Reporter investigation: Parents want to care for the elderly at home, who will provide professional care?

Editor's note

Not long ago, Jiangsu Province announced the results of the provincial elderly care professional and technical qualification evaluation committee, and the province (and the first batch of the country) 168 elderly care professional and technical personnel were released. According to the evaluation of the industry, the elderly care practitioners can evaluate the title, which is the practical need of the elderly care industry to accelerate the training of high-quality and compound professional and technical talents, and will also enhance the professional honor, responsibility and sense of belonging of practitioners, and realize the continuous improvement of elderly care services with higher professional quality.

As the aging of the population in mainland China continues to deepen, it is urgent to expand the team of skilled talents in elderly care. Relevant data show that there is a potential demand for elderly care workers in mainland China is more than 10 million, but there are only more than 300,000 practitioners at present, and there is a huge gap. An important reason for this problem is that the social status of the elderly care industry has not been high for a long time, especially the low recognition of some young people, resulting in the lack of "fresh blood" inflow in this industry.

How to give full play to the role of talent motivation and broaden the career space of senior service talents? "Rule of Law Daily" focuses on these issues and launches special reports to help build a social system that provides pension services. Stay tuned.

Comics: Li Xiaojun

"In a year and a half, three people took care of my father, and a lot of money was spent, and there was no reliable pension service. Li Xue (pseudonym), who lives in Chaoyang District, Beijing, recently reluctantly told a reporter from the "Rule of Law Daily".

Li Xue's father, who is in his 80s, lives alone in a neighborhood near his daughter's home. Li Xue was not in good health and could not take care of her father, so she wanted to send her father to a nursing home, but her father was unwilling to go because of the difficulty of leaving his old home, so he could only agree to his father's home care. But what puzzled Li Xue was that it was too difficult to find a reliable caregiver.

According to the National Bureau of Statistics, by the end of 2023, there were 296.97 million people aged 60 and above in mainland China, accounting for 21.1% of the national population, of which 216.76 million were aged 65 and above. Correspondingly, by the end of 2023, there will be a total of 8.201 million elderly care service beds in the country.

This means that even if all the elderly care service beds in the country are full, they can only accommodate about 3% of the elderly aged 65 and above, and the vast majority of the rest of the elderly still need to care for the elderly at home.

Experts interviewed by reporters believe that whether it is the actual situation of the construction of pension service beds in the mainland or the willingness of the elderly to provide for the elderly, it shows that the vast majority of the elderly are willing to care for the elderly at home. However, in terms of providing old-age services for the elderly at home, the mainland has not yet formed a team of old-age service talents with appropriate scale, reasonable structure, and both moral and technical skills, resulting in the inability to provide life care, rehabilitation care and other old-age services for the elderly at home.

The interviewed experts suggested that the mainland urgently needs to carry out supply-side reform in the pension service industry, and it is necessary to build a social system to provide pension services in the top-level design, especially to create a third-party platform supported by the government and market-oriented operation, so as to open up the source channels of elderly care workers and provide professional one-to-one or one-to-many elderly care services to families in need. At the same time, the establishment of vocational training, title promotion, treatment and other supporting systems, expand the source of pension service talents, including pension care workers, broaden the career space of pension service talents, and improve the social status of pension service talents.

Claims to be experienced

Actually, nothing

Li Xue, who is in her 50s this year, has retired and has been in poor health and often needs to go to the hospital for recuperation. Her husband is a middle-level cadre in a public institution and is busy working all year round.

What makes Li Xue feel relieved is that although her father is old, his body is still quite strong, and he can still take care of himself. The only thing she can't worry about is what to do if her father, who lives alone, stumbles and falls. She once offered to let her father live with her, but his father refused, feeling more comfortable living alone. She also proposed to send her father to a nursing home to be cared for by elderly care workers, so she went to Beijing and surrounding nursing institutions for field visits, but her father felt that living in a nursing home was more unfree, so he refused.

Seeing that her father was getting older and older, Li Xue accepted the fact that her father was willing to care for the elderly at home, and instead offered to ask someone to take care of her at home. At the beginning of last year, after repeated communication, my father finally agreed to hire someone to take care of him.

Li Xue found that it is difficult to find someone to take care of the elderly in society, and it is difficult to find a nanny with high professional quality like a nursing staff in a nursing institution, so you can only find a nanny who can take care of the elderly, "but it is not easy to find a nanny who can take care of the elderly."

