to China once a year to see her, which made Li feel rather solitary. Li also said that even though she had lived in central China for most of her life, she missed the south and her hometown. It seemed that she had never truly adapted to the life out of her hometown.

The aging phenomena in China

With the largest number of aged people, China had become an aging society as early as in 1999. China takes up one-fifth of the world's population, and shockingly, it also accommodates one-fifth of the world’s aged population.

By 2050, the percentage of old men above 60 years old will take up over 30% of the entire male population. According to The Economic and Development Cooperation(OECD)(http://www.oecdchina.org/)forecasts that by 2030, the percentage of aged people over 65 years old in the Chinese society will exceed that of Japan, making China the world largest ageing society. 

There are many reasons for the increase of China's aging population, but the most important reason is low birth rate, especially after the implement of one child policy for more than three decades. Even now after the policy was revised, few Chinese families have the second child. Though China's economy grows rapidly, people’s living and health conditions should be our major concerns. The development of science and technology in the country also makes people’s life expectancy prolonged.These can all help to illustrate why the aged population in China has skyrocketed these years.

The present condition of Chinese nursing homes

Nursing home endowment also called institution endowment or institution care, can be referred to as special care, food, accommodation and nursing service provided by all welfare houses and nursing homes for the old people. Once the old people check in, they will spend almost all their life in it.With the special family planning policy of China, most Chinese families are small in size and cannot shoulder the burden of endowment. Therefore, more obligations are put on the society. As one way of social endowment, nursing home endowment is more specialized and humanized , meeting the demands for daily-life cares, nursing and rehabilitation and mental health of the old people, thus being more and more accepted by the people.

In China, there are three kinds of nursing homes, private-run, public-run and private-run and public-assisted. Public-run ones can receive funds from the governments, thus charging little or even being free for some empty nesters who have made great contributions to the society before. Private-run ones are established by private funds while private-run and public-assisted ones are established by private funds but supported by the government. In face of the rapid growth of aging population, private-run nursing homes emerge in great numbers in recent years. They accept self-paying old people and charge them based on different accommodation conditions.

Chinese people's attitudes towards nursing homes- in great changes

Dr. Wang Yuan, from Fudan University sociology said , "The social welfare system is not good enough, the role families play in old age caring is weakening, and the number of empty-nesters is increasing. We should also find new and special ways to deal with the “getting old before getting rich"problem.” 

"Clan, blood relationship, and humanities consist up of the base of the Chinese society, which is largely affected by the traditional Chinese culture which lasts for thousand years. Therefore, considering sending parents to nursing homes as not filial cannot be changed all of a sudden. With the pass of time and the development of the society, people's attitudes and perceptions will certainly change and be updated. After decades’ implement of the one-child policy, most Chinese families have only one child, which make it even more difficult for the children to take care of their aged parents. With the wealth gap among different regions, the change of the real estate market, the widespread notion of contract views, people’s notions towards such phenomenon are continuously changing."

"There is a big population of aged people now. On one hand, though there is a prevailing traditional Chinese saying that 'Bring up children to support yourselves when grow old', the young generation in China are not able to look after their parents because they are already overburdened by their children and jobs." said Li Fei, the director of the old age apartment in Zhengzhou. Of course this phenomenon also prevails among the American 'sandwich generation'. However, in China, because of the one child policy, the situation is more intensified. 

"For most of the old-aged parents of China's single-child families, the majority will live the rest of their lives in nursing homes. With the development of the society, people's attitude towards the issue has also changed. An increasing number of aged people decide to live in nursing homes themselves.They don’t even consider it as anything terrible. They do this simply because they do not want to disturb their children’s lives." 

"In the past, public attitudes toward nursing homes were far more negative than today, but now, at least for the Chinese aged people in urban areas, nursing homes are more and more acceptable. However, in rural areas, it is still difficult for people to accept it. There are a number of reasons, including traditional notions and their economic conditions." said Director Wang in Henan Old Age Research Center.("Geracomium" means "Nursing home".)

The present challenges for Chinese nursing homes

Although the social attitudes are changing, challenges still exist. Nursing homes in China still face a series of challenges now, first, limitation in number and scale; second, high costs of private nursing homes and out-of date facilities of public ones; third, the shortage of nursing staffs.

Li Fei says that One of the most common difficulties in nursing institutions right now is the recruitment and retention of nursing staff. Professional and experienced nurses for the old people, especially those who are disabled, are in great shortage". According to the National Health and Family Planning Commission of the People's Republic of China (http://www.nhfpc.gov.cn/zhuzhan/index.shtml), currently China needs about 10 million nurses to meet the domestic demands.Li Fei also explains that there is still a great shortage of workers in this field while there are many volunteers working in nursing homes with low salaries. Low wage and treatment can be a stab in the old people caring system.Salaries of public welfare officers are also low in China. The average monthly salary of these nursing staff is 2500-3000, even for those who have nursing certificate. The situation can be worse for those without certificates.

"First, some nursing polices are difficult to implement. Second, the construction of nursing homes always fails to catch up with the fast growing aging population and social demands.The investments by government into nursing home service is insufficient, which drags down the speed of its the development. The reasons can be high costs, long process, and low return rate on investment, which lead to the inactive participation from the citizens' side. Thirdly, professional nurses are in great shortage, and they are flowing to other fields. Because of the longer working hours and the stress caused by the job, low salaries and some other reasons of nursing service staffs, it is difficult to recruit and maintain these workers."

In the eyes of the majority of old people, the country-run public nursing homes are usually not as good as private ones, but the cost of less than 3000 RMB per month are more affordable and bearable for both the old people and their children. The biggest problem with nursing homes that people should wait a long time to move in, maybe one or two years.The high cost of private nursing homes, the lack of public nursing homes, the unguaranteed security problems are all great challenges. Old people in urban areas worry a lot about whether they can afford the costs of private nursing homes, how long they may wait to move in and whether they will be well cared for. 

The recent changes, present condition, and the future for Chinese nursing homes

"In recent years, some positive policies have been passed to address these problems, and great support has been given, such as, strengthening nursing home instruction on a large scale, supporting the NGOs to open up nursing homes and encouraging foreign investments into the endowment service industry, encouraging family-run small-scale nursing homes and society-run large-scale nursing home chains, integrating and transforming more nongovernmental capitals into the construction of company plants and commercial facilities and all other disposable social sources to support the endowment service.But there are still many problems remaining, which is natural for such a rapidly developing nursing service industry."Director Wang said. 

China, with an extremely large population and complex national condition, face more difficulties when addressing the problem of endowment. The shortage of money for pensions, being aged before becoming wealthy, the immature social welfare system, the increase in the number of solitary aged people, the failure of families to offer care for the old people, all make this problem even more complicated. The present Chinese nursing homes are limited in number (though the number is still increasing), small in size, high in cost and also lack professional staff members. However, overall speaking, the nursing home industry in China is growing at a rapid speed. The role family plays in caring for old people will gradually shift to nursing homes. The society's reliance on nursing homes will be stronger.

With the flood of aging process, China should pave a new path for endowment system construction, in accord with the Chinese national condition.