How China respects its elders

BEIJING — Confucius described old age as a ‘good and pleasant thing’ which caused you to be ‘gently shouldered off the stage, but given a comfortable front stall as spectator’. This honourable sentiment paints a melancholic image of how senior citizens should be treated, given peace in their twilight years while able freely to dispense their wisdom to younger generations.

Retirement homes are highly uncommon in rural areas of China where traditional entrenchment about the nuclear family is mainstream. ‘Placing your parents in retirement homes will see you labelled as uncaring or a bad son. To abandon one’s family is considered deeply dishonourable’, said Zhou Rui, a Guangxi native living in Beijing. Even in extreme circumstances, there seems to be little deviation from this belief. When tackling such degenerative illnesses as Alzheimer’s disease, most families would prefer hiring a permanent caregiver than to place their relative in a nursing home. ‘But since I live in Beijing for my work, and I am an only child, my mother has accepted to go into a home. Better to go against tradition than leave my mother all on her own’, says Zhou Rui.

Western societies have become increasingly uncomfortable with the view that retirement is the end of one’s useful contribution to society. In such settings, Confucius’ words may find little hold. In China, however, taking care of one’s parents is the lot of all children – failure to do so would mean a major loss of face for any family. From all sections of society, children receive consistent reminders that they owe everything to their parents and that they must repay this debt in full. This responsibility, and the ties it creates, is never better illustrated than in the massive human migration seen during the Spring Festival and National Day holidays, when people across this vast country visit their parents.

While this unity between the generations may seem eternal, two looming factors might disrupt it. The first is a direct result of the Communist Party of China’s (CPC’s) ‘one-child’ policy. Traditionally, parents were taken care of through having many offspring: sons and daughters who would all contribute to looking after their parents when they got old. Now, with only one child per family in towns and cities, or two in rural areas, the social attitudes of China are rapidly changing. Already, national media deplore the self-centred attitudes of the ‘xiao huang di’ (little emperors) generation who have been raised as only children and apparently have little respect or time for tradition, preferring instead to focus on improving their own standing.

The second potentially disrupting factor is simply that people are living longer than before. At the end of 2005, China counted 144million people over the age of 60 – that’s 11 per cent of its total population. While longer and healthier life is of course something to celebrate, and a testament to advances made in Chinese society in recent years, such a rise in the number of elderly people will also put a strain on the economy and society, both of which will have to readjust to compensate. While the ‘ageing question’ is rising the world over, China must also address problems all of its own. Recent efforts by the CPC to bolster rural healthcare and establish a better social security system have in part been motivated by a single realisation: many Chinese families are no longer able adequately to provide for their older members.

While the average life expectancy is steadily improving, China finds itself lacking in related areas: expert geriatric care; widespread knowledge of debilitating conditions such as Alzheimer’s; an understanding of the psychological conditions of the elderly.

These harsh realities mirror a rise in the importance of nursing homes, lone bastions of competent care for the elderly. Despite familial reluctance at placing their parents in such institutions, there is increasing evidence that these constitute a positive environment for China’s aged, where they can find companionship and professional care.

An unlikely example of this is nestled away from the hustle and bustle of Beijing, in a small, gated compound near Xizhimen. Ducking past restaurant staff enjoying their lunch break and the imposing inner courtyards of Maoist residential buildings, one comes across a pleasant garden belonging to the Zhanglan Road Community Home. Outside its entrance, five or six residents enjoy the springtime sun, the women merrily chatting while the men mull over a game of chess.

Tang Xiumin, a 70-year-old former kindergarten teacher, was asked by the local government to take over the home after her retirement 14 years ago. Since assuming her duties, she has worked ceaselessly to improve both the lives of the residents in her care and the wider understanding of what a retirement home can provide.

‘Zhanglan Road Community Home was set up and is financed by the local government itself’, explains Tang. ‘All residents here hail from the neighbourhood, usually with their families living close by.’

Visiting the Zhanglan Road Community Home, meeting its staff and seeing how content its residents seem would likely dispel many Chinese families’ fears that their parents may not be well taken care of. Although this is a relatively small retirement home, with only 20 beds, the organisation that runs it is very well-structured. It is one of three sister homes, each catering to old people who need differing levels of care. Zhanglan Road was the first to be set up and takes in relatively spry retirees who are largely able to take care of themselves. Alongside Tang, two nurses, two care assistants and one chef complete the staff roster, and they all seem to enjoy a very close bond with the residents. Furthermore, the home has a partnership with the local hospital, which offers both free monthly check-ups on site, and also instant intervention during any health emergencies.

The home has a two-tiered admissions system. The first tier is for those applicants who are childless, a description often used by Tang with a weary shake of her head. These individuals are taken in completely free of charge, and their entire upkeep is provided by the state. The second tier is for those whose children are too busy to look after them. In this case, the sons or daughters pay a monthly fee of 650 RMB directly to the local government, offering an affordable option to leaving their parents alone all day.

Tang is quick to point out that despite these advantages, misconceptions about the nature of a retirement home are still widespread. Consequently many residents are very uncomfortable when they arrive. Pangs of rejection and abandonment are common, particularly among widowers. Although the concept of psychological care is very limited in China as a whole, Tang and her staff have established a mechanism which seeks to educate both potential residents and families about life in a nursing home.

Zhao Yunhui, the home’s 91-year-old doyenne, spoke of her worries at feeling lonely or miserable – a sentiment exacerbated by the fact that she has no children. Prior to moving in, she suffered two heart attacks and was not thought likely to live much longer. Eight years later, she now shares a room with two long-standing friends and, although still very frail, she appears contented. Zhao’s roommate, 90-year-old Wang Xiuqing, laughs from her bed, and quips: ‘We have walking races, because none of us can run anymore.’

Tang has set up an open-doors policy, allowing families to visit at anytime. She has also organised collaborations with local schools and universities so that young people can come and spend time with the residents. The fact that this small home must service a vast community shows that there is still a social stigma attached to the idea of nursing homes, and Tang is taking measures to overcome that by opening the home to numerous visitors.

Wonderful as it is to imagine the Zhanglan Road model being copied across China, the reality is markedly different. At the end of last year, the State Council published a white paper entitled The Development of China’s Undertakings for the Aged. It set a number of bold and ambitious targets, including full insurance, adequate medical care and an increase in activities for old people. The plight of the aged in China will go hand in hand with that of migrant workers, with the improvement of rural healthcare and with the nationwide expansion of health insurance coverage. These three all represent areas into which the central government has poured funds of late, trying to gain a foothold.

The future for China’s elderly remains uncertain. As the population continues to age and the state moves to accommodate this trend, one would hope that more local governments set up their own homes. However, while this solution may be relatively easy to implement in urban centres, in the countryside it would require a veritable unification by all levels of government.

Chris Dalby is a freelance journalist who specialises in international relations and a regular contributor to China.org.cn in Beijing. Email him at: {encode=”dalbychristopher@hotmail.com” title=”dalbychristopher@hotmail.com”}.