Li Xue's community has a social group for housekeeping services, and she posts her needs to the group, and soon a staff member of the housekeeping company contacts her. After paying more than 2,000 yuan for the service, the housekeeping company recommended a woman in her 50s, who said that she was experienced in caring for the elderly, could cook, and was good at making pasta.

Considering that her father can take care of himself, and finding a nanny is to help with simple life care such as cooking, laundry, and nursing, Li Xue quickly signed an agreement with the housekeeping company and the nanny, paying 4,500 yuan per month, and the nanny working 26 days a month.

But a few days later, when Li Xue went to visit her father, she found that the nanny made noodle soup for the old man every day, and would not adjust the cooking for the old man, such as boiling porridge and stewing rice and stir-frying. She also found that because the nanny didn't eat at night, she steamed some steamed buns, and when the elderly needed to eat, they would eat them hot. In addition, the nanny does not clean up the housework very much, rarely accompanies the elderly downstairs for a walk, and does not take care of the elderly as the housekeeping company says.

Li Xue asked to change the nanny, and the housekeeping company recommended another one, still introducing that she had rich experience in taking care of the elderly. But in Li Xue's view, the second nanny doesn't know anything, and she has nothing to do with the experience of caring for the elderly. Once, she saw the nanny breaking up the cold steamed buns and throwing them into a bowl of boiled water while cooking dinner, so she asked the other party what she was doing. The nanny said that if you add some pepper oil to the bowl, it will taste delicious. She was "depressed." Another time, she went to visit her father in the afternoon, and after knocking on the door for a long time, it was his father who opened the door. When she saw it, the nanny was still sleeping in her room.

Li Xue immediately contacted the housekeeping company and asked for another replacement. The housekeeping company recommended a third nanny, who is quite simple, but doesn't know how to cook at all. Li Xue found that it was difficult to find a nanny who could take care of the elderly, so she had to start teaching the nanny to cook. She also found someone to install a camera in the living room of her father's house, so that she could see her father's situation at any time.

There are not enough beds for the elderly

Young people are less employed

Mr. Zhou, who lives in Shunyi District, Beijing, is also troubled by the lack of a professional caregiver for the elderly. Mr. Zhou's father, who is in his 80s, suffers from Alzheimer's disease, commonly known as Alzheimer's disease, and has no ability to take care of himself.

Mr. Zhou found a couple to take care of the elderly through a housekeeping company for 9,000 yuan a month. "The housekeeping company said that they were very good at taking care of these elderly people, but they didn't. Mr. Zhou told reporters that the couple would have neither life care nor medical care. They always try to save trouble when cooking for the elderly, making a lot of food in advance and freezing it in the refrigerator, and taking it out to heat it when needed, which leads to malnutrition in the father. They didn't know how to replace the ordinary bed with a nursing bed, nor did they know how to use a nursing mattress, and they didn't often clean and care for the elderly, which caused their father to get bedsores, which did not get better again and again.

Mr. Zhou asked for a change, but the few nannies recommended by the housekeeping company were not satisfactory. "My dad is an elderly person who can't take care of himself, and I wanted to find a nanny who understands medical care, but I haven't been able to find it. Mr. Zhou said.

The problems encountered by Li Xue, Mr. Zhou and others are not unique.

Wang Li (not her real name) is a manager at a chain housekeeping company in Beijing. According to its introduction, the housekeeping company provides nursing services to the elderly, and the prices of caregivers are 5,000 yuan to 5,500 yuan, 6,000 yuan to 6,500 yuan, and 6,500 yuan to 7,000 yuan per month according to the degree to which the elderly can take care of themselves, semi-self-care, and inability to take care of themselves.

Wang Li said that the demand for elderly care services of housekeeping companies is particularly large, accounting for more than 50% of the business volume of housekeeping companies, in this case, customers can basically find nannies, but it is difficult to find nannies who understand both nursing skills and professional ethics. Because most of the nannies are between 50 and 60 years old, and most of them have junior high school education and below, their service level and service awareness are difficult to keep up with the service demand.

In fact, caring for the elderly is a very professional job, including life care, meal assistance services, bathing services, cleaning services, walking services, medical assistance services and a series of contents.

According to Wang Li's observations, most people under the age of 50 are willing to work in higher-paying jobs such as childcare and sister-in-law, and few are willing to choose to care for the elderly, and she rarely sees young people doing this work, let alone young people with professional nursing skills, unless they are in nursing homes.

There is a shortage of nursing staff

The age structure is on the older side

However, pension institutions also have their own pain points, mainly because they cannot retain young pension service personnel.

Ms. Wang, 90, lives in a nursing home on the edge of Beijing's North Fourth Ring Road. Since the Spring Festival this year, she has been to the hospital more than a dozen times, and her health is getting worse.

