By Wang Weijin
Research Report Vol.20 No.1, 2018
The Fifth Plenary Session of the 18th CPC Central Committee proposed to “establish a multi-tier elderly care system in which families take primary responsibility, communities provide support, and institutions play a complementary role”, reaffirming the “supporting role” of the community in the elderly care system and reversing the tendency in elderly care practices to place disproportionate emphasis on institutions over communities and families. Community is the basic unit of social governance and plays an important role in the elderly care system. Urbanization, smaller family size and the “empty nest” phenomenon have weakened the function of families in taking care of the elders, and institutions for the aged have played a limited role under the impact of the global trend of “deinstitutionalization”. Against this backdrop, the role of communities in elderly care has become increasingly important.
I. Redefine Community-based Elderly Care Geared Up to Diversified New Practices
The Opinions on Strengthening and Improving Urban and Rural Community Governance (hereinafter referred to as the “Opinions”) issued by the CPC Central Committee and the State Council called for efforts to increase the community service supply capacity, carry out rural community mutual assistance activities with mutually-assisted elderly care as the main form, improve the ability of the community to prevent and resolve conflicts, and strengthen the humanistic care, psychological comfort and mental health services for left-behind elderly and other groups of urban and rural communities.
To truly enhance the service capacity of the community and give full play to its supporting role in the elderly care system, it is necessary to redefine community-based elderly care from the viewpoints of “provision of service by the community” and “provision of service to the community”. For a long time, community-based elderly care has been regarded as a complement to home care that provides daytime care, entertainment facilities, meals, or door-to-door meal delivery service for the aged. This concept has obviously lagged behind the theory and practice of elderly care. It is unable to solve the problem of 24-hour service supply in the community, and disregards the role of institutions in elderly care, making it difficult for the elderly to receive specialized services in the community. At the same time, the boundaries between home care, institutional care and community-based care have been blurred, highlighting the important role of the community. First, there are new modes of community-based services for the elderly. For example, some older communities, after renovations, have been turned into specialized communities for the aged after the natural outflow of young population; in other communities, the elderly have realized quasi-institutional care through mutual assistance; community health institutions have expanded the function of elderly care service, combining medical and elderly care services. Second, innovations in providing elderly care services to the community are also emerging. The new community institutions for the aged, such as elderly care stations and micro-nursing homes based in communities, have the characteristics of both community-based elderly care and institutional care.
To sum up, community-based elderly care should include community-supported home care, elderly care service provided by community institutions, community mutual support, specialized community for the aged, and community-based medical and elderly care services. We should bring into play the role of the various forms of community-based elderly care, and give attention to and encourage related innovation.
II. Challenges Faced by Various Modes of Community-Based Elderly Care
1. General problems in community-based elderly care
Community-based elderly care is unable to meet the enormous and ever-growing demand for elderly care. The reasons include: lack of service facilities, and insufficient beds; limited content of services, serious shortage of basic services such as daily care, medical care and psychological comfort, and lack of professional guidance on the psychological wellbeing and social life of the elderly; poor medical infrastructure in medical and elderly care institutions, and shortage of competent medical and elderly care staff.
Shortage of specialized personnel and volunteers. Take community-supported home care for example. Most of the service providers are urban laid-offs, migrant workers and younger elders who have never received specialized training. Meanwhile, many specialized service workers are not willing to work in the industry due to the low salary. Compared to developed countries, the volunteer team for elderly care service is too small in China, and the supply of volunteers is not stable.
Funding difficulties faced by different modes of community-based elderly care. In particular, rural seniors have a low level of pension and income, and thus a very limited service purchasing power. With regard to community-supported home care, the funds mainly come from the elderly and the communities or village groups, with insufficient government support and a low degree of private participation. As to elderly mutual assistance in rural areas, the funds are mainly provided by village collectives, complemented by limited government subsidies and private donations. Moreover, the inputs of village collectives are unstable and vary from region to region, and face the risk of capital chain rupture. As to the combination of medical and elderly care services, there are great funding gaps for deploying and allocating the service capacity of community institutions, hindering the process of the integration of medical and elderly care services.
In addition to the common problems, the various modes of community-based elderly care also face some specific difficulties.
2. Small scope of services, limited coverage and imbalanced quality of community-supported home care
The community provides a small scope of services available to a limited number of elderly people, mainly including popularization of health care knowledge, door-to-door meal and drug delivery, handling of household and neighborhood disputes. Due to the absence of a sound regulatory mechanism, the quality of community-supported home care varies widely, and the social benefits are not high.
3. Problems faced by community elderly care institutions
As a new mode, community elderly care institutions face the problems of both traditional community-based elderly care and institutional care, including the enormous service gaps and low efficiency of resource management and usage. Government-led elderly care institutions are generally unable to provide adequate and quality medical services, so the elderly have to go back and forth between elderly care institutions, hospitals and their home. At policy level, community elderly care institutions are mostly small, and it is difficult for them to obtain operating qualifications, fiscal subsidies and policy support.
4. Cultural obstacle to mutually assisted elderly care and disputes about the role of the government
Due to the influence of traditional concepts, having the seniors moving into mutually assisted elderly care institutions is often considered a shame to the family, a “loss of face” to both the seniors and their children, posting a barrier to such institutions. There are also disputes over the role of the government. First, policy and fiscal support provided by the government for these institutions may result in excessive administrative intervention in these institutions. Second, by encouraging mutually-assisted elderly care the government may fall under suspicion that it is shirking the responsibility for taking care of the aged.
5. Challenges faced by specialized elderly care institutions
Most commercial communities for the aged are struggling to balance the social benefits and economic benefits. Some investors in these communities are leaders in the real estate industry and have sufficient capital and rich business operation experience. However, as the investors fail to distinguish specialized communities for the aged from common real estate projects or lack experience in the field of elderly care, these specialized communities finally go astray, generating unsatisfactory social benefits. In contrast, some other investors have rich experience in the field of elderly care and take the provision of elderly care as a main objective, but their projects are in poor operation and suffer from losses. As a result, these projects are short of funding and cannot be sustained any longer. Meanwhile, local governments only give policy support to land used for non-profit elderly care, meaning that land for commercial elderly care is not entitled to the preferential policy. In addition, many specialized communities for the aged are developed based on western modes, resulting in high construction costs but low efficiency of use and thus making them unsustainable.
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