Elders find non-governmental old folks' daily care centers well suited to their needs.	Zhang Defang, Chongqing Municipality's first centenarian, conducts fellow residents of the Huayan Old Folks' Home in Jiulongpo as they sing her "Happy Birthday."	Two elders survey the layout of an old folks' home. Senior care in certain areas is heading in the direction of chain operations and conglomerates.

GAO Yuhua has been living at the Beijing No. 1 Welfare Institute for 18 years. “I never considered living at a welfare institute. It seemed to me that, as I have sons and daughters to support me, why should I? I first started coming here in the daytime to join in the sing-songs and drawing classes. I enjoyed it more each day, and it distracted me from my illness.” Gao Yuhua was diagnosed with cancer 20 years ago, something her lively, cheerful demeanor belies.

Government-run Welfare Institutions

Gao Yuhua entered the Beijing No.1 Welfare Institute in 1989, but it was not until five years later that she actually moved in. Gao recalls, “It was after falling sick while alone at home that I decided it was time to live full-time at the institute. If ever I feel uncomfortable, I just press a button and a nurse comes within two minutes, and because of my illness, I’m served special meals.”

Gao Yuhua says that the majority of her fellows at the institute also had specific reasons for moving in there. Zhang Luzhi, director of the Institute, concurs, explaining, “Most seniors choose to live in retirement homes purely because they are unable to take care of themselves. The average age of residents at our institute is 82, and one third of them are widowed or childless.”

Wang Xueshu and Ji Yuliang chose to live in the welfare institute when their only son died. They live in an 80-sq m area. “Our food and lodging cost about RMB 4,000 (US $533) each month, which is inexpensive. We have no need to shop, cook or do cleaning. I no longer worry at night about what to do if my husband takes a bad turn, because there is a nurse on hand who will come the minute I call. This helps me sleep soundly each night, and during the day we spend our time having fun,” says Ms Ji, contentedly.

Having lived at the welfare institute for three years, Ms Ji now regards it as her home. On one wall hangs the big red Chinese “happiness” character, and on another are a dozen or so photographs of the couple at various scenic spots. "I like it here very much. The nurses come to see how we are each morning and evening, but are otherwise unobtrusive. We can come and go as we please and, unlike many other old people's homes, the gates here are open all day. The furniture in our rooms is simple, comfortable and practical, rather than resembling that in an hotel,” Ji tells us, with evident satisfaction.

The Beijing No. 1 Welfare Institute is invested and funded by the Beijing Municipal Government. Its current 510 beds will almost double when the second phase of construction is complete. Room renovations and upgrading of equipment, at an investment of RMB 66 million, began in 2002. “We do our utmost to make our residents feel at home,” says Institute Director Zhang Luzhi. The projected renovations include the construction of sunny leisure halls and various recreation rooms, expanded balconies, installation of a hot water supply, an emergency call service, and air-conditioning. New furniture and bedding are to be provided, and purchases of medical apparatuses specifically for elderly needs made. The Beijing No. 1 Welfare Institute is well reputed for its reliable service and nursing facilities. Director Zhang Luzhi tells us, “We stopped taking bed reservations long ago, but there are still more than 1,000 elderly residents waiting for a place at our institute.”

China’s senior citizen population stands at about 150 million, 5 percent of whom expect to live out their time in elderly caregiving institutions. This creates the need for 7.2 million beds. The 39,546 senior-care institutions in urban and rural areas represent a total 1.497 million beds, according to the Development of China’s Undertakings for the Aged white paper, published in 2006. This disparity in supply and demand obviously calls for serious action as regards future gray accommodation.

Non-Governmental Senior-Care Institutions

The government encourages non-governmental as well as government-run senior-care institutions. They are actually the sole alternative for seniors that are unable, for whatever reason, to enter government-run institutions. When her mother succumbed to senile dementia, career woman Chen Yue had no option but to find a retirement home that could provide the care she needed. After visiting a dozen such institutions in Beijing, she finally took her mother to a non-governmental home. After looking at several places, she made her choice based on its having the best environment and most up-do-date equipment. “It’s a bit far from where I live, but I chose it because of its reliable, professional old-age care,” Chen Yue explains.

Finding qualified geriatrists is a big headache for non-governmental senior-care institutions. One of the administration staff at the Xiying Old People's Apartments, which has prime location in a residential subdistrict, explains, “The main reasons why we chose to locate on an expensive downtown site is its close proximity to a hospital. Our residents find this extremely reassuring.”