In Ms. Wang's opinion, although the cost of staying in a nursing home is high, she can eat three meals a day well and ensure her own safety with the care of nursing staff. But she just wasn't used to the collective life of the nursing home, "not feeling at home".

"If you live in a nursing home, you have to obey the management regulations of the nursing home, live a collective life, you have to get up when you are told to get up, you have to eat when you are told to eat, and you can do whatever you are told to do. You say I want to eat noodles today and drink porridge tomorrow, that's impossible, nursing homes have fixed recipes. Ms. Wang said that she used to be very free at home, sleeping until what time she wanted, eating whatever she wanted, and going out whenever she wanted.

In Ms. Wang's view, the young nursing staff in the nursing home moved too fast, and she finally got to know them, but it didn't take long for them to leave and then change to a new one. The nursing staff also rarely took the initiative to chat with her, "they are few and busy, they have to take care of all of us, and after a few words with me, they go to work on other things."

Ms. Xiao works as a health doctor in a nursing home in Zhumadian City, Henan Province, where it is difficult to recruit young caregivers, and even if they do, they cannot be retained, and most of the women who are willing to do the work of caring for the elderly are 40 to 50 years old, and the education level is not high.

Li Pingping, 30 years old this year, is the head of a pension institution in Chaoyang District, Beijing. Nine years ago, she graduated from a university majoring in pension service and management, and 80 people graduated from two classes to enter the pension service industry. Nine years later, there are less than 10 people like her who still insist on working in the pension service industry, and the rest have changed careers.

Mr. Liu, from Nanjing, Jiangsu Province, once ran a nursing home where the average fee for the elderly was 2,000 to 3,000 yuan a month, but it closed down after only two years. "It's hard to get the right caregivers and managers without paying a high price, and we often have to rely on migrant workers over the age of 45 to provide care and care services. ”

According to the special survey report on the status of senior service talents jointly released by the China Research Center on Aging Science and the Pension Industry Association of the Xinjiang Production and Construction Corps in 2023, the senior service talents are mainly women, and the age structure of the talent team is large, with 56% of respondents in the age group of 41 to 55 years old. Elderly care workers are the main body of elderly care service talents, among the respondents, elderly care workers accounted for 53.6%, and 85.6% of the interviewed elderly care service institutions believe that elderly care workers are the most scarce.

According to the survey, one of the reasons for the shortage of elderly care workers is the low satisfaction of pension service personnel with salary income - 40.1% of respondents think that the salary level is average, 17% of the respondents think that the salary income is low, and 8.4% of the respondents think that the salary income does not match the workload.

Tired from work and low salary

Lack of development prospects

Chen Jia (pseudonym), 29, has been working in the pension service industry for more than 5 years, and he has a deep understanding of the high workload and low income of the pension service industry.

Chen Jia graduated from a technical college in Shaanxi Province in 2019 with a major in rehabilitation therapy, first worked in a local elderly care institution, and in 2022, she was hired to work in a nursing institution in Xicheng District, Beijing, which has nearly 100 elderly care service beds and an occupancy rate of more than half.

Chen Jia's main job is to monitor the health of the elderly, and coordinate the provision of services such as pedicures, haircuts, bathing assistance, meal assistance, and medicine collection for the elderly in the vicinity.

Chen Jia's first door-to-door service was to help an old lady go downstairs. A few years ago, the old man because of a sudden illness caused by inconvenience in his legs and feet, the residential building where he lived did not have an elevator, although he lived on the second floor, but he had not gone downstairs in the past two years, and one of her great wishes was to be able to go downstairs and walk around. In April 2023, it is the season of spring flowers, and after learning about the wishes of the elderly, Chen Jia discussed with her family members and the nannies of the elderly to carry the elderly from their homes to the first floor, and put them in wheelchairs to a nearby park to go for a walk. After that, Chen Jia and others sent the elderly home.

More often, Chen Jia feels hard and "very tired" - as a nursing assistant, it is the norm to work night shifts, and it is a night shift that does not sleep all night, because it is necessary to pay attention to the call ringtones of the elderly at any time. The elderly are prone to sudden illnesses in the middle of the night, so they should be inspected from midnight to early morning.

