At present, the pension service is facing the shortage of human resources such as "only child can not take care of, it is difficult to find a nanny, the number of professional nurses is small, and the turnover of nursing staff is large". Visual China | fig
When people are old, what do they care about the most?
70-year-old Zhao Lun felt that it was for eating, seeing a doctor, and providing emergency medical aid; Zhang Xia, who lived alone, was not old, but every night before going to bed, she would pull the bedside emergency call rope to the pillow, for fear that she would "suddenly have an accident"; Zhang Songxue, who was over eighty years old, fell on the balcony of her apartment after falling on the balcony of her apartment, fearing that "people would leave" after freezing overnight, so she gritted her teeth and moved herself into the house and pulled down the emergency caller with force.
According to a statement issued by the National Health Commission and other authoritative departments, falls are the number one cause of injury death among people over the age of 65 on the mainland. The older you are, the higher the risk of falling and injury or death from falls.
Obviously, compared with the 2024 New Year's Eve movie "If You Are Honest Do Not Disturb 3", the 70-year-old empty nester played by Ge You fell in love with an AI bionic robot, and the real problem of the old people is not the wind and snow, but how long it takes to be found after falling.
This is closely related to the shortage of human resources faced by the current elderly care services, such as "only children cannot be taken care of, it is difficult to find nannies, the number of professional nurses is small, and the turnover of nursing staff is large". Zhang Sifeng, executive director of the China Social Security Association and professor of Xi'an Jiaotong University, told Southern Weekend that replacing manpower with a pension service robot is an inevitable choice to solve this problem.
The "Opinions on Developing the Silver Economy and Improving the Well-being of the Elderly" (hereinafter referred to as the "Opinions") just released by the General Office of the State Council responded to this call. The "Opinions" emphasize the creation of a new format of smart health care for the elderly, promote the integrated application of a new generation of information technology and smart devices such as mobile terminals, wearable devices, and service robots in home, communities, institutions and other elderly care scenarios, and promote the application of intelligent nursing robots and other intelligent equipment.
However, Southern Weekend's research on pension service institutions in Beijing, Henan and other places found that the smart pension model being implemented by domestic pension communities and pension institutions has encountered many obstacles in reality, such as "not being smart enough, being expensive, and ignoring the needs of the disabled elderly".
From emergency call systems to electronic "fences"
Zhao Lun and his wife, who did not have children, decided to spend their old age in a centralized home-based elderly care community.
Four years ago, the old couple moved into Beijing Shuangqiao Gonghe Home, which is the first domestic co-ownership pension pilot project, buyers have 95% of the property rights of the pension house, each room must live an elderly person over 60 years old, and pay a monthly service fee of 3,000 yuan, provided by Lecheng Group as a pension operator.
Initially, the 24-hour emergency call alarm system was installed in the apartment for the elderly and the community public service space, and was triggered to connect to the community central control room by means of buttons and ropes. However, Lu Shuo, the director of Shuangqiao Gong and Homestead, found that there were still elderly people who were unwell when they went out for a walk, or fell at home alone, and could not reach the wall pager.
In 2023, Shuangqiao Gonghe Home will introduce a wireless positioning badge configuration, and integrate the community meal card and access control card into one, which is convenient for the elderly to carry with them.
Zhao Lun shows his wireless positioning badge. Xi Lijie|Picture
On the basis of wireless positioning, the community has set up an electronic "fence" for the elderly living alone and the elderly with dementia who are at risk of getting lost, and the elderly who live alone do not go out of the house for more than a day, the staff will receive the information on the mobile phone platform and take the initiative to contact the elderly to confirm their physical condition;
These practices of Shuangqiao Gonghe Home are basically consistent with the current situation of domestic intelligent elderly care services. At present, there are three types of intelligent pension services in China, the first type provides health data for the elderly, remote emergency medical treatment information, remote medical monitoring services, and activity trajectory viewing and analysis; the second type is that the elderly can choose various life service items on the platform by clicking on smart devices; and the third type is that the elderly enrich their spiritual and cultural life through voice mutual aid functions and interactive information exchanges.
"These services mainly rely on information equipment and technology such as smart wearables and remote monitoring, and the functions are focused on detection, alarm, reminder and information transmission. Zhang Sifeng said.
