China has entered an aging society. (Reference photo) As the fastest aging country in the world with the largest elderly population, elder care has become one of the challenges that young people in our country must face. Moreover, China has encountered this issue while its economy is not yet fully developed. "Aging before getting rich" means that the resources the society can provide are very limited, and preparations in various aspects are insufficient.
Family-based elder care has always been the main method of elder care in China. However, the family planning policy has created a "4-2-1" family structure, which has determined that this method is unsustainable. After marriage, the post-80s generation faces the challenge of supporting four elderly parents, or even more, and the tension and pressure have gradually become evident. Additionally, the changes in thinking brought about by social transformation have resulted in differences in attitudes and behaviors between children and the elderly regarding elder care.
Our newspaper has consistently paid attention to the topic of elder care. This report focuses on specific cases for an in-depth investigation, attempting to showcase the contradictions and conflicts in current elder care issues, as well as the joys, sorrows, and helplessness of people, hoping to attract broader attention from all sectors and jointly seek solutions to the elder care problem.
Surrounded by mountains and green trees, in the log cabins styled like resorts in the northern suburbs of Beijing, there lives a group of elderly people.
The elderly are not accustomed to appreciating the beautiful scenery. An old lady sleeps curled up like a child of five or six years old, her thin blanket rising and falling slightly, with a nasal cannula inserted and her mouth wide open for breathing. On the bedside table, a red "Teletubbies" doll is a gift from her grandchildren.
An old man spends the entire morning focused on the TV screen filled with snowflakes, occasionally seeing human figures. Another old man sits naked on a specially designed commode, his door wide open, staring blankly out the window.
This nursing home named "Phoenix" mainly admits elderly people who have lost their ability to take care of themselves. According to statistics from the Ministry of Civil Affairs, currently, the population of people aged 60 and above in the country has exceeded 149 million, and more than 30 million elderly people require varying degrees of home-based care. Among them, the number of elderly people who have lost their ability to take care of themselves has reached 9.4 million.
Although social elder care is no longer a novelty in China, in a country that believes in "raising sons to support oneself in old age," sending severely disabled elderly people to elder care institutions remains a reluctant choice for many families.
Who will accompany you through the last leg of your life journey?
Despite the avoidance of the term "end-of-life," referring to it as "Phoenix" or "nursing home," the fact is that most of the elderly sent here have entered the final stage of their lives.
Families choose this place because "compared to most of the nursing homes we've investigated, this one is professional, clean, and has beautiful scenery." But the most beautiful scenery in the hearts of the elderly is a place where they can enjoy the happiness of being with their families.
Resident Fan Yiniao, an elderly engineer at "Phoenix," is clear-minded and optimistic: "I'm old, and I have some problems with my legs, so I'm temporarily recuperating here. In half a month, I'll go home." He gestures vividly, describing in detail the address and arrangement of items in his home. Home seems to be just within reach. He tells the guests, "Remember my home phone number; in a while, I'll go home." The elderly often prefer to believe that the nursing home is not the end of life. However, the nurse privately indicates that according to the old man's condition, not only will he not be home in half a month, but he may never go home again. To stabilize the old man's emotions, his children have woven a benevolent lie.
Professor Wu Ming from the School of Public Health at Peking University Medical Center once wrote that for elderly people with more severe disabilities, the cost of home-based care is higher than institutional care, and institutional care can provide 24-hour services. From a purely caregiving perspective, institutional care is the optimal choice.
According to Wu Ming's survey of 317 elderly people: 82.56% of the elderly prefer to age at home with their loved ones; among those choosing institutional care, 42.45% do so because "they don't want to burden their families," and 15.49% because "their families are too busy to find time."
However, the only problem with institutional care is the lack of family affection. This means that elderly people leaving their families must adapt to the lonely and standardized collective life of care institutions.
"At first, the elderly are not used to it, just like when kindergarten children start daycare," said Tian Zhongfan, the director of "Phoenix." The newly arrived elderly often "cause a lot of trouble."
Living in a south-facing single room, Grandma Mi Yanmin has a loud voice and continuously calls out to the caregivers throughout the morning, saying, "Come here, I hurt, I hurt." When the caregiver comes, she asks them to help her take out her mobile phone to make a call.
