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Making Basic Elderly Care Available to the Entire Elderly Population

By Li Jiheng Source: English Edition of Qiushi Journal Updated: 2023-03-02

In his report to the 20th National Congress of the Communist Party of China (CPC), General Secretary Xi Jinping proposed pursuing a proactive national strategy in response to population aging, developing elderly care programs and industries, improving services for seniors who live alone, and making basic elderly care available to the entire elderly population.

I. The importance of providing basic elderly care in building a modern socialist country

Basic elderly care is provided directly to the elderly by the state or by relevant entities with state support. The objective is to provide care and support that is inclusive, meets essential needs, and ensures basic living standards, including material assistance and specialist and general care services. Making basic elderly care available to the entire elderly population reflects the fundamental plans of the CPC Central Committee with Xi Jinping at its core.

Making basic elderly care available to the entire elderly population is an important aspect of fulfilling our Party’s founding missions and conveying the essence and strengths of Chinese socialism in the new era.

Since the CPC was established in 1921, its founding missions have been to pursue happiness for the Chinese people and rejuvenation for the Chinese nation, with improving people’s standard of living as the immutable goal of all of its work. It is the wish of all Chinese people to be looked after in their old age. More than 2000 years ago, Confucianism advocated that we should “Care for one’s own aged parents and extend the same care to the aged parents of others; love one’s own young children and extend the same love to the children of others,” and stated that in the ideal society, “The elderly live out their final years happily; able-bodied adults are usefully employed; children are brought up properly; and widowers, widows, orphans, the childless elderly, the disabled, and the sick are well cared for.” Our Party regards enabling the Chinese people to lead better lives as its abiding goal and has implemented corresponding policies through decades to achieve this. In recent years, China’s composite national strength has constantly increased, which has provided a solid material foundation for ensuring basic care of the entire elderly population. Basic elderly care is an important public service, and after many years of efforts, a preliminary system has been put in place that can be extended to the entire elderly population. Ensuring elderly care of all is a new strategy proposed by the CPC on its journey to building China into a modern socialist country in all respects. We must strive to implement President Xi’s instructions to “strengthen public services for the elderly, diversify what is available to them, and funnel more financial resources toward them, and involve the whole of society in looking after the elderly and helping them to enjoy their twilight years.” This guidance embodies the fundamental aims of serving the people wholeheartedly and the people-centered philosophy of development. It befits the requirements of the times, demonstrates the aspiration of the Party and the will of the people, and conforms to the laws of development.

Making basic elderly care available to the entire elderly population is an inherent requirement for improving the system of socialism with Chinese characteristics and advancing the rejuvenation of the Chinese nation through a Chinese path to modernization.

The Chinese path to modernization, which is being pursued under the leadership of the CPC, seeks common prosperity for all and involves every undertaking. By the end of 2021, there were 267 million people over 60 in China, accounting for 18.9% of the population. Every family has elderly members, and growing old is a fact of life. Elderly care is not just important on a personal and familial level, it is important to the whole of society and the country at large, as it affects the happiness of millions of families and public wellbeing. Making basic elderly care available to all seniors involves the maturation and improvement of our distinctly Chinese system of elderly care to guarantee that people’s basic needs are met. It requires the enhancement of the world’s largest social security system and the Chinese socialist system. Providing basic elderly care to the entire elderly population and ensuring that seniors are supported and well looked after are conducive to familial, intergenerational, and social harmony. It will promote social development based on collaboration, participation, and shared benefits in the new era, and it will advance the modernization of our national system and capacity for governance. Ensuring all elderly people have access to elderly care, which involves optimizing the structure of income distribution to the elderly, making elderly care more affordable, and allowing the elderly to share in the fruits of socioeconomic development, is a suitable response to the people’s calls for common prosperity. It is also a tangible achievement of Chinese modernization in caring for the elderly population.

Making basic elderly care available to the entire elderly population is required to improve the system of population services covering people’s whole lives as well as to promote balanced, long-term population development.

Population issues have a bearing on the sustainable development and rejuvenation of the Chinese nation. President Xi has repeatedly emphasized that demographic issues have overall, long-term, and strategic significance for China. He has pointed out that China’s population development has changed significantly in recent years, and we face pressures caused by our large population as well as challenges resulting from the shift in our demographic structure. The provision of basic elderly care is inclusive of all, for example one-child families and families whose only child is deceased or has a disability. It entails further improvements to the system of population services for the whole of people’s lives, and it is a positive response to challenges brought about by the shift in China’s demographic structure. Ensuring access to elderly care for all and making the necessary institutional arrangements to support the elderly population can alleviate widespread public anxiety regarding elderly care, reduce the pressure on young people who are expected to care for their elders in addition to their children, and give people peace of mind regarding how they will be looked after in their old age. It will give young people the confidence to have children, free more of the workforce from caring for elderly family members, and promote balanced long-term population development.