For Zhao Lun, who is in good health, the most frequently contacted smart service is the smart information platform built by the community, which can be used to make appointments for repairs, haircuts, pedicures, home cleaning, and accompanying medical treatment by clicking on the mobile app. The community holds weekly mobile phone classes for the elderly to teach them how to use the system.
The traditional repair system needs to take photos, match text, and record maintenance demands, which is not friendly enough for the elderly who need to write on the smart phone one by one. On this platform, Zhao Lun only needs to click the button of video recording, and he can verbally convey his demands while recording the video.
"Taking care of one's own parents is not the same as taking care of someone else's parents"
Compared with serving the elderly, Qi Yinglin, assistant general manager of the health care division of Lecheng Group, said frankly that the artificial intelligence and Internet of Things devices of Shuangqiao Gonghe Home are more to liberate the staff of the community and alleviate the manpower plight of elderly care services.
"Uncle Wu, the new disabled old man, weighs 180 pounds, he can't move to the toilet at all, and his waist hurts so much that he really can't do this job. In order to introduce the newly purchased electric lift in the hospital, Cheng Chuantao, the director of Henan Shangqiu Fumantang Nursing Center (hereinafter referred to as Fumantang), filmed a short video, and the plot was designed for Zhou Jing, a nurse, to resign from the director.
After using the electric lift, Zhou Jing helped Uncle Wu to sit upright from the bed, buckled the lift machine under the old man, and moved the old man out of the bed like a wheelchair, solving the problem of the old man's shifting. At the end of the video, Zhou Jing smiled and said to the dean that she was "not resigning".
Aside from the ending of this Spring Festival Gala sketch, the bridge design of Zhou Jing's "resignation" is actually a true portrayal of the high mobility of elderly care workers.
There are nearly 300 elderly people living in Fumantang, with an average age of over 80 years old, half of whom have lost their ability to take care of themselves. The monthly salary of a caregiver who chooses to take care of the disabled elderly in the all-care area is up to 1,600 yuan higher than that in the self-care area.
Most of the applicants were rural women in their fifties, who claimed to have taken care of their parents and were not afraid of dirt and hardship. But Cheng Chuantao found that when it came to the stage of independent employment, "three out of ten people" who could stay in the whole protection area were considered good.
Nursing, feeding, bathing, carrying, and handling of stool ...... Zhang Zejiao, an associate professor at the School of Public Policy and Management at Xi'an Jiaotong University, found in the survey that the traditional pension service is a typical labor-intensive industry. On average, a nurse in the institution needs to take care of 5-6 elderly patients, working day and night shifts, and the work content is "dirty, tiring and dangerous".
In an apartment for the elderly somewhere in Shaanxi, an 81-year-old disabled old man told Zhang Sifeng that in addition to getting up, eating, and sleeping, the nurses basically do not come at other times, and sometimes press the bedside caller, and the nurses cannot arrive in time.
The bigger problem is the aged care industry, where highly educated young people are still in the minority. In 2023, a study published in the Journal of Nursing showed that only 12.2% of medical professionals in integrated medical and elderly care institutions currently account for 12.2%, of which 0.23% have a graduate degree, 6.95% have an undergraduate degree, and 70% have graduated from primary and secondary schools.
"Elderly people who are completely disabled are often accompanied by incontinence, and many people are unable to overcome psychological barriers, and often ignore one point: taking care of one's own parents is not the same as taking care of someone else's parents. Cheng Chuantao said.
Feeding robots "can't find their mouths" happen from time to time
In the video comment area of Cheng Chuantao's introduction of the electric lift, experienced netizens kept asking questions: "What should I do if it is very laborious to help the elderly sit up?" and "How to take off the pants of the elderly while sitting on the lift?"
At the Fumantang Nursing Center in Shangqiu, Henan, caregivers use electric lifts to move the disabled elderly. Photo courtesy of the interviewee
Implicit in these doubts is the reality that smart products at this stage "have not yet achieved true intelligence or intelligence." Repetitive mechanical tasks such as turning over, feeding, and carrying still cannot be accurately completed by machines, so that caregivers cannot devote their energy to higher-level and more accurate care.
and electric lifts were acquired into Fumantang, as well as feeding robots that help the disabled elderly. During the trial, Cheng Chuantao found that normal people use it according to the specifications, and the machine can indeed free their hands, but in the face of the elderly who are disabled and bedridden and unable to adjust the neck angle, the machine is difficult to identify the user, and the situation of "can't find the mouth" occurs from time to time.
