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August 6, 2012

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Senior care shortages acute, getting worse

LU Suqin, 90, eases with trembling hands into a bamboo chair, assisted by a health care worker at the Huangpu District No. 2 Seniors Home.

She has lived there for nine years, sharing a three-bed room. At the other end of the small room, a nurse is bathing a bedridden woman.

There's hardly room for visitor chairs, but Lu isn't complaining. In fact, she counts herself lucky to have found a bed in a nursing home at all and hopes fees don't rise and force her out.

As Shanghai's population ages and more young families can't take care of their elders at home, vacancies in senior care facilities have become scarce. The situation is most acute for people with dementia or physical disabilities who require more care, but many facilities won't accept them.

Retiree Zhang Jinghui recently sent her 86-year-old mother, suffering from dementia and other illnesses, to a hospital in Qingpu District. She still has her paralyzed father at home - she can't find a place for him in a nursing home.

"I contacted several nursing homes in Xuhui District, but I was told that either the waiting list for beds is very long or that they don't accept patients with dementia or physical disabilities," Zhang said.

An estimated 9 percent of Shanghai's population of people aged 60 or older suffers some sort of physical or mental disability. That's about 410,000 seniors who need specialized care, and the number is rising.

The ancient virtue of filial piety, which may have worked well in rural settings for centuries, has broken down to some extent in China's fast-paced mega-cities. Sometimes it's a matter of sons and daughters becoming elderly themselves and unable to care for even older parents. Sometimes sons and daughters have to work and can't provide round-the-clock care.

Lu said she moved to a nursing home voluntarily so that her grandson could marry and have her apartment to live in. She has four sons, the oldest now 70. Her care is paid for by her pension and contributions from her sons.

"I felt being abandoned and ashamed at first because I have four sons," Lu said. "It took a long time for me to get used to this new situation."

Shanghai Daily contacted 35 local nursing homes in downtown and suburban areas. Seven said they don't accept people with paralysis or dementia. All 35 said they do assessments to determine whether dementia patients are so severe they might disrupt other residents.

At the end of 2011, the city had 631 registered nursing homes, with 100,200 beds. About half of the homes were privately owned. Most publicly owned homes, particularly in downtown areas, are full, while their private counterparts - which charge more - usually have 30 to 40 percent of their beds unoccupied.

The Jianyang Seniors Home in Hongkou District said it provides space only for people who can take care of themselves and don't need specialized care. No vacancies.

The 175-bed Shanghai Jiukang Nursing Home in Xuhui District tells prospective residents they may have to wait up to three years for a bed. No vacancies.

The Xinzhuang Nursing Home in Minhang District, which has 600 beds, said it has a waiting list of 1,200 people. No vacancies.

Financial woes

Public nursing homes said they are struggling to make ends meet.

The Xinzhuang Nursing Home, a publicly owned elderly facility, said it charges 900 yuan (US$145) a month for an average resident. By comparison, fees at privately run nursing homes in Shanghai can run as high as 4,000 yuan a month, though the average is 1,000 yuan to 2,000 yuan per person.

City authorities issued a notice in 1999, setting uniform management and nursing fees for publicly operated homes. There are three levels of care, with the most acute eligible to charge 500 yuan per patient in management fees and 480 yuan for nursing.

Privately owned homes are allowed to set their own prices.

The director of the government-run Huangpu District No. 2 Seniors Home, who gave only his surname Ji, said his facility just expanded by 50 beds last year, and only 20 of its 170 beds are currently vacant. The home offers accommodation to those with physical and mental impairments, operating with a 60-member staff giving 24-hour care.

Most of the staff are older - 50 years or more - and come from other parts of China. Many don't stay long, he said.

"It is extremely difficult to hire or keep nursing home workers because their monthly income is only slightly above Shanghai's current minimum wage (1,450 yuan), and we can't afford to pay more," Ji said.

Nursing workers must show basic skills in elderly care before being hired. The work of cleaning rooms, disinfecting hallways, bathing seniors, serving food and even feeding patients, if necessary, is demanding and often heart-wrenching.

With dementia patients, staff have the extra burden of having to keep a watchful eye that patients don't wander off.

The Shanghai Civil Affairs Bureau, which oversees nursing homes, said it is well aware of the problems and is working to address them. Shanghai plans to add another 20,000 beds in senior care facilities by the end of 2015, and wants 70 percent of new beds earmarked for people with dementia or physical disabilities, said Ma Yili, bureau director.


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