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Barbara Quirk: China zeros in on massive elder care issues

Barbara Quirk  —  9/08/2008 5:31 am

"We strive to ensure social justice and welfare for the elderly, especially elder women and those who are among the most disadvantaged in communities."

Does this sound familiar? It could be the mission statement of any number of American-based aging organizations. Perhaps it should come as no surprise that this is the mission statement of the Community Alliance in Beijing. With the eyes of the world centered on the Olympics, another behind-the-scene drama has been playing out. China's 153 million people 60 years and older are caught in a kind of time warp, created by centuries of tradition and a legacy of political proclamations that have left them in untenable situations.

Two major contributors to the situation are China's single-child family policy and the rapid industrialization of the nation, causing many young people to move away from home.

I suspect that the desirability of male children over females may also be contributing to the problem. The rather sick joke in geriatric America is: Q. "What do you call a daughter?" A. "Social Security." It is certainly true the majority of caregivers for older adults are female in this country, and in my travels it is also true elsewhere.

The term "empty-nest elderly" already applies to nearly half of Chinese seniors. This estimate comes from the Community Alliance, a nonprofit public interest organization that has a very ambitious agenda including:

Community centers for the elderly.

Elder women's cooperatives providing grants and assistance.

Make-a-wish program volunteers to help relieve psychological stress.

Public hotline for the elderly offering legal referrals and assistance.

National network for protecting elder rights.

Public awareness raising.

These programs and issues are a mirror image of the development of programs and services that the aging network here has been striving to achieve since the Older American Act was passed in 1965. While our efforts are not yet perfect, perhaps China would do well to model its programs after ours.

The basic thrust in China is to move from the traditional model of family responsibility for elder care and create a new community-based model. "Aging in place" are the buzzwords and the Chinese government hopes to establish community-based elder services in all large cities and in a minimum of 80 percent of the towns and villages. This sounds ambitious, but consider that by 2020, the elderly population in China will reach 248 million, and by 2051 the number will reach 437 million, or 31 percent of the population. Those are staggering numbers and a big reason for the change in where and how China's older adults are cared for.

Research shows that currently 6 to 8 percent of those Chinese 60 and over are being cared for in institutions. That means there is a need for between 9 million and 12 million nursing home beds. Unfortunately, China now has only 1.73 million beds.

The problem with numbers and statistics is that they have no face. One can only imagine the older Chinese people who are, in a real sense, being abandoned by their children who were supposed to be there to care for them. Not only is the financial support they had depended on disappearing, but the emotional support as well. Studies in this country have shown that the greatest fear older Americans have is the fear of abandonment. I am sure this is no different in Asia. The traditional family patterns are being shattered and an entire generation of older adults is threatened.

The challenges for China to convert from a family-based elder care system to one that is community-based are almost overwhelming. For starters, the seniors themselves, when compared to developed countries, are poorly educated, and have not had access to good health care. The system itself does not have a cadre of workers. We know the impact of the nurse shortage in America. Think of how the shortage of trained providers of elder care will hinder the development of programs and services.

Over the next few years, it will be interesting to watch China's shift from family to community for elder care. It gives whole new meaning to "It takes a village ..."

Barbara Quirk is a Madison geriatric nurse practitioner.

Barbara Quirk  —  9/08/2008 5:31 am