The complexity of intelligent elderly care lies in the fact that the individual situation of the elderly is very different. The same is feeding, in the Gongheyuan pension institution under the Lecheng Pension, some elderly people have bad teeth and eat slowly; some elderly people have shaky hands, but there is no problem with eating, and they can swallow after chewing for a while; some elderly people have the risk of choking and need to pay attention to care; some elderly people with dementia are like children, they can't sit down and eat with peace of mind, so they love to wander around. Even with a unified feeding robot, only two or three elderly people may barely be able to feed the machine.
Existing smart devices are also difficult to match complex elderly care scenarios. Qi Yinglin told the Southern Weekend reporter for example, if a stall of water is sprinkled on the ground, it will become a major hidden danger for the elderly to fall, but the sweeping robot can only clean according to the established route, and cannot clean the sprinkler in time and at a fixed point.
Even so, Qi Yinglin and Cheng Chuantao's pension institutions have been at the forefront of intelligent pension. Since 2017, Zhang Sifeng's team has gone deep into 23 counties (districts) in 10 cities in 3 provinces in China, visited more than 40 elderly care institutions, and almost did not see the practical application cases of highly intelligent elderly care service robots, and the number of elderly care institutions with assistive devices such as smart beds did not exceed 10% of the total number of surveys.
Yang Zhihao, product director of the rehabilitation innovation project of Shanghai Fourier Intelligent Technology Co., Ltd., told Southern Weekend that the pension industry cannot be clearly distinguished as an independent industry in many cases, and Fourier Intelligence focuses on the application of robot technology in the field of intelligent rehabilitation, and most products are suitable for both young and old people. In the early stage of research and development, the needs of the elderly group will be considered, but the "elderly version" will not be launched in a targeted manner.
The "Action Plan for the Development of Smart Health and Elderly Care Industry (2021-2025)" issued by the Ministry of Industry and Information Technology and other departments proposes to focus on improving the supply capacity of smart products and developing five categories of products: health management, elderly care, rehabilitation assistive devices, traditional Chinese medicine digital intelligent products and home service robots.
Zhang Sifeng believes that the research and development of highly intelligent elderly care service robots is no less important than the development of self-driving cars. At present, the limitation of intelligent pension products is that they are still inseparable from human services, and they cannot fundamentally reduce the use of human resources.
Some smart products not only do not reduce the burden, but also increase the workload of caregivers. Fumantang has a walking robot that can help the paralyzed elderly "stand up" again, but the elderly still need the assistance of a caregiver when using it. In desperation, a 20,000 yuan walking robot was placed in the building, and family members can use it for free when they are caring, and if they need the assistance of a caregiver, they need to charge an additional fee.
"Detached from social reality"
During the free trial, the walker robot is a "hot item" of Fumantang, and the elderly with inconvenient legs and feet want to rehabilitate and exercise. In stark contrast, after the increase in the charging mechanism, almost no elderly people are willing to pay for it.
A pair of smart crutches that can identify the fall of the elderly, and can also talk and locate, the price is nearly 1,000 yuan, and it is also unsalable in Fumantang. Cheng Chuantao also took a fancy to smart mattresses and a smart watch that could monitor the heart rate, body temperature, and number of nights of the elderly, but in the end they were not introduced, "these costs will eventually be transferred to the elderly, but the elderly in third- and fourth-tier cities have not yet been able to pay for smart products."
Even if some intelligent elderly care facilities are installed in the community, it is difficult to undertake follow-up services like a centralized elderly care community.
Qi Yinglin believes that in ordinary communities, decentralized home care for the elderly has increased the difficulty of laying smart devices, and even if emergency callers are installed, community workers rather than doctors and nurses respond, making it difficult to provide assistance to the elderly in the first place. Only when the demand is relatively concentrated, it is possible to organize a large number of resources to serve the elderly, "the elderly do not want that (intelligent) thing, but the follow-up professional support services provided by people."
The pension model of Kyowa Futahashi Home is called "Housing for the Elderly with Services" in Japan. But in both Japan and China, this model is far from the mainstream, and more elderly people choose to age at home. The Department of Aging and Health of the National Health Commission has summarized the mainland pension model as a "9073" pattern, with about 90% of the elderly living at home, about 7% of the elderly relying on community support for the elderly, and 3% of the elderly living in institutions.