"This is an elderly person suffering from brain atrophy and severe osteoarthritis," Tian Zhongfan introduced. Although her children are very filial, they are all over 50 years old and unable to provide home-based care. The family has prepared all the necessary medications and snacks for her, everything arranged meticulously.
However, for Grandma Mi, who is somewhat confused, these are not enough. Her top priority is making phone calls. Before the call connects, she shouts, "Ping'er, is that you? Come see me, come quickly."
After several empty calls, the phone finally connects. A female voice asks, "What's wrong, Mom? What happened?"
Besides "come, come," Grandma Mi cannot articulate a proper reason. After two minutes of silence, she hangs up her daughter's call and dials another number: "My younger son, he cares for me."
"Doo...," in the quiet room, Grandma Mi makes three calls until she hears once again, "The number you dialed is temporarily unanswered." Finally, she quiets down, and the brand-new mobile phone slides into the hands of the caregiver.
The nurse says that actually, the day before, her son had visited, staying with her for three or four hours before leaving. "Over time, she will adapt," they hope.
If the family were to bear the responsibility of caring for these elderly, their situation might be even more difficult.
Another resident, Huo Wei, living in a different nursing home, was also once deeply attached to his home. On the weekend before his passing, Huo Shurong and her sister managed to bring their father home for a bath. The elderly man requested like a child, "Let me stay at home, don't leave, okay?"
"Who wouldn't want to be with their own family?" Huo Shurong said. If the elderly could take care of themselves, they would certainly age at home. Sending their father to a nursing home was an unavoidable decision.
A few years ago, after Huo Wei developed Alzheimer's disease and became irritable, someone needed to be with him constantly. Even if the children took turns and abandoned all their work to take care of him at home, it was still challenging: sometimes family members would leave for a short while to buy food, and when they returned, something had gone wrong. After several falls at home, the five children decided that having someone take care of the elderly full-time in a nursing home might allow him to spend his later years better.
Thus, that weekend, the family saw that the elderly wanted to go home, but they decided to let him stay in the nursing home first, taking him home every week for baths to make him happy.
In an environment firmly believing in "raising sons to support oneself in old age," some people find it hard to understand such choices. Some say, spending thousands of yuan per month on a nursing home might as well hire a nanny and let the elderly stay at home. However, for cases like Huo Wei's or those with mental illnesses, hiring a nanny isn't practical.
The daughter of an elderly person with a mental illness expressed her difficulties: "Nowadays, it's hard to hire a nanny. Once nannies see the elderly person taking psychiatric medication, they refuse to come. And even if they agree to come, they aren't necessarily professional or responsible. Taking medicine is as important as eating meals for the elderly; they can't miss a single dose, and the timing and dosage must be strictly controlled. How can you trust just anyone?"
"Even if you hire a nanny, the elderly and the nanny often don't get along. Once the nanny quits, I have to drop everything and find a new nanny. Doing this repeatedly makes it impossible to work."
The family members caring for incapacitated elderly people have unspoken hardships. From the outside, some elderly seem logically clear, but in reality, they are already confused. When relatives visit and ask, "What did you eat for lunch?" some elderly, despite having just finished eating, would say, "They didn't give me any food."
Home-based care for incapacitated elderly people involves hard work, complexity, and misunderstandings. The woman mentioned that taking care of her mother with a mental illness almost drove her to the brink of mental collapse.
A nursing home might be the most suitable place to receive incapacitated elderly people. However, finding a nursing home that meets the requirements is not easy. Some places have good conditions but do not accept elderly people with mental disorders or those unable to take care of themselves; others admit elderly people but charge tens of thousands of yuan per month; some facilities that meet both the conditions and price expectations of the family encounter real-world issues: old-age homes provide only daily care without medical care, making it difficult to meet the treatment needs of the elderly.
Huo Shurong said that her children had all scrambled to find a suitable place for their father's old age. In the end, she chose a relatively famous nursing home with decent conditions, reasonable prices, and proximity to her home. Initially, she was quite pleased: "Sometimes I visited him two or three times a day, which was almost like being at home."