One night, an elderly man was fine at dinner and slept normally, who knew that he had a sudden asthma at one o'clock in the night. Chen Jia happened to be on the night shift, and he contacted the doctors of the cooperative hospital, and under the guidance of the doctors, he urgently took measures such as oxygen inhalation, blood pressure measurement, and blood sugar measurement, and at the same time contacted his family. The family decided to send the elderly to a nearby hospital for rescue, Chen Jia quickly dialed 120, the ambulance arrived, he accompanied the elderly to the hospital to hang up the emergency department, arrange hospitalization, two hours later, the family members of the elderly rushed to the hospital to take over.

On another occasion, an elderly man fell ill at around 3 a.m. Chen Jia was sent to the hospital for treatment with the consent of his family, and because of his critical condition, he was transferred to the hospital twice in a row, and finally operated on the elderly in a tertiary hospital until he returned to the nursing home at 5 p.m., during which he assisted the family to communicate with the doctor about treatment and surgery.

When asked about her income, Chen Jia was a little embarrassed: "Our salary is a little low. According to him, after deducting the five insurances, the salary he got was four or five thousand yuan. Because of this, he found that many young people could not endure this hardship, and felt that the elderly care service was "serving people", and left after working in the nursing home for a period of time, "In the nursing home where I live, the mobility of nursing staff is quite large."

In February, Ms. Chen also left the nursing home. After the Chinese New Year, he found a new job at a local elderly care facility in Shaanxi.

Taking Beijing as an example, Li said that the monthly salary of nursing staff employed by nursing institutions is four or five thousand yuan, and the work of nursing homes is divided into day shift and night shift, "night shift is particularly hard, because some dangerous situations are prone to occur at night, such as the elderly falling, choking, falling from bed, and acute lesions such as cerebral infarction and heart failure, and it is necessary to pay attention to the physical condition of the elderly in time, and it is the norm for nursing staff to stay awake all night." ”

The above-mentioned survey report also shows that improving treatment is the highest demand for pension service talents. For example, 71.1 per cent of respondents raised their salaries. Another 30.6% of the respondents said that there was a lack of career advancement paths, and 42.9% said that there was a lack of professional guidance in their careers. The issues of career benefits, career promotion and career development need to be given due attention.

Nurturing a professional team

Increase the supply of systems

A question arises, what is the reason why it is difficult for the current elderly care service staff to meet the needs of home care?

Tang Jun, a researcher at the Social Policy Research Center of the Chinese Academy of Social Sciences, believes that the main reason is that the design direction of the mainland's previous pension service system has deviated.

Tang Jun explained: "Before this, we believed that the elderly were mainly in nursing institutions, so the idea of designing the elderly service system focused on the construction of elderly service institutions. But in fact, the vast majority of the elderly are not willing to go to nursing institutions for the elderly, but are in a state of home care. When we visited foreign countries, we also found that more than 95% of the elderly in developed countries live at home, and in fact, no country in the world has built enough capacity to build up elderly care service institutions to meet the needs of all elderly people. ”

In his view, since home care for the elderly is the norm, that is to say, the design of the mainland's pension service system should focus on how to meet the service needs of the elderly for home care. Home care for the elderly mainly needs three aspects of security, namely old-age security, medical security and long-term care security, but the mainland's system supply, pension service facilities, and pension service personnel have not kept up in time, and are still far behind the actual needs.

The interviewed experts believe that in terms of system supply, there are indeed "shortcomings" in the top-level design, such as there is no special legislation for pension services at the national level, the institutional framework to meet the needs of home care has not yet been established, and the government investment guarantee is insufficient.

In addition to the system supply has not kept up, Gao Yunxia, deputy dean of the China Philanthropy Research Institute of Beijing Normal University, believes that the supply of senior service talents has not been well realized in a professional and professional way, especially the supply and demand of home care services have not been well matched.

She observed that especially in the supply of pension service talents, the overall treatment of the pension service industry is relatively low, the social recognition of pension care workers is also relatively low, and the sense of professional identity is relatively poor, making it difficult to attract professionals including young people to join the pension service industry. In addition, the lack of career advancement for elderly care workers has led to a high attrition rate across the industry.

The interviewed experts believe that it needs to be emphasized that pension service is a professional work, and it is matched by the need to cultivate a professional pension service team.

In Tang Jun's view, the elderly care services needed for home care can be used by the word "care", which includes three meanings, the first is life care, the second is rehabilitation and nursing (not pure medical rehabilitation care) that is inseparable from life care, and the third is elderly care, with the support of professional institutions and community platforms, informal caregivers and professionals provide care services for the elderly in need.

Tang Jun called for the need to build a social system to provide pension services in the top-level design, especially to create a third-party platform supported by the government and market-oriented operation, and to form a new pension service system supported by platform institutions, supported by the community and based on home.

