The financial burden of hiring someone to care for the elderly is heavy The reporter investigates the plight of caring for the disabled elderly

About 4 meters from the east wall to the west wall, and about 4 meters from the south wall to the north wall, in this room with an area of about 16 square meters, a wheelchair is parked at the entrance, and against the wall is a nursing bed about 1 meter wide and 2 meters long, which is almost all the living space of Mr. Zhou, a resident of Shunyi District, Beijing. Only when the weather is good can he sit on a chair at the door and bask in the sun.

Mr. Zhou, 86, is an elderly person with a disability who needs to be cared for by others for eating, dressing, and going to the toilet. Since the nursing home near his home does not accept the disabled elderly, Mr. Zhou's children still have to work every day, so his family has to hire a nanny to take care of him at home. And nannies who know how to care are usually difficult to find, and they have changed four or five back and forth. It is inconvenient to go to the hospital when you are sick, so you can only go to the hospital to register with the doctor after your family members have taken photos and videos. "One person is disabled, the whole family is unbalanced", talking about taking care of his disabled father, Mr. Zhou's son Zhou Ming (pseudonym) sighed.

According to the Fifth Sample Survey on the Living Conditions of the Elderly in Urban and Rural China, 11.6% of the elderly with disabilities like Mr. Zhou in mainland China currently account for 11.6% of all the elderly. It is estimated that by 2035, the number of disabled elderly people in the mainland will reach 46 million, and by 2050, it will reach about 58 million.

Caring for the disabled elderly is a rigid need for elderly care services, and it is also where many people are anxious about elderly care. Solving the problem of caring for the disabled elderly and responding to the demand for super-large model care services is related to the overall development of the country and the well-being of hundreds of millions of people.

Experts interviewed by reporters believe that solving the problem of caring for the disabled elderly is a systematic project, and with the deepening of the aging of the population and the change of family structure, it is difficult to meet the needs of all disabled elderly people by relying solely on family care. Therefore, it is recommended to amend the Law on the Protection of the Rights and Interests of the Elderly and other relevant laws and regulations, and further refine the specific responsibilities of the family, the government and the society in the care of the disabled elderly, such as increasing the support policies for family care and clarifying the government's investment and regulatory responsibilities in the construction of the social pension service system.

After disability, it is too difficult to find a professional caregiver with limited mobility

When the reporter saw Mr. Zhou, he was lying on the nursing bed in pajamas, and the nanny was standing in front of the bed, holding a bowl in one hand and a spoon in the other, feeding him.

Zhou Ming revealed to reporters that his father's life after his disability was basically eating and sleeping. Every morning at 7 a.m., when Mr. Zhou wakes up, the nanny will first change his urine pads, scrub his body and change into underwear, and then carry him to a chair to rest. At around 10 o'clock, the nanny fed him, and due to the deterioration of his chewing function, Mr. Zhou had difficulty eating, and a meal usually took more than an hour. When the weather is nice, my father will sit at the door and bask in the sun, but more often than not, the nanny will carry him to the bed and lie down. At six or seven o'clock in the evening, my father had another meal, and then slept until the next morning.

"This is the fourth time I've hired a babysitter, and I don't know how long I can do it this time." Zhou Ming said with emotion that since his father was lying in bed, finding a nanny who could take care of him has become a major problem in his life.

Zhou Ming recalled that in 2019, his father's ability to take care of himself was fine, but there was a problem with his cognition, and he didn't know how to go home when he left home, so he spent more than 5,000 yuan a month to hire a nanny. A year later, Mr. Zhou had difficulty walking, and his legs were injured, making it increasingly inconvenient to get in and out of bed, so he could only rely on people to support him, and he could only lie in bed most of the time. Since 2021, his health has deteriorated, and he needs to be fed for eating, helped to go to the toilet, and wiped for bathing......

"The doctor told me that my father's physical and cognitive abilities were declining, and he belonged to what is commonly referred to as a disabled elderly person." Zhou Ming said.

After Mr. Zhou became disabled, the nanny he hired was unwilling to take care of him and chose to resign because he needed help with everything. Zhou Ming could only find two nannies to take care of his father through a housekeeping company, and the monthly cost was 9,500 yuan.

