BEIJING — The southern Beijing hospital applied to specialize in vascular tumors, particularly benign birthmarks that are common in infants.
But if a A fire broke out there last monthin which at least 29 people were killed, many of the victims had been there for a different reason: they were elderly people with disabilities who were being cared for, some of whom stayed at the private clinic for months or even years, even though it was not licensed as a provider of long-term care.
The tragedy at Changfeng Hospital – the deadliest fire in China’s capital in more than two decades – has put a long-standing problem under renewed scrutiny. China’s population is aging rapidly, with 400 million people, nearly 30 percent of the population, expected to be over 60 by 2040. But medical resources have not kept pace; At the end of 2020, there were only about eight million nursing home or aged care beds, accordingly official statistics.
Authorities have recognized the urgency of addressing the shortage with Beijing’s latest five-year plan pledge to increase that number to nine million beds by 2025. But many obstacles remain.
Social stigma towards retirement or care facilities is still widespread in a culture that emphasizes children’s duty of care to their parents. Even for people willing to use long-term care facilities, public facilities often have long waiting lists, and private facilities not covered by statutory health insurance can be prohibitively expensive.
And then there’s the issue of getting facilities proper accreditation to care in the first place, a process experts say is complicated by bureaucratic requirements and a shortage of qualified staff. As a result, some private companies looking to meet elder care needs are operating underground.
Local officials are now investigating whether Changfeng Hospital illegally provided long-term care for the elderly state media reports. Some people who escaped the blaze told Chinese media that the limited mobility of some patients may have contributed to the death toll.
There is no clear link between the potentially unauthorized care and the fire; deadly fires have also broken out at licensed nursing homes. But the fire has drawn public attention to the underground market and the reasons for its existence.
Relatives of some victims and public health experts have urged authorities to look beyond punishment and bring providers out of the shadows.
“That’s just the tip of the iceberg,” he said Sabrina Luk Ching Yuen, a professor at Singapore’s Nanyang Technological University who studies aging, added that there were likely many similar cases of underground nursing. “If the market is there, what is the government trying to do?”
Efforts by the New York Times to reach the victims or their families directly were unsuccessful. Changfeng Hospital has been closed to visitors since the fire, and when Times reporters attempted to interview victims or their families at other hospitals where the injured were transferred, hospital staff blocked them or led them out.
Authorities, as is usual after disasters in China, have tried to control the narrative and prevent reporters from speaking to victims. They just said that the patients who died ranged in age from 40 to 88, with an average age of 71, and so on most of the 21 seriously injured had chronic diseases.
However, some Chinese news outlets managed to interview relatives of patients at Changfeng Hospital, who described an elderly father who had been there since last summer due to disabilities after a brain hemorrhage, and other Man, 76, who had no motor skills and lived there full time.
Supposedly the relatives called They were drawn to the hospital because of its ability to provide medical care to their loved ones with disabilities. In contrast, nursing homes in China have historically provided little to no medical care.
Relatives also estimated that changing beds was less of a problem in private hospitals, which, while significantly more expensive than public ones, were less crowded. According to one report, one woman said her father was forced to commute between different facilities before finding Changfeng Hospital.
This woman called She paid about $870 a month in foster care fees for her father. Some online ads for a nursing facility at the same address as Changfeng Hospital have reported fees of up to $1,400 per month. The average monthly pension in Beijing was 4,157 yuan, or about $600. in 2019.
Private hospitals have many incentives to try to capitalize on unmet demand for long-term medical care, he said At 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 due to their higher prices.
Then, under China’s three years of strict Covid restrictions, so did people who could avoid hospitals. Out-of-town patients, who often traveled to big cities like Beijing for treatment, dwindled as the country tried to restrict movement.
The listed parent company of Changfeng Hospital lost more than $14 million between 2020 and the first half of 2022, according to public filings. Several requests for comment went unanswered.
“I see some ways that this has led private hospitals to say, ‘Hey, we can provide care for these older adults with disabilities because that can be a potential revenue stream,'” said Dr. Wu.
The government actually has promoted 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 other countries, has a glaring shortage of staff specially trained to care for elderly patients. And the government departments that oversee medical supplies and nursing are separate, further slowing down the approval process, said Professor Luk in Singapore.
“The intention is good,” she said of the integration plan. “But in reality, it’s really hard to implement.”
She said she hoped one outcome of the Beijing fire would be a call to action for the government: either provide more long-term care facilities itself or make it easier for private companies to do so.
In fact, the need will only grow. According to official statistics, the number of elderly Chinese with disabilities is expected to more than double this decade and reach 100 million by 2030.
The facilities are particularly important for the lucky few who have found space for their loved ones. Hua Ailing, a postal accountant in a small county in Anhui province, decided last year to send her 89-year-old mother to a private hospital licensed for long-term care after her mother lost the ability to walk. She said she feels more comfortable sending her there than to a traditional nursing home, where medical care could be unreliable.
If that option hadn’t existed, she and her siblings wouldn’t have known what to do. “After a while, we couldn’t take care of them ourselves,” Ms. Hua said. “After all, we’re all in our 60s too.”
Joy dong reported from Hong Kong. Li you contributed research.