After frequent visits, Huo Shurong realized that to ensure the elderly live comfortably, hardware facilities alone are not enough—caregiving work is equally crucial.
She noticed that some caregivers had to look after three or four elderly people, often leaving them seated on toilet stools while they attended to other tasks, returning at an uncertain time. "It's not their fault; the pay is low in nursing homes, and the workload is heavy. It's unrealistic to expect them to care for the elderly like family members," she remarked.
Nevertheless, her father kept complaining about the caregivers: "She keeps hitting me" or "When I wet the bed, they hit me." Despite understanding that her father's confusion made his words unreliable—"Even if cared for at home, occasional accidents are inevitable"—she still hired a "reliable" male caregiver from the nursing home and secretly gave him an extra 100 yuan per month, hoping he would treat her father better.
Only a few days after bathing at home, on the 24th day of staying in the nursing home, 79-year-old Huo Wei suddenly experienced cardiac arrest upon waking. With the deceased gone, what worried her more was the future: "I originally planned to enter a nursing home with friends later on, but after this incident, I'm really afraid. However, I only have one son, and it's unbearable to let him take care of me."
The nursing home finds itself in a difficult position.
Huo Shurong only hopes that in the future, if the state could introduce a policy to train and classify all caregivers, she would feel much more at ease.
In fact, for nursing homes, finding caregivers is also a headache. Yuan Yanzheng, the general manager of "Phoenix," pointed to a large photo and told the reporter, "There's only one left." The photo shows seven young female caregivers in white uniforms standing in the snow half a year ago. The shortest-staying one among them did not even last a month.
Due to its remote location, offering only around a thousand yuan in salary, and the demanding job of looking after incapacitated elderly people, "Phoenix" struggles to recruit staff in Beijing. "Beijing's youth wouldn't even glance at such a job, and their parents would rather support them doing nothing than let them do this kind of work," Yuan Yanzheng said. "Phoenix" has learned the hard way that caregivers must be recruited from poorer areas. Currently, all caregivers come from rural areas in Gansu, Hunan, and Sichuan provinces.
The question is, now that people are coming, can they do the job well? Tian Zhongfan said that for terminal care workers, their heart must be extremely kind. Other skills can be trained, but bad temper is a dealbreaker. "At this stage, the situations are special. Without patience, it's impossible to treat the elderly well." In the case of caregiver shortages, "Phoenix" once fired someone: the caregiver washed the elderly person's feet but only the tops, resulting in a foul smell between the toes.
Another issue is, now that people come, can they be retained? These young girls imagine Beijing differently. One of the longest-serving caregivers said that in a year at "Phoenix," she hadn't even stepped foot in downtown Beijing, and the nursing home wasn't much different from the mountain village where she lived. Furthermore, they rarely interacted with others, leading to intense loneliness. More importantly, earning little money is something they find hard to endure. "We can endure all kinds of hardship and dirt, but not being able to earn enough money makes it impossible to justify to our families."
It was reported that initially, a caregiver at "Phoenix" could only earn 800 yuan, later increasing to a bit over 1000 yuan. During the interview, there was even a delay in payment due to "Phoenix" facing a financial crisis.
For Yuan Yanzheng, "Phoenix" is having a tough time. He even doubts his initial judgment and whether it's worth continuing. According to Yuan's accounts, "Phoenix" incurs a monthly rent of 80,000 yuan, plus 35,000 yuan for personnel expenses and over 70,000 yuan for water, electricity, and gas, totaling at least 125,000 yuan. This requires at least 50 elderly residents to break even. However, "Phoenix" has never reached this number, sometimes with only a dozen people, sometimes with twenty-some. "Every day, as soon as I open my eyes, it means losing several thousand yuan, which is indeed terrifying," he once hoped the government could provide some subsidies.
To cut costs, "Phoenix" once adjusted the diet. However, this was quickly noticed by the families. "Eating stir-fried cucumbers five times a week, the elderly were afraid to eat, which was truly unacceptable," even Tian Zhongfan couldn't tolerate it. Families confronted Yuan Yanzheng. Yuan retorted fiercely, "