"Housekeeping companies say they're good at caring for these seniors, but that's not the case." Zhou Ming said that the two nannies would neither provide daily care nor medical care. When they cook for the elderly, they always try to save trouble, make a large amount of food in advance and freeze it in the refrigerator, and then take it out to heat it when needed, which leads to Mr. Zhou's malnutrition. They did not know how to care for the disabled elderly, and they did not provide regular cleaning care for the elderly, which led to Mr. Zhou's bedsores, which were difficult to heal over and over again. Zhou Ming asked the housekeeping company to change people, but the few nannies recommended later were difficult to satisfy.

By chance, through the introduction of a neighbor, Zhou Ming met a nanny who worked as a nurse in the hospital, with a monthly salary of 8,000 yuan, and was responsible for taking care of Mr. Zhou for 6 days a week, with one day off (Zhou Ming and his wife took care of his father during the break). The nanny, who has experience in nursing, first suggested replacing the regular bed in the home with a nursing bed, and then suggested purchasing an inflatable wave nursing mattress. After a period of meticulous care, Mr. Zhou's bedsores were able to heal. Under the guidance of the nanny, Zhou Ming also equipped the home with many instruments: blood pressure monitor, nebulizer, oximeter, oxygen concentrator, sputum aspirator, etc.

Zhou Ming regretted that after the Spring Festival this year, the nanny resigned due to something at home. In desperation, he had to spend 12,000 yuan a month to hire a couple to live in his home and take care of his father around the clock from Monday to Sunday.

"My father's pension is not low, but it is basically used to pay for the babysitter." Zhou Ming said.

He was truly powerless to care for his father alone. Zhou Ming, who works at a unit near Beijing's southwest Third Ring Road, leaves the house at 7 a.m. every Monday to Friday and arrives home at 7 p.m. His father lives in Shunyi, and in the past few years, he has rushed back to Shunyi almost every weekend to visit his father, and he has no time to take his children on trips.

When asked why he didn't send his father to a nursing home, Zhou Ming admitted that there was no nursing home near his father's community that was willing to accept disabled elderly people, and he was unwilling to send him too far away from home. "My concept is also more traditional, and to be filial to the elderly, we should take care of them at home, not send them to nursing homes. What's more, in nursing homes, a caregiver often needs to take care of multiple elderly people at the same time, so it is not as meticulous as hiring a nanny to take care of them one-on-one at home. ”

Zhou Ming said frankly that it is easy to find a nanny, but it is not easy to find a nanny who understands nursing, and taking care of the disabled elderly requires a certain amount of physical strength. At present, the people who work as nannies are older, many of them are over 50 years old, lack of nursing knowledge and energy, and are not good at caring for the disabled elderly.

There are disabled elderly people at home, and there are many helpless places. For example, Mr. Zhou can only stay in bed and is usually unable to go to the hospital for treatment. Some time ago, Mr. Zhou's lips were pale, so Zhou Ming had to take photos and videos and go to the hospital to register for a doctor. Unable to conduct a detailed examination, he found doctors from several tertiary hospitals and prescribed a bunch of medicines, but the effect was not satisfactory.

"It would be great if there were nursing homes near the community that could take in the disabled elderly, how great it would be if there were doctors who could visit the disabled elderly at home, and how great it would be if the cost of family care for the elderly was not only borne by the family, but could be shared by many parties." Zhou Ming said with emotion.

Expenses have increased, burdens have doubled, and life is stretched

Even if you find the right babysitter to take care of the disabled elderly at home, it doesn't mean that you can completely worry.

Tian Xiaogang (pseudonym), who drives a taxi in Shijiazhuang City, Hebei Province, also hired a nanny to take care of his disabled father, Mr. Tian. Mr. Tian, 58, had been running a small business and had no social insurance, which meant that he had no source of income if he stopped working. A few years ago, Mr. Tian suffered a sudden cerebral hemorrhage, and although he was treated by the hospital, he was still left with hemiplegic sequelae and had to stay in bed.

Mr. Tian's wife, Ms. Chen, is 59 years old and has been retired for more than four years. Considering that his mother was too old to take care of his father alone, Tian Xiaogang found a nanny who did not live at home, worked six days a week (one day off), arrived at Mr. Tian's house at 8 a.m. every day and left at 6 p.m., at a monthly cost of 4,000 yuan.