He also suggested that, on the one hand, the organization of various human resources in the society, the implementation of regular and professional training, the establishment of a sound occupational security system, the formation of a new force to provide pension services, to provide pension services for the elderly at home; on the other hand, the elderly at home through the platform terminal or pension service agency terminal, put forward one-to-one or one-to-many pension service needs.

In terms of building a team of pension service personnel, Li Chao, a professor at China University of Political Science and Law, believes that according to the "14th Five-Year Plan" for the development of national aging undertakings and pension service system, it is necessary to improve talent incentive policies and broaden talent training channels. Encourage the employment of elderly care workers who have obtained vocational skill level certificates, promote the professional development of the industry, improve the salary and social insurance policies of elderly care workers, strengthen the incentive orientation of skill value, and promote the reasonable increase of the wages of elderly care workers. Support local governments to explore the inclusion of high-skilled pension service practitioners in short supply in the industry into the talent catalog, points settlement, citizen treatment and other policy scopes for preferential treatment.

"In terms of talent training paths, production, education and research are combined. Guide ordinary colleges and universities, vocational colleges, open universities, adult colleges and universities to increase the cultivation of senior service talents. Promote school-enterprise cooperation in the training of vocational caregivers, cultivate a number of industry-education integration pension enterprises, and support the joint construction of pension service training bases. Li Chao said.

In Gao Yunxia's view, the stability of the scale of the pension service personnel and the improvement of the treatment of the pension service industry are inseparable from the improvement of the pension service security system for the elderly and the protection of the law. Therefore, while accelerating the construction of the basic pension service system, the mainland should speed up the process of special legislation for pension services.

Digital technology empowerment

Accelerate model innovation

With the deepening of the aging society in the mainland, the reduction of the working population has become an inevitable trend for a period of time. In this regard, the interviewed experts believe that the digital empowerment of elderly care services should also become a trend.

Li Chao believes that from the perspective of technology integration, the pension model can be divided into traditional pension models (such as home pension, institutional pension, etc.) and new pension models (Internet + pension, wisdom pension, etc.), the rise and development of the new pension model benefits from the integration of digital information technology and traditional pension industry in the mainland, accelerating the innovation of the pension model.

In Li Chao's view, at present, the mainland wisdom pension has a low degree of informatization and intelligence, insufficient product "wisdom", the lack of unified standards and immature development of the wisdom pension industry, the information management of the elderly is not standardized, etc., the future wisdom pension service should achieve effective coordination between the supply side and the demand side, the introduction of products and services that are more in line with the needs of the elderly, the need to establish and improve the institutional system, support the rapid development of the wisdom pension industry.

Tang Jun believes that intelligent elderly services are based on the international consensus on healthy aging, and provide a fast and efficient modern service system for the elderly and elderly service institutions at home by means of cutting-edge technologies and information technologies such as intelligence, robots, networking, Internet of Things, big data, and cloud computing.

"However, it is important to note that the comforting nature of care work limits the potential for robots and other technologies to replace human labor. In most cases, smart elder services must be closely integrated with person-to-person services to make a real difference. Tang Jun said.

Li Chao suggested that the digital empowerment and Internet + services of the elderly service industry can meet the nursing needs of the elderly at home with the application of new technologies such as intelligent nursing and care robots. The pension service industry may require enterprises to continue to innovate and discover the innovation of business models.

She believes that government encouragement, support and supervision are indispensable. In terms of policy, the government should guide and support the scientific and technological content of nursing services, and encourage pension service institutions and pension service personnel to actively participate in Internet + nursing services by providing financial subsidies, tax incentives and other policy means; In terms of technology research and development, through big data analysis and artificial intelligence and other technical means, we can accurately match the needs of elderly care service resources with the needs of the elderly at home.

Zhao Zhao, a practitioner in the aging industry, also believes that the digital technology assistance of the pension service industry is an inevitable trend. With the deepening of the aging of the mainland, in the future, the overall size of the working-age population is shrinking, correspondingly, the scale of the pension service staff will also be reduced, at that time, the shortage of pension service personnel will become an inevitable, and the population in need of pension services is relatively increasing, to make up for the gap may need to rely on digital technology to replace.

Zhao Zhao believes that if digital technology, including intelligent pension service robots, is introduced into the pension service industry, for a long period of time, it will be more about the combination of pension service personnel and intelligent robots, that is, the combination of man and machine to provide pension services for the elderly at home, and at the same time carry out digital education and publicity for the elderly to help them overcome their resistance to cold robots.

Author: Chen Lei, all-media reporter of the Rule of Law Daily