Until recently, institutional elder care in China was rare and limited to the so-called “Three No’s”—people with no children, no income, and no relatives, who were publicly supported welfare recipients.26 Institutionalized elders were stigmatized.27 Few families could imagine placing a loved one in an institution to be cared for by strangers. Most residential care homes were run by the state, municipalities, local governments, or collectives.
In the mid-1990s China implemented reforms to decentralize the operation and financing of state welfare institutions.28,29 Since then, these institutions have shifted their financial base from reliance on public funding to more diversified revenue sources, including privately paying individuals.27
Elder care homes have proliferated, primarily in the private sector in urban areas.4,7 Although there are limited data, one recent study provides a glimpse into the growth and character of this nascent industry over the past thirty years.4 In Tianjin, for instance, there were only 4 facilities in 1980 (all government run), but there were 13 by 1990, 68 by 2000, and 157 by 2010 (20 of these facilities were government run, and 137 were privately run). Similar rates of growth were also observed in Nanjing and Beijing.4
The historical pattern of residents in elder care facilities and the sources of revenue that pay for their institutional care have also changed, as shown in Exhibit 4. In Tianjin in 2010 and Nanjing in 2009, almost all residents in nongovernment-run homes were private payers. Even in government-run homes, most residents were private payers. Welfare recipients were rare and mostly housed in government facilities.
The current mix of facilities spans a wide spectrum, ranging from “mom and pop”–style board-and-care homes providing little professional care to modern nursing homes with skilled nursing and medical services.4
As of 2010 there were an estimated 40,000 elder care facilities and 3.15 million beds in those facilities nationwide.30 On a per capita basis, China has about half as many long-term care beds per 1,000 older people as most developed countries do. Just 1.5–2.0 percent of people ages sixty-five and older live in residential care facilities in China, compared with 4–8 percent in Western countries.31,32
China’s twelfth five-year plan (2011–15) for socioeconomic development set a goal of adding another 3.42 million beds in the next five years, to boost total capacity to thirty beds per 1,000 elders ages sixty and older by 2015, from roughly eighteen beds per 1,000 elders in 2011.30
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