The everyday challenges of China’s ageing population demand attention
Lijia Zhang says her experience of one care facility brings home immensity of the ageing problem
PUBLISHED : Monday, 27 October, 2014, 4:06am
UPDATED : Monday, 27 October, 2014, 4:06am
Lijia ZhangLLOW SCMP
SCMP and RTHK present Hong Kong’s Top Story 2014
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A retirement home in Beijing. China’s care facilities can accommodate only around 1.6 per cent of its old people. Photo: EPA
At 50 and in excellent health, I had hardly given any thought to ageing. Having spent the past two weeks at my father’s hospice in Nanjing, however, I was pushed to confront the grim reality of it and the extremely alarming situation China’s vast ageing population will face.
My 86-year-old father, terminally ill with a heart condition, had lived at home with my 78-year-old mother who cared for him. When she could no longer cope with her heavy-boned and demanding husband (he would wake her up in the middle of the night just to ask for some warm tea), our family decided to send him to this nearby hospice.
It consists of a concrete yard with a flowerbed in the centre, and a nondescript four-storey building which houses 70, mostly terminally ill, patients.
It’s not a grand establishment by any standard. Yet there’s a three- to four-year wait to get in. My father was ushered in through the back door, thanks to a good guanxi there.
The hospice was established 10 years ago in response to market demand and to cope with China’s "grey tidal wave".
Many countries, in Europe, North America and some Asian countries such as Japan and Korea, face similar problems, but none is nearly as severe as China’s. Some 185 million Chinese are aged 60 and above. It is also ageing with unprecedented speed, thanks to a sharp increase in the average life span and a dramatic drop in the fertility rate.
Traditionally, Chinese parents relied on their children for old-age care. My beloved grandmother, a courtesan turned concubine, suffered war, famine and other hardships in life. By the time she neared the end of her life, however, she regarded herself as a very fortunate woman as she was well cared for by her daughter’s family. For someone of her generation, having "three generations of the family under one roof" was the ultimate happiness.
Today, rapid development, urbanisation, smaller families, a more mobile population and an ever more individualistic society have loosened family ties and broken the traditional elderly care system.
According to research released last year by Peking University’s China Health and Retirement Longitudinal Study, only 38 per cent of old people live with their offspring.
Those who live away from their parents usually cannot manage frequent visits home due to work and other demands. Many of the millions of migrants labouring in the cities only have the time and money to visit home once a year – during the Lunar New Year.
Those who can’t rely on their family to provide care may be dismayed to discover the appalling social provisions for the elderly.
China’s care facilities can accommodate only around 1.6 per cent of its old people. It’s unrealistic to expect a sudden or massive investment by the government on the provisions. China, after all, is still a developing country.
Here is another challenge: China became old before it got rich, unlike its neighbour Japan.
Even if you are safely inside a care facility, it doesn’t mean you are home and dry. In my father’s hospice, caregivers are supposed to provide a 24-hour service, from changing nappies to feeding people and cleaning rooms. Weighed down with too many tasks, however, they cannot respond to each patient’s every need instantly.
Once, my father’s roommate, a semi-paralysed, childless 80-year-old, was left in the corridor to do his business – his wheelchair also functions as a toilet. For hours, he sat in the grilling sun, clutching his trousers and grunting for attention whenever he saw a caregiver passing by. When you have so little control over your life, dignity shatters all too easily.
My father is much luckier. His wife and three children take turns to be at his bedside. At one point, when my sister and her grown son were visiting, my sister half-joked: "Son, one day, you’ll have to treat me the same way I am treating my father." Her son scratched his head and smiled politely.
The truth is that he may not be able to, even if he is willing. He and his wife, also a single child, will have to look after her parents as well. By 2053, some 35 per cent of the total population will enter the so-called "grey tide", compared with the world average of 20 per cent.
This issue will have to be jointly dealt with by the government, society, family and individuals. In fact, an all-out war is needed. The government should build more affordable old people’s homes; communities should build leisure centres and other facilities for the elderly and train community nurses to provide basic medical care.
Volunteers should be encouraged to visit the elderly. One of my father’s neighbours, a bed-bound old woman, told me that she hates the loneliness more than the physical suffering.
In Nanjing, the local government is considering a new policy: to pay a family member to care for the old person at home, provided some criteria are met. Different levels of the government will all have to come up with more, similarly creative, ideas.
Lijia Zhang is a writer, journalist and social commentator
This article appeared in the South China Morning Post print edition as The everyday challenges of China’s grey tidal wave demand our
lijia zhang's blog 
This is not the sort of article I can say I like. The truth seldom makes for a very likable story when it concerns the treatment of seniors. Things are not very different here in Canada. There are even stories of the elderly being abused and killed in the homes that are supposed to be providing care for them. Thank you for sharing your story. It is much appreciated.