The nanny gets busy as soon as she enters the house every day, making the bed, feeding (breakfast is prepared by Ms. Chen in advance), feeding medicine, changing clothes, helping Mr. Tian turn over every two hours, cooking and feeding at noon, cleaning and cleaning up the housework in the afternoon, and occasionally assisting Mr. Tian to go to the toilet and clean up the urine and urine with Ms. Chen. Because Mr. Tian is hemiplegic, half of his body can't move, half of his body can move, his language ability is limited, he is not willing to wear diapers, he will wet the bed if he is not careful, and the nanny has to clean the sheets and bedding from time to time.

However, Ms. Chen was not at ease with the nanny, and felt that she was the best to take care of her, so the nanny always worked with the nanny when she was at home, and even more so after the nanny left, she often had to help Mr. Tian get up several times a night. Ms. Chen often felt physically and mentally exhausted, and sometimes dozed off as soon as she sat down during the day.

"Mother's time is completely spent on father, and it is distressing to watch." Tian Xiaogang saw it in his eyes but couldn't do anything, after all, it is very difficult to find a local nanny who is willing and will take care of the disabled elderly, and the price of a live-in nanny is already a big burden for them, and the price of a live-in nanny is even more unaffordable.

Tian Xiaogang also wants to take care of his father, but because his father has no pension, his mother Ms. Chen's pension is only 3,000 yuan per month, which is not enough to pay for the nanny. Tian Xiaogang went out to run the car at five or six o'clock in the morning and was busy until the evening.

"It is necessary to support both the elderly and the children. In order to earn money, I basically didn't rest all year round. Tian Xiaogang said, "Whoever the disabled elderly fall into is a nightmare for whom." ”

Although some nursing homes are willing to accept the disabled wife of Zhao Tong (pseudonym), a resident of Kaifeng City, Henan Province, Ms. Li, Zhao Tong does not feel that life is easy.

Ms. Lee, 68, has been retired for 13 years and suffers from a variety of chronic diseases, including diabetes. Eight years ago, she had a cerebral infarction, and although she was cured at that time, due to her high blood pressure, high blood sugar, and high blood lipids, Ms. Li's cerebral infarction recurred every year, and her health became worse and worse. More unfortunately, in July 2022, Ms. Li fell while taking a shower in the bathroom and was hospitalized with a fracture. They had only one daughter, who lived in another city and could not rush over to take care of her mother.

Seeing that he couldn't take care of his wife alone, in desperation, Zhao Tong decided to send her to a nursing home after his wife was discharged from the hospital, 3,800 yuan a month, the cost was all-inclusive, and the daily necessities were uniformly equipped, and the remaining 7 disabled elderly people lived in a large open room, with three or four caregivers responsible for care.

When Ms. Li was first admitted to the nursing home, half of the expenses were reimbursed by the long-term care insurance provided to her by the employer, and her daughter paid the other half. But since her grandson started primary school in September this year, there are more and more places to use money, and it is difficult for her daughter to pay for this fee, and her pension is only 2,300 yuan per month. Most of the couple's savings are spent on buying medicine, and they can only save money on food, and their lives are stretched.

The family was exhausted and completely deprived of their own life

Li Juan (pseudonym), who lives in Jizhou District, Tianjin, takes care of her elderly mother, Ms. Wang, on her own.

After the Spring Festival this year, Li Juan heard from her mother that her leg joints were often painful and swollen, and she was unable to work in the field, and she suspected that she had arthritis.

Li Juan and her husband rushed to take her mother to a local hospital for examination, and the results showed that her mother had bone cancer. In order to comfort her mother, Li Juan told her that she had rheumatoid arthritis. Doctors ordered hospitalization for conservative treatment, including morphine injections for pain relief. The mother considered that the cost of hospitalization was high, and her pension was definitely not enough, and she didn't want to cause trouble to her daughter, so she insisted on going home for treatment. In desperation, the doctor had to agree and tell the patient to rest more and move less, and also prescribed a variety of drugs for treatment.

After returning home, Ms. Wang lay down on the kang to rest and take medicine on time, but her condition became more and more serious, and she was in pain all over her body when she moved, and she couldn't even turn over, let alone get off the ground.

