Xining is Qinghai Province’s capital and largest city. According to the 2010 census, Xining has over 2.21 million residents, more than 161,000 of whom were at or over the age of 65. The elderly therefore represent 7.52% of the city’s population. This is good for first when compared against the same mark for Qinghai’s seven other administrative divisions, which posted numbers of between 3.40% and 6.58%, with a median of 5.13%. Moreover, the percentage of Xinning’s elderly went up by 2.46 percentage points since 2000. Xining is, in short, an aging city and its transformation is typical of the change befalling or inevitably getting ready to befall the rest of China.
Qinghai and Xining have been in the news lately because of Xining’s bid to provide fully-funded day care centers for all of its elderly residents. If newspaper reports are to be believed, the experiment which began in 2010 has so far been a success. Below, I translate “Xining: Daytime eldercare centers are really receiving full coverage (from the state),” an article from the China Senior Daily to introduce readers to this experiment.
As you read think about this. Last week Benjamin Shobert warned that the window for Western long-term care operators in China is not a permanent one owing to domestic competition. Will we see state funded efforts to provide senior care become an equally salient threat to Western entrepreneurs?
Chinese will be first.
本报讯 青海省民政厅自2010年在西宁启动社区老年照料中心项目试点以来，通过投入省本级福利彩票公益金6410万元，在西宁市区内新建了93个社区老年日间照料中心。目前，西宁市已实现老年日间照料中心全覆盖。
(Washington) Since the launch of the elderly daycare center pilot in 2010, the Qinghai Provincial Civil Affairs Department has invested 64.1 million Chinese Yuan using community fund proceeds collected through the welfare lottery, into the construction of 93 community daycare centers for the elderly. Currently the city of Xining has realized full coverage of the centers.
省民政厅和西宁市政府高度重视老年日间照料中心建设，要求每个中心服务用房面积不少于150平方米，配置床位10张以上，内设老年人的生活服务、保健康复、娱乐等服务设施、设备；在运营过程中，采取无偿、低偿和有偿服务相结合的方式，为老年人提供个性化服务。与此同时，西宁市各区县政府每年投入每个中心的运营经费不低于两万元，鼓励以公建民营、民办公助等多种形式作好运营服务。另外，还明确规定了老年日间照料中心的服务形式和内容、老年日间照料中心的房屋产权归属、年度考核奖补机制等。
The Provincial Affairs Department and the Xining city government place high value on the construction of community day care centers. They have required that each center is to have at least 150 square meters of space for service stations, 10 or more specialty beds, as well as senior-friendly facilities and equipment, healthcare and rehabilitation facilities and equipment, and entertainment facilities and equipment. In terms of the operations process, a mix of unpaid, low-paid and regularly paid services will work in combination to provide individualized services. At the same time, the district and county governments annual contribution for every center’s operating costs is not to go below 20,000 yuan per center, and they are to encourage both public ownership-private management models of care (公建民营) and publicly created-community run models of care (民办公助) so long as the service provided is good. Moreover, the district and county governments also control the daycare center’s structure/form and substance/content, housing and ownership rights of those managing the facilities, as well as the assessment and award/promotion mechanisms.
据悉，今后青海省将继续加大对全省老年福利设施的投入力度，以建设西宁市社区老年日间照料中心试点工作为基础，稳步向省内其他人口较为密集、气候条件较好、社区发育程度较高的地区推广。（卿 文）
According to reports, Qinghai Province will continue to develop new elder care facilities across all of the province’s other prefectures, using the Xining pilot as the foundation of all future projects. The move forward will be steady and concentrated. And when the conditions are right, the pace of promotion for the project will increase across regions.
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Damjan,
Thanks for posting! Looking at the videos of these centers, these “daycare centers” look more like recreation centers and mahjong rooms than the residential care facilities that I assume most Western senior care companies are fixing to operate. If Xining is just buying a bunch of exercise equipment and putting it in a newish building, then I don’t know if it directly challenges Western-invested residential facilities, especially in Qinghai where there probably aren’t many US operators anyway.