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A police officer provides information to senior residents in the Xiangshan Community, Guli Town, Guizhou Province. On November 5, 2022, Guli’s Office of Social Stability and Security, together with the local police station, launched a public awareness campaign on preventing and combating fraud targeted at elders, in which officers gave in-person talks and had informal conversations with the elderly to help boost their awareness of the law and ability to avoid fraud. PEOPLE’S DAILY

Making basic elderly care available to the entire elderly population is an important undertaking that reflects an acute understanding of people’s requirements in old age and presents a solution to the global issue of population aging.

Coping with an aging population is a common problem faced by countries around the world, the foremost problem of which is ensuring that seniors are cared for properly. Since China became an aging society in the late 20th century, the size of our elderly population and its proportion of the total population have constantly increased. We are expected to live in a “moderately aging society” during the 14th Five-Year Plan period (2021-2025) and a “severely aging society” by 2035. China’s population aging is going to closely accompany our efforts to realize the Second Centenary Goal. It is a basic national condition in our journey toward building a modern socialist country against the backdrop of change on a scale unseen in a century in the world. China is home to approximately a quarter of all elderly people in the world, and we face the prominent difficulties of our country growing old before it is prosperous and before it has implemented the necessary safeguards for our elderly population as well as of imbalanced development between regions. The challenge China faces in caring for its elderly population has no precedent in world history, and there is no template to copy from. Ensuring all elderly people have access to elderly care, thereby solving this issue in the country with the world’s largest elderly population, as well as harnessing the “silver economy” to drive employment and expand domestic demand and achieving positive interplay between domestic and international economic flows, can serve as a valuable reference for countries around the world to respond positively to the major challenges posed by population aging and build a global community of shared future.

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A staff member explains how to use an intelligent robot at the Aihejia At-Home Eldercare Services Center in Feixi County, Anhui Province, September 30, 2022.Since the 18th CPC National Congress in 2012, Feixi County has been working to improve its eldercare services network, develop a multi-tiered eldercare services system, and improve related service facilities and functions. PHOTO BY XINHUA REPORTER LIU JUNXI

II. Making elderly care available to the entire elderly population in the course of the new journey

We must uphold our Party’s overall leadership in our work of elderly care.

We must champion CPC leadership, which is the defining feature and the greatest strength of China’s socialist system. We must continue to take guidance from Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, ensure that the Party fully exerts its core role in providing overall leadership and coordinating the efforts of all sides, and allow Party committees to provide leadership, governments to offer direction, and the public to participate in the provision of basic elderly care. Local Party committees and governments need to incorporate the provision of basic elderly care in their socioeconomic development plans and agendas, in their arrangements for the proactive national strategy to respond to population aging, and in their list of tasks related to people’s wellbeing that require urgent attention, so as to resolve major issues with the provision of basic elderly care.

We must adhere to the overall development objective of fulfilling the elderly population’s aspirations for a better life.

We must thoroughly implement President Xi’s instructions to “ensure every elderly person can live securely, peacefully, and comfortably, so that seniors can live long and healthy lives and enjoy their twilight years.” While ensuring the provision of basic elderly care for all, we must prioritize care for elderly people who face particular difficulties, such as those who are disabled, at an advanced age, or have no family members to take care of them. We need to focus on the most basic, intractable, and all-encompassing elderly care requirements as well as on solving elderly care issues that the public have reported as being of the greatest concern to them. We must gradually expand what is included in basic elderly care, continue to make it more equitable and accessible, and ensure that policies on basic elderly care accord with our national realities and meet the changing demands of the people, thereby demonstrating to the people that our Party serves them wholeheartedly and will always be on their side.

We must make the provision of distinctly Chinese elderly care the objective of our reforms and innovation.