For Li Juan, after her mother "lay down", her life was also disrupted. She is a teacher at a local school, and she reduces the number of classes she can reduce during the day, and after class, she returns to her mother to accompany her, cooks and feeds her mother, chats with her, bathes her, etc., and regularly goes to the hospital to prescribe painkillers to her. I slept on the big kang with my mother at night, and I would wake up at the slightest movement. She found that her mother often dragged her and nagged her, did not want to lie down every day, and looked forward to working in the fields every day. Gradually, my mother also felt that she was seriously ill, thought that she was dragging down her family, and even thought of suicide. She could only persuade her mother not to think nonsense.

Since taking care of her mother, Li Juan has rarely returned to her own home, and can no longer take her children out on vacation to travel as before, "completely without her own life".

Also having the same feelings as Li Juan is Wang Feng (pseudonym), who lives in Zhumadian City, Henan Province.

During this year's National Day, when the reporter met Wang Feng, who was in her 40s, she was pushing her father, who was nearly 80 years old, to walk her son home from outside, and with the help of her mother, she lifted her father from the wheelchair to the bed and covered it with a quilt. One day in October 2021, my father, who was in his 70s, suddenly suffered a cerebral hemorrhage and collapsed to the ground while loosening soil for a flower bed in the yard. Wang Feng hurriedly called the emergency number and sent his father to the hospital for treatment. After treatment, although my father's life was saved, he was left with the sequelae of hemiplegia, and the right half of his body could not move, and he could only lie in bed. Since Wang Feng did not go to work, the matter of taking care of her father mainly fell on her and her mother.

My father liked to go for a walk outside. Regardless of spring, summer, autumn or winter, every morning, as long as the weather permits, Wang Feng and her husband will help their father into a wheelchair and push him outside for a walk for an hour or two, while his mother cooks breakfast and cleans up the housework at home. After her husband went to work, she pushed her father home, and her mother fed her, and she went to rest after eating. In the afternoon, my mother accompanies my father while she cleans up the house and prepares dinner. After his father fell asleep after dinner, it was Wang Feng's own time, "only one or two hours a day, you can relax a little."

In the interview, more than a dozen respondents with disabled elderly people in their families said that they "have no life of their own", and that it is indeed "one person is disabled and the whole family is unbalanced".

The state attaches great importance to local promotion to alleviate anxiety about elderly care services

The interviewed experts believe that the absolute number of disabled elderly people has become an important national condition that we cannot ignore, and it is of great significance to solve the problem of caring for the disabled elderly.

Li Chao, a professor at China University of Political Science and Law, believes that as far as the individual elderly are concerned, through professional care services, they can ensure that the basic life of the disabled elderly is properly cared for, meet the basic living needs and spiritual needs of the disabled elderly, improve the quality of life of the elderly in their later years, and safeguard the dignity and rights and interests of the elderly. As far as the family is concerned, the care of the disabled elderly is not only the needs of the elderly themselves, but also directly affects the quality of life of family members.

"At the social level, respecting, respecting and loving the elderly is the traditional virtue of the Chinese nation, and by providing high-quality care services, more elderly people can enjoy their old age in peace. At the macro level, the development of care services for the disabled elderly can lead to the development of the silver economy. Li Chao said.

Gao Yunxia, deputy dean of the China Philanthropy Research Institute of Beijing Normal University, believes that solving the problem of caring for the disabled elderly is actually to solve the problem of the elderly and their families.

The care of the disabled elderly is the top priority of the elderly care service in mainland China. The "National Medium and Long-term Plan for Actively Responding to Population Aging", "Opinions of the Central Committee of the Communist Party of China and the State Council on Strengthening the Work on Aging in the New Era", and "The 14th Five-Year Plan for the Development of National Aging Undertakings and Pension Service System" have been issued one after another, all of which include the care of the disabled elderly in the construction of the pension service system.

At the local level, in recent years, local governments have also actively introduced local regulations, rules and policy measures to strengthen care services for the disabled elderly.

In December 2023, the General Office of the Zhejiang Provincial People's Government issued the "Implementation Plan for Building a Multi-level Long-term Care Security System in Zhejiang Province" to build a multi-level long-term care security system for the disabled elderly in the province, forming a multi-level long-term care security system with policy-based long-term care insurance as the main body, Huimin commercial care insurance as a supplement, and other commercial nursing insurance, social assistance, social welfare and other systems in an orderly connection and common development, with the active participation of all market entities.

