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BEIJING – A hospital in southern Beijing advertises itself as a specialist in vascular tumors, especially benign birthmarks that often appear in babies.
But when a fire broke out last month, killing at least 29 people, many of the victims were there for other reasons: Elderly people with disabilities receiving nursing care, some of whom stayed in private hospitals for months or even years. , although not licensed as a long-term elder care provider.
The tragedy at Changfeng Hospital – the biggest fire in the Chinese capital in more than two decades – has renewed a long-standing problem. China’s population is rapidly aging, with 400 million people, nearly 30 percent of the population, expected to be over 60 by 2040. But medical resources are not constant; there will only be around eight million nursing home or elderly care beds by the end of 2020, according to official statistics.
Authorities have acknowledged the urgency of addressing the shortage, with Beijing’s latest five-year plan promising to raise the number to nine million beds by 2025. But obstacles remain.
The social stigma against retirement or nursing facilities is still widespread in a culture that emphasizes the task of caring for children on parents. Even for those who are willing to accept institutional care, public facilities often have long waiting lists, and private ones – those not covered by public health insurance – can be prohibitively expensive.
And then there’s the issue of facilities becoming properly licensed to offer nursing care in the first place, a process complicated by bureaucratic requirements and a lack of trained staff, according to experts. As a result, some private companies that want to meet the demand for senior care are operating underground.
Local officials are now investigating whether Changfeng Hospital illegally offers long-term elderly care, according to state media reports. Several survivors of the fire told Chinese media that the limited mobility of some patients may have contributed to the death toll.
There is no clear link between unlicensed care and fire; deadly fires have also broken out in licensed nursing homes. But the fire has drawn public attention to the underground market and the reason for its existence.
Some relatives of the victims and public health experts have asked the authorities to look beyond the punishment and bring the providers out of the shadows.
“This is just the tip of the iceberg,” said Sabrina Luk Ching Yuen, a professor at Nanyang Technological University in Singapore who studies aging, adding that there are many similar cases of soil treatment. “If the market exists, what will the government do?”
Efforts by The New York Times to reach the victim or his immediate family were unsuccessful. Changfeng Hospital has been closed to visitors since the fire, and when Times reporters tried to interview victims or their relatives at other hospitals where the injured were transferred, they were blocked or escorted out by hospital staff.
The authorities, like most after disasters in China, have tried to control the narrative and prevent journalists from talking to victims. He only said that the patients who died ranged in age from 40 to 88 years old, with an average age of 71 years, and most of the 21 seriously ill patients had chronic diseases.
But some Chinese news was able to interview relatives of Changfeng Hospital patients, who described an elderly father who had been there since last summer due to disability after a cerebral hemorrhage, and another man, 76, who has no motor skills and lives there full time. .
The family was informed that they were drawn to the hospital because of its ability to provide medical care for their disabled loved ones. In contrast, nursing homes in China have historically not provided medical care.
Relatives also appreciate that bed turnover is not a concern in private hospitals, which, although more expensive than public ones, are less crowded. According to one report, a woman said her father had been forced to shuttle between several different institutions before he found Changfeng Hospital.
The woman said she pays about $870 a month in nursing expenses for her father. Some online ads for nursing facilities at the same address as Changfeng Hospital list fees as high as $1,400 per month. The average monthly pension in Beijing is 4,157 yuan, or about $600, in 2019.
Private hospitals have many incentives to try to capitalize on the unexpected demand for long-term medical care, said Bei Wu, a professor of global health at New York University who has studied aging in China. Even before the coronavirus pandemic, many were struggling to attract enough patients to make money, as prices were higher.
Then, during the three years of strict Covid restrictions in China, people who could avoid the hospital did so. Out-of-town patients, who often travel to major cities like Beijing for treatment, are on the decline as the country seeks to restrict movement.
The parent company of publicly traded Changfeng Hospital lost more than $14 million between 2020 and the first half of 2022, according to a public filing. It did not respond to multiple requests for comment.
“I can see some ways this pushed private hospitals to say, ‘Hey, we can provide care for these old adults with disabilities because this can be a source of revenue-generating potential,'” Dr. Wu said.
The government, in fact, promotes the integration of medical and elderly care, encouraging nursing homes to build medical facilities and hospitals to provide more nursing services.
But China, like many countries, lacks specially trained staff for elderly patients. And the government department that oversees medical care and nursing care separately, slows down the approval process, said Professor Luk, in Singapore.
“The intentions are good,” he said of the integration plan. “But, actually, it’s really hard to do.”
He said he hopes one outcome of the fire in Beijing will be a call to action for the government: Should it provide its own long-term care facilities, or is it easier for private companies to do so.
Indeed, the need will only grow. The number of elderly Chinese with disabilities is expected to double this decade, reaching 100 million by 2030, according to official statistics.
The facility is very important to the lucky few who find a place for their relatives there. Hua Ailing, a post office accountant in a small county in Anhui Province, chose to send her 89-year-old mother to a licensed private hospital for long-term care last year, after she was unable to walk. She said she was more comfortable sending him to a traditional nursing home, where medical care was unreliable.
Left with no choice, he and his siblings didn’t know what to do. “After a while, we couldn’t take care of him by ourselves,” said Ms. Hua. “After all, we’re all in our 60s too.”
Joy Dong reported from Hong Kong. Li You contribute to research.
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