The National Medium- and Long-Term Plan on Population Aging sets the goals of having a mature system of elderly care with Chinese characteristics and available to the entire elderly population by 2035. To achieve this aim, we must ground our work in our basic national conditions including our aging population, feature high-quality development and make reform and innovation the fundamental drivers. We must pivot our efforts from only providing basic services to elderly people with particular difficulties to the entire elderly population and from the delivery of services via institutions to a mix of home-, community-, and institution-based care, as well as promote a combination of medical and health care. The provision of basic services should also change from being state-run to being delivered by multiple entities, including the government, market entities, and societal forces. We will constantly work to remove institutional barriers to elderly care, stimulate enthusiasm for the new development philosophy, and demonstrate Chinese wisdom in the course of creating our own distinct solutions and approaches to the issue of elderly care.

We must do everything in our capacity to improve elderly care.

The formation of the basic elderly care service system is a long-term task whose primary function is to help those most in need and guarantee people’s basic needs. The government must play a leading role in this process while upholding the principles of ensuring basic needs are met, focusing on key areas, improving systems, and guiding expectations. We must strive to constantly grow investment, accelerate equal access to basic elderly care, and gradually increase support. We must do our best to consider affordability at all levels of government, not exceed our current stage of economic and social development, and avoid the “welfare trap” often associated with middle-income countries. In addition to utilizing the role of government to ensure basic needs are met and fulfilling its position as a service provider, we must fully utilize the role of the market and social entities. We must promote the provision of diverse services, strike a balance between what is needed and what is possible, and seek balanced development between urban and rural areas and between regions as part of our efforts to achieve the aims of guaranteeing basic needs, offering comprehensive coverage, and being sustainable.

We must coordinate the development of both basic and non-basic elderly care.

Elderly people have diverse, tiered, and ever-changing requirements for elderly care services. Both basic and non-basic elderly care are required to meet the needs of elderly people. They are two distinct but closely connected parts of the modern elderly care system that are mutually reinforcing. As a result, their development must be coordinated, and they need to be tiered and distributed accordingly with category-specific guidance. We shall promote elderly care policies in line with requirements on achieving the integration, coordination, and efficiency of systems, optimize institutional resources, such as social insurance, social assistance, social welfare, charity, and preferential treatment for the elderly, and coordinate reforms of systems in related areas. We must unleash the role of elderly care and seek to create a new, distinctly Chinese elderly care model based on family support, with the government guaranteeing people’s basic needs, a diverse supply of products in the market, and assistance provided through social welfare.

III. The key tasks in making basic elderly care available to the entire elderly population on the new journey

The next five years are a critical period for the development of the system of basic elderly care, and they are a window of opportunity in our response to an aging population. We must thoroughly implement the guiding principles of the 20th CPC National Congress and put into practice the decisions and plans of the Party Central Committee on ensuring the provision of basic elderly care. We need to uphold the general principle of pursuing progress while ensuring stability, strive to improve areas of weakness, consolidate foundations, and harness strengths, and accelerate the establishment of a sustainable basic elderly care system that covers the entire elderly population, and has clearly defined rights and responsibilities and appropriate levels of support.

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In the last 10 years, Qingyang City in Gansu Province has diversified its eldercare services system by putting into operation a comprehensive eldercare services center, a step that has been warmly welcomed by the city’s senior residents. The picture shows a resident of the service center painting in the art and calligraphy room, June 23, 2021. PHOTO BY XINHUA REPORTER MA XIPING

We will put in place a sound system of basic elderly care.

A list-based system lies at the core of basic elderly care, as it provides a clear basis for governments at all levels to fulfill their roles and for elderly people to enjoy associated rights. In accordance with the overall requirements to ensure that basic needs are met, the provisions of relevant laws, regulations and policy documents, as well as the need to ensure fiscal viability, we will categorize basic elderly care, such as material assistance and specialist and general care services, to create a list of national and local services. Lists formulated and issued by local governments must include national-level items of basic elderly care, and their provision must meet the requirements of the national list. We will look into the establishment of a long-term mechanism for dynamically adjusting basic elderly care in line with socioeconomic development in order to respond proactively and precisely to people’s basic elderly care requirements. We must also include in the list of basic elderly care the means-tested provision of stable and sustainable support for elderly people who are functionally impaired, disabled, or have no family members to take care of them, thereby ensuring that we fulfill our moral obligations and meet people’s actual needs for basic elderly care.

We will optimize the provision of basic elderly care.

Making basic elderly care available to the entire elderly population is predicated on having adequate supply, reliable quality, convenient access, and solid assurances. We must develop a system of elderly care that links families, communities, and institutions, combines health and medical care, and offers more providers and methods, in order to diversify and