At the beginning of this year, Fujian Province issued the "Several Measures on Accelerating the Construction of the "Fujian Health Care" Happy Pension Service System", focusing on ensuring the basic and bottom line, strengthening the comprehensive protection for the extremely poor, low-income, elderly and disabled elderly, and ensuring that the basic old-age service system covers all the elderly.

The General Office of the Shandong Provincial Government recently issued the "Several Measures on Strengthening the Care Services for the Disabled and Demented Elderly", proposing to further strengthen the care services for the disabled and dementia elderly from four aspects: improving the ability assessment system for the elderly, improving the care service system for the disabled and demented elderly, optimizing the care services for key groups, and improving the quality of care services. Liaocheng City, Shandong Province, has specially issued the "Liaocheng Regulations on Care Services for the Disabled Elderly" to standardize the care services for the disabled elderly and improve the quality of life of the disabled elderly.

In this regard, Gao Yunxia believes that from the perspective of system supply, from the central to the local, the mainland has taken the disabled elderly as a key group of old-age services, and the care services for the disabled elderly as an important part of the old-age services, and introduced a series of relevant policy documents and supporting measures to strengthen and improve the care of the disabled elderly from all aspects.

Improve relevant laws and regulations and establish a pension service system

The mainland has a large elderly population and a rapid aging rate, so the task of coping with the aging of the population is heavy. With the increasing aging of the population, the problems of aging and empty nesting are becoming increasingly prominent, and the proportion of disabled and dementia elderly people is increasing year by year. According to the Fifth Sample Survey on the Living Conditions of the Elderly in Urban and Rural Areas in China, there are currently about 35 million disabled elderly people in mainland China, and the prevalence rate of the elderly is four times the average of the total population, and the survival time of the elderly is more than eight years.

The recently released "Report of the State Council on Promoting the Construction of the Pension Service System, Strengthening and Improving the Care of the Disabled Elderly" pointed out that in the face of the huge demand for disability care, there is still a big gap between the current work and the implementation of the national strategy of actively responding to the aging of the population and the care needs of the disabled elderly. On the one hand, the existing social assistance and welfare are narrow in scope and of low standards. The care needs of the elderly with financial difficulties and disabilities from ordinary families have not been effectively met, the elderly's ability to pay is generally low, and the problem of "where does the money come from" is more prominent. On the other hand, the supply of care is still insufficient, the basic pension service system is under construction, the layout of pension service facilities is unreasonable, and the phenomenon of "hard to find a bed" in the central urban area and a large number of idle pension beds in suburbs and rural areas coexists. The shortcomings of rural disability care are prominent, and it is even more difficult to care for the disabled elderly in rural areas.

In addition, the construction of nursing talent teams is lagging behind. The quality of elderly care workers is generally not high, the number is insufficient, the structural level is unreasonable, the sense of professional identity is poor, and the salary is low. The incentive mechanism for all kinds of pension service talents, including elderly care workers, is not perfect. The care of the disabled elderly involves many departments and coordination matters, and the overall coordination of policies also needs to be strengthened. The coordination mechanism for mutual recognition of the ability assessment of the elderly is not perfect, and the base number of disabled elderly is not accurate.

The interviewed experts believe that to solve the pension problems faced by the disabled elderly group, it is necessary to strengthen the top-level design, and the joint efforts and responsibilities of the government, families and the whole society are needed to increase the old-age security for the elderly and improve the social security and welfare system. This includes formulating and revising relevant policies and regulations, and establishing and improving the pension service system.

Zheng Xiang, a professor at Beijing Jiaotong University, said that the care of the disabled elderly has always been the most difficult part of the pension problem. The mainland is facing the practical problem of rapid aging of the population, and the core problem is where the funds and manpower to provide pension services will come from. The social reality of "growing old before getting rich" is the basic premise for us to deal with policy considerations.

Zheng Xiang believes that to solve the problem of care for the disabled elderly, the primary task is to do a good job in top-level design, break down institutional barriers, coordinate and unify policies, and establish a coordination mechanism for functional management departments and related system cohesion mechanisms, such as long-term care insurance system, social security system and pension subsidy system should be smoothly connected, and promote the formation of a joint force between pension services and social security and health support.

