Mainland struggles to care for the aged

PUBLISHED : Wednesday, 02 February, 2005, 12:00am
UPDATED : Wednesday, 02 February, 2005, 12:00am

Ten per cent of the population is over 65, but there are only 100 hospices to cater for dying patients

China's ageing population has left policymakers and health chiefs grappling with the issue of how best to care for people in the twilight of their lives.

With only 100 hospices across the country containing 3,000 beds, analysts warn that the country could end up facing a critical 'death problem'.

Cui Yitai, director of the China Hospice Care Commission, said mainland hospices could cope with only a fraction of the rapidly ageing population.

Ten per cent of the mainland's population, or 132 million people, are above the age of 65, with the number expected to reach 167 million by 2020.

In 15 years, China's elderly will make up a quarter of the world's aged population, according to the United Nation's second World Assembly on Ageing.

Li Xiaoping , from the Chinese Academy of Social Sciences' Institute of Population and Labour Economics, said most people died of chronic illnesses, rather than acute ones.

He said better medical technology meant people took longer to die.

'In the next several decades, as many parents of the first generation under the one-child policy enter the final stages of their lives, most urban couples will have to take care of four dependant old people at the same time, an unbearably heavy burden for a family,' Professor Li said.

In addition, the traditional Confucian principle of filial piety had lost its appeal in a society dominated by fierce competition.

'The combination of these conditions means it's essential to transfer support for the elderly from relations to a fully fledged social welfare system,' he said. 'Society, rather than offspring, should take responsibility for caring for ageing people until they die.

'The establishment of a hospice system in rural China will be a harder goal to reach. We cannot rely on governmental efforts, but should depend on private financing to achieve it.'

Despite the calls and need, the development of hospices on the mainland is still subject to official and moral hurdles.

For example, most of the existing hospices are affiliated to state-owned hospitals and restrained by their policies and regulations.

But approaches that work for hospitals do not necessarily apply to palliative care.

Professor Cui said operations were usually pointless for people in hospices with irreversible illness, and painkillers were the preferred option.

The World Heath Organisation has developed a pain-control programme for cancer patients but Professor Cui said it would be hard to implement, given regulations limiting fees for medicine to no more than half the cost of treating in-patients.

Professor Cui said high mortality rates in hospices made hospitals reluctant to open palliative care departments 'because it would have a negative effect on the hospital's annual assessment'.

While state-owned hospices struggle, the situation is even more perilous for the private facilities that account for less than 20 per cent of the industry.

Li Wei, founder of Beijing's Songtang Hospice, said it had been forced to move seven times in the past 17 years.

'At first we could only rent houses, which were usually shabby, and we had to move when the contract expired.

'Sometimes we were just driven out by residents in the neighbourhood because people believe living near a hospice with people dying every day is a bad omen.'

All private hospices operate outside the medical insurance system and this has an impact on the patients that they can accept. The average cost per patient ranges between 1,000 and 3,000 yuan.

Dr Li said: 'Due to the large demand, my hospice can now just make ends meet, but there is no chance for great expansion or professional training.'