One small point on the last paragraph, although I don’t think it affects your overall point about the expiration date on this opportunity… 全省is referring to Qinghai only. If you look at the bottom of this article (http://www.qh.gov.cn/system/2012/09/19/010890237.shtml), it uses some of the same language, then lists the other cities in Qinghai where they plan to implement this model (Golmud, Delingha, and other places with sufficient levels of development, populations, climates, etc).
“….省民政厅介绍，今后，民政部门将继续加大全省老年福利设施投入力度，以建设西宁市社区老年日间照料中心试点工作为基础，总结经验，做好居家养老服务的“扩面”和“深化”工作，[[[逐步实现西宁市、格尔木市、德令哈市社区老年日间照料中心全覆盖，并稳步向省内其他人口较为密集、气候条件较好、社区发育程度较高的地区推广]]]]，推动全省居家养老服务工作迈上新台阶，让老年人生活的更有亲情、更有尊严、更加快乐幸福。”
Stephen,
First off, you’re spot on about that translation point. I fixed that in the text.
Second, I should specify that the video is of some place in inner mongolia, but your point is valid. I had the same thought watching that video.
I don’t know whether these programs will ultimately challenge Western facilities or not, but I do think that these efforts are in line with two important aspects of the Chinese worldview.
On the one hand they are free for the people, which is inline with the Chinese public’s expectations and the expectations of many policy makers that healthcare and care more generally should remain largely public. But this is the less important point.
On the other hand, the potentially more important point, is that daycare centers accommodate the filial piety tradition of taking care of one’s parents (孝顺父母). They allow elderly to live at home while also enjoying the benefits of nursing home living. Done right, this sort of model could provide a lot more than exercise equipment.
I’m aware, of course, that modern life has in many cases eliminated traditional notions of filial piety, but I also believe that the tradition of filial piety has been replaced by filial piety as a pop culture phenomenon. What I mean by that is that despite the effects of the modern economy and the Cultural Revolution, sixty years of cultural propaganda videos have seeped into modern consumer culture so that if you watch CCTV for a fairly short amount of time you can catch a song or a product advertisement that stresses the importance of loving one’s elderly family members. And, we are all well aware of how news reports love to showcase Chinese students visiting the elderly in nursing homes. Therefore, despite the filial tradition to some extent having been erased, there may never the less exist within the modern Chinese culture as a whole a genuinely strong sense of duty towards the elderly.
That being said, I think another important aspect of the above news excerpt is that the Qinghai policy planners say they are open to private management of these facilities. So it’s not at all the case that they need be wholly governmental projects. What do you think about something like this as a potential opportunity for potential operators? Qinghai is further inland, but it has the relevant target population in spades, and a government apparently eager to help those who want to help them. I’d be interested to hear your thoughts.
Damjan,
Even though the media touts this as a success, I think the scale is quite small. The requirements for the 93 facilities are 150 square meters and ten beds (the use of which is not specified). That obviously does not meet the need of >160k seniors in Xining alone, so some sort of private management/investment is almost required to fill that hole.
But if you look at the types of projects that foreign investors usually are involved in, like the ones in this article (http://www.reuters.com/article/2012/10/01/us-china-healthcare-seniors-idUSBRE8900BI20121001), they all cater to super elites. Nobody in Xining or Golmud could afford this sort of thing, so I doubt this luxury model would ever work outside of Shanghai/Beijing/Tianjin/Guangzhou.
I think in-home care would be a much more workable solution since China does not have the crazy restrictions on health care workers that the US does (i.e. a CNA license required to change bed pans and take temps, nurse making $50/hour giving medicines that cost $0.10, etc.) I think Chinese families would be more than willing to take care of changing linens, feeding, etc and let the traveling medical personnel take care of more specialized tasks like physical therapy, breathing treatments, or IV meds. But there’s a lot less money in that than the mega rich suburbs of Shanghai.
Also, as this article mentions (http://www.plasticstoday.com/articles/chinese-medical-market-growing-changing-rapidly1002201202), I think there’s a lot of room for cheap medical devices in places like Xining that are unlikely to ever see a villa-style retirement community. Things like a talking pill box, easy to use glucose meter, or even more of these daycare centers could yield big health dividends for non-elite Chinese seniors.