Gao Yunxia also believes that a coordination mechanism should be formed at the national level, such as further giving full play to the coordinating role of the National Office on Aging, coordinating multiple departments such as civil affairs, medical insurance, and health care, and systematically promoting the care service system, talent training and facility construction for the disabled elderly.

"Next, we should carry out accurate investigation of the needs of the disabled elderly as soon as possible, establish a screening system and evaluation system for the disabled elderly with communities and villages as the starting point, and find out the bottom number, so as to form an accurate long-term care service plan." Gao Yunxia said.

After finding out the base number of disabled elderly people, the question of who will take care of them needs to be solved.

Zheng Xiang suggested that from the perspective of the nursing talent team, it is urgent to solve the problems of small number of nursing staff, low professional level, low professional identity, low salary and high turnover rate. On the one hand, it is necessary to mobilize social forces to participate in the training and education of caregivers, and on the other hand, it is necessary to change social concepts, make care services professional and professional, respect the labor of care service personnel, and improve their welfare benefits.

Gao Yunxia proposed that in the construction of the nursing talent team, it can be regulated and guaranteed from the legislative level, and the standard requirements for the qualifications of professional talents and the corresponding professional treatment can be formed, which will be recognized in the national system. Specifically, it includes encouraging colleges and universities to open relevant geriatric care or service management majors, encouraging socialized vocational talent training from the social level through the support of educational supporting policies, and establishing national vocational certification standards and subsidy mechanisms.

In the interview, the reporter found that where the disabled elderly can care for the elderly is also an urgent problem to be solved.

"There is a shortage of supply and waste of resources in old-age service facilities, some of the service conditions are good, the cost of reasonable pension institutions beds is tight, and some of the suburbs or rural pension institutions tend to have a low occupancy rate. To change the unreasonable layout of old-age service facilities, it is necessary to set up old-age service facilities in places where there is a real need for elderly care. At the same time, we should respect historical habits, encourage the development of pension beds set up at home and in the community, so that pension services can be flowed, and various pension resources and pension needs can be accurately matched. In addition, from a technical point of view, the introduction of intelligent elderly care facilities, the transformation of the elderly for the elderly, and actively promote the development and application of artificial intelligence products that truly reduce the labor intensity of care services. Zheng Xiang said.

Li Chao analyzed that home care is the way for most of the elderly, but due to the change of family structure and the increase in the work pressure of young people, many families have limited ability to care for the elderly, especially for the disabled elderly, the cost of care and care is usually high, and some families can not afford the high cost, resulting in the disabled elderly can not receive adequate care.

In her view, the disabled elderly need professional nursing care, and their care responsibilities are usually borne by family members, nursing institutions or professional caregivers, which can be solved by multi-party cooperation and joint efforts. Family members can provide daily care and attention, including eating, dressing, bathing, etc.; Nursing institutions or nursing institutions can provide professional nursing services, including medical care, rehabilitation care, psychological care, etc.; Professional nursing staff, such as nurses and rehabilitation therapists, can provide medical consultation, rehabilitation guidance, psychological support, etc. The cost of care is generally shared between the family, the government and society.

The Law on the Protection of the Rights and Interests of the Elderly stipulates that the elderly should be provided for at home on the basis of home, and family members should respect, care for and care for the elderly. At the same time, it also clarifies the government's supporting role in the security of the elderly, that is, the state establishes and improves the family pension support policy to provide assistance for family members to take care of the elderly.

Li Chao suggested that although the family currently bears the main responsibility in the care of the disabled elderly, with the deepening of the aging of the population and the change of family structure, it is difficult to meet the needs of all disabled elderly people with the family as the main care. Therefore, it is suggested to amend the Law on the Protection of the Rights and Interests of the Elderly, and further refine the specific responsibilities of the family, the government and the society in the care of the disabled elderly, such as increasing the support policies for family care and clarifying the government's investment and regulatory responsibilities in the construction of the social pension service system.

Zheng Xiang said that considering the distribution of care responsibilities for the disabled elderly, it is still necessary to emphasize the basic responsibility of family support, but it is also necessary to recognize the practical difficulties faced by the disabled elderly and accurately assess their needs. For families with disabled elderly, the government shall provide appropriate financial subsidies, social organizations and volunteer service personnel to provide service assistance, and develop community-embedded elderly care service institutions to provide support for the disabled elderly and their families.

Title Picture | Yangcheng Evening News data map

Editor: Xue Renzheng