Zhang Sifeng bluntly said that like most intelligent pension products, the centralized pension model is currently difficult to promote, also because it does not match the payment ability of the elderly and the concept of pension, "out of social reality".
It is rare to see local elderly people under the age of 80 at Fumantang Nursing Center, and most of the elderly people Cheng Chuantao comes into contact with are over 70 years old and still need to work at home to cook and take care of their grandchildren. Some elderly people found Cheng Chuantao and wanted to come to the nursing home, but the children disagreed, "saying that it was to honor the elderly, but the old people themselves knew that they didn't want to lose a free nanny."
Neglected needs of disabled older people
In addition to the concept and ability to pay, there is another problem that is often ignored - in the face of intelligent pension, there are a large number of elderly people who can only passively accept services. Are they satisfied? This question is often not answered accurately.
Holding a smart portable bathing machine, Cheng Chuantao scrubbed up and down for 15 minutes for an elderly man in the hospital who had been bedridden for a long time and could not turn over.
Severely disabled older people often have consciousness and slurred speech. At the end of the trial, Cheng Chuantao asked the old man to use the number of blinks to express his feelings, the full score was five stars, the old man blinked four times, where did the remaining one go? Cheng Chuantao asked and answered himself - probably not as comfortable as a shower.
Among the service objects of intelligent elderly care, the disabled elderly are a special group, and their daily life and medical care must rely on the help and care of others. But at the social level, the disabled elderly are often in a state of invisibility.
As a technology company focusing on intelligent care for the disabled, Cai Yitong, assistant to the chairman, told the Southern Weekend reporter that one of the major difficulties in the promotion of the product is that the exposure is too low, the care of the disabled group cannot be widely valued, and the new concept of "intelligent nursing" has not yet formed a business format. "As a smart nursing track aimed at the disabled elderly with science and technology, it originally originated from the fact that the founding team members had the experience of taking care of the disabled, and then found that there was still a gap in the intelligent care products and enterprises for the disabled people in China. ”
The intelligent urine and urine care robot can automatically process the excrement of the disabled elderly. Photo courtesy of the interviewee
At the same time, there is also the need for elderly care for the disabled. "The primary need of the elderly with dementia is health care, and at the same time, attention should be paid to the improvement of spiritual comfort and mental state. During the investigation, Zhang Zeyan found that due to limited mobility, the disabled and dementia elderly have long lacked communication and socialization, and their needs for spiritual comfort are higher than those of the general elderly.
Cheng Chuantao believes that under the "9073" model, 7% of community pensions mainly solve the problem of self-care for the elderly, and 3% of pension institutions must face the rigid needs of the disabled elderly.
According to the health status (self-care-semi-disabled-disabled) and income (low-income-middle-income-high-income), Zhang Sifeng divided the elderly into nine types, and proposed that the semi-disabled and disabled elderly are the key objects of old-age services, and the semi-disabled and disabled elderly with low and medium income should be the key objects of government funding and social attention. "In the future, the development direction of the intelligent pension industry should also concentrate resources on the disabled elderly, develop high-intelligence elderly care robots on the supply side, improve the payment ability of the elderly on the demand side, and make efforts at both ends of high-tech and popularization. ”
"The essence of pension is money and health, and one of them can solve most of the pension problems. With neither money nor healthy old age, pension is the most difficult problem. Cheng Chuantao said.
Cai Yitong said that from the perspective of supply, the research and development of integrated intelligent robots can not be achieved overnight, and it is necessary to develop a one-stop intelligent nursing cabin that solves the six nursing needs of the disabled elderly, such as convenience, bathing, eating, getting in and out of bed, walking around, and dressing, from the initial hardware equipment, to the combination of software and hardware, and then to the formation of a big data platform.
In the movie "Robot and Frank", Frank, who suffers from Alzheimer's disease, and the robot become friends. In Shuangqiao Gonghe Home, there are elderly people with dementia who no longer recognize their children, but they regard the caregivers they take care of every day as their youngest sons, and there are elderly people with dementia who shout the names of the caregivers before they die, hoping to see him. "The end of intelligent pension is not to let machines replace people, nor to completely hand over pension to robots. Palliative care, such as irreplaceable humanistic care services, still requires human participation. Zhang Sifeng said.
• (Zhang Song and Zhang Xia are pseudonyms in the article)
Southern Weekly reporter Huang Siqi and Southern Weekly contributing writer Xi Lijie
Editor-in-charge: Cao Haidong