Comfortable to the point of luxury, the Xiying Old People's Apartments resemble hotel guestrooms. “Our rates are relatively high compared to most retirement homes in Beijing. We charge RMB 3,000 (US $400) per month, which covers food and accommodation,” says Wang Qing, an apartment manager. “The government has exempted the home from several tax items and also partly subsidizes it, but we still operate at a loss.”

The Xiying Old People's Apartments have 150 beds, but only 30 seniors currently live there. Wang Qing explains, “Most of our residents are widowed. We are unable to provide the overall medical care offered by government-run retirement homes, by virtue of their affiliations with state-run geriatric hospitals (Which is the case with the Beijing No. 1 Welfare Institute). Our nurses are newly graduated, and therefore inexperienced. This restricts our business scope.”

Cheng Qinghua’s parents have lived in two non-governmental old folks’ homes. She tells us, “My decision as to which retirement home would suit my parents was, in addition to economic factors, based on whether there was a hospital nearby, and whether visiting my parents would be convenient.”

Home-based Senior Care

Beds in government-run welfare institutions being limited, and conditions in non-governmental institutions variable, a new home-based old-age care mode has emerged in Beijing.

The China Research Center Survey on Aging of 2003 indicated that 10 million seniors over the age of 80 need care, which a full 98 percent of respondents expect from their family.

“A new mode, featuring governmental support, non-governmental undertakings, marketized operation, professional service, and community participation supplemented by volunteers has taken shape, whereby the elderly continue to live at home rather than being placed in retirement homes,” explains Tian Ying, director of the Aging Affairs Office of the Yuetan Subdistrict Office. There are 27,000 seniors -- including 6,374 that are "empty-nested" -- living in the 26 communities under its jurisdiction, accounting for 22 percent of the district population.

At 11 am sharp, Liu Huifang, aged 67, enters the Baiyunxiang Restaurant not far from her home. Several of her neighbors are sitting at the table especially reserved for them by their community. “We inform community workers one day in advance, pay RMB 11, and lunch here, rather than cook at home. It’s inexpensive and convenient,” says Liu Huifang. Lunch comprises soup, one meat and one vegetable dish, and a bowl of rice.

Meanwhile, in the nearby Qinan Subdistrict, Zhou Huainan, a disabled senior, is waiting for his lunch to be delivered and served by a nearby restaurant.

That afternoon at 16:30, Huang Meining, in his 70s, finishes his afternoon tea at an old folks daily care station. He bids his fellow seniors and neighborhood committee staff a cheery farewell, and goes home.

Luo Xiulin, a widow living in the same building, is confined to the four walls of her home by chronic arthritis, as her building has no elevator. Xiao Zhu, a home helper sent by a nearby domestic service center, chats with Luo as she tidies her living space. While combing Luo’s hair, Xiao Zhu advises her, “You should leave the window half open.” Before leaving, she checks the gas stove and closes the door with care.

These glimpses into the lives of three seniors indicate how they live within the home-based senior care program.

“Our life is better this way than at an old folks’ home,” says Liu Huifang with conviction. She has visited several retirement homes. “The services provided are about the same, but at home we feel freer, and our expenses are much lower. Seniors in the community have a long acquaintance, and many topics in common. If ever anyone meets difficulties, we help each other out.” A full 90 percent of Yuetan Subdistrict seniors have joined the home-based old-age care program.

The Yuetan Subdistrict Office established a community retirement home for its elderly residents unable to take care of themselves in 2005, but it operated at a loss until 2006, when it was transferred to a professional old-age care institution -- the Tianjin Hetong Old-age Welfare Association.

“Prior to the transfer, the home’s biggest problem was its low occupancy owing to a lack of professional nursing care. The Hetong Association solved this problem through its professional nursing and management mechanism. Professor Kang Xiaoguang, president of the NGO Institute of the School of Public Administration of the People’s University of China, who has undertaken the research for this project, comments, “The successful cooperation between the Yuetan Subdistrict Office and Hetong is attributable to mutual complementation. Both Tianjin Hetong, as a non-profitable organization, and Yuetan Subdistrict Office, as a grassroots government unit, have their advantages. Tianjin Hetong badly needs government involvement and support, while Yuetan lacks Tianjin Hetong's superior professional capabilities and management level.”

Government-run homes also benefit from government publicity and mobilization advantages. Since the transfer, the Yuetan Subdistrict Office has increased the Hetong Association occupancy rates through publicizing its reliable nursing services.

The greatest advantage of new-mode senior care is that its government aid plus social resources alleviate the shortage of old-age care institutions, and also ease pressure on seniors unwilling to leave their own homes.

Industry insiders tip this integrated system as China’s main senior care mode for the future