The Myth of Filial Piety

Today, the Asia Healthcare blog publish a guest post that I co-authored with the Ninie Wang, the founder of the elderly care company Pinetree Senior Care Services.  The article explores the changing nature of filial piety in China as the economic and family structures undergo sweeping changes.  It also examines the future of the elderly care industry.  I have reproduced parts of it below:

When speaking to friends abroad about the situation of China’s ageing population, they often talk about how Chinese senior citizens must be well taken care of given China’s traditional values of filial piety which emphasizes respect and care for one’s elders.  However, when one takes a careful look, this is not the case.  Many of the young think only of pursuing a comfortable lifestyle.  That their parents devoted so much in raising them as children does not register with them, and the youth tend to grow impatient as their parents become slower both mentally and physically.  Examples like Zhou Yang, the Chinese gold medalist in speed skating, who said that she hoped she could make her parents live more comfortably are increasingly rare in China today.  Society is encouraging people to both respect and take care of the elderly, but in reality people keep them at a distance.

This type of professional care designed especially for the elderly is in great demand in China.

Nursing homes have grown rapidly in China, yet the national capacity of less than 3 million beds only serves a small share of the potential demand of about 8 million.  With its significant capital requirement and unclear return on investment, government and private investors alike are reluctant to push for its development.

(For more on elderly population and status of nursing homes see: 国养老遇尴尬: 一床难求和养 老院空置现象并存, and 北 京市2008年老年人口信息和老龄事业发展状况报告 )

For example, to build a large nursing home with 1,000 beds, initial investment can already range from 30 to 150 million yuan.  Even with up to 10% initial investment and annual subsidy of 300 to 1200 yuan from the local government, nursing homes struggle to break even.  A national survey revealed rather low willingness to pay – urban seniors are willing to pay 710 yuan per month for living at a nursing home, while rural ones only 121 yuan per month.  In addition, challenges such as attracting and retaining professional care staff, managing risk and even meeting safety standards are issues of great concern for many veteran managers of nursing homes.

Some people prefer to hire companies that send nannies or care-workers.  Unlike in the US or many other developed countries, these groups in China often lack a basic education, and are assigned into customers’ homes with a limited number of hours’ training (if any).  Although many of them can do a good job at house-keeping and/or cooking, few are equipped with elderly care knowledge.

Increasingly, community hospitals are extending their medical services to homes in their neighborhoods.  What prevent them from providing nursing services are the lack of nurses and the unwillingness to manage the low-margin troublesome service model.  The doctor/nurse ratio in China today reflects the hospitals’ emphasis on revenues and profit, with less than one nurse per doctor.

There is a need for an alternative service.  Pinetree’s professional home care has the potential to be the most cutting-edge solution to the care needs of millions of families with seniors.  Focusing on delivering nurse visits to seniors living near each of its local service units, Pinetree’s asset-light business model with a strong emphasis on quality control and personnel development has started bringing hope to many. If there was any way to re-promote traditional filial piety in the modern China context, Pinetree can actually help make a difference.

China is now struggling with how to deal with the often competing forces of modernity and tradition.  Arguably, China has stronger social structures than other countries to encourage elderly support, but these are under great pressure.  The relocation of career opportunities and urban sprawl have spread families across the country and have raised new questions and challenges.  China will be looking to more developed nations as examples.  Systems like America’s where there exist nursing homes, elderly communities, Social Security, Medicaid that all enhance family support will be models that China will emulate and adapt.

China’s development of elderly care will undoubtedly be based upon in-home care.  In addition to the overwhelming percentage of elderly who prefer to be in their own home rather than a nursing home, the government has already begun to dedicate its attention and resources to developing this industry.

The benefits to an individual’s physical and psychological health when ageing in the home are clear. Economically, in-home care is less of a financial burden as living full time in a hospital or nursing home.  This is a field that other countries are increasingly emphasizing, whether one is making decisions such as how to reform a nation’s healthcare system or how to care for one’s own ageing parents.  In time, it is quite feasible that China may in turn be the model that other countries study.

Today, we are faced with questions such as: has the myth of filial piety already become a burden for China?  What type of treatment can we expect in our own old age?   Confronted with the shattered myth of filial piety and the dissolution of family support structures, all societies must now decide whether they are content to let these values dissolve into nothing or whether they are able to rebuild the social and medical infrastructure to allow the elderly to enjoy the comfort and dignity they deserve.

For those interested in learning more about this field, please refer to Ninie's blog (in Chinese).