Long-Term Care Around the Globe
The “Leap Forward” in Nursing Home Development in Urban China: Future Policy Directions

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Abstract

In the past decade, the number of nursing beds in China has increased annually by an average of 10%, reaching 4.3 million in 2013. Although the State Council pushed for further increases to a ratio of 30 nursing home beds per 1000 persons by 2015, service utilization, quality assurance, and regulatory oversight are the inherent challenges in developing an equitable long-term care (LTC) system that can safeguard older persons' rights. We review and analyze both laws and policies in light of demographic and socioeconomic changes and advocate 3 policy directions for LTC development in China: allocating LTC resources with comprehensive eligibility criteria, with particular consideration of family needs; establishing viable quality standards for outcome-driven evaluation; and highlighting standardized monitoring mechanisms in both institutional and home LTC settings.

Section snippets

Decline of the Traditional Social Contract for Elder Care Provision

As a Confucian society, the principle of filial piety has long been cornerstone of elder care provision in China.9, 10 While family members assume responsibility for providing care for their ill and frail elderly parents at home, state social welfare institutions only provide care for destitute older persons who fall into the categories of the “3 no's” (those without family support, source of income, and unable to work) in urban areas11 or “5 guarantees” (those requiring government guarantee of

Policy Initiatives for a New Social Contract and Its Objective to “Leap Forward” Residential Home Beds

While the traditional social contract has been eroded, modernization and marketization also have driven welfare reform and the formation of a new social contract. Social welfare socialization since the 1980s allowed state social welfare institutions to admit older persons who can pay service charges. After the 1990s, further decentralization of rights and responsibilities extended the provision of residential care services from state to non-government organizations, individual and private

Three Promising Policy Directions to Better Foster a New Social Contract in Contemporary China

The recent LPRIE (2012), Permission Rule (2013), and Administration Rule (2013) indicate the Chinese government's commitment to build a comprehensive system regulating residential care facilities. These rules, though, are written in general and broad terms, and require the Chinese authorities to further enact supplementary rules to standardize the provision and quality of residential care homes and to fill the gap for actual implementation.34, 35 Until new supplementary rules are enacted, “2

Conclusion

In 2013, the Chinese government adopted the policy objective to reach a ratio of 30:1000 residential care beds in 2015. This “leap-forward” development goal now faces problems of both low occupacy and failure to meet the needs of older care recipients. We have identified 3 possible policy directions that could enhance the Chinese LTC system. The first is to estabish national eligibility criteria for LTC. Besides considering age, means, and needs, it is strongly suggested to include

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    The authors declare no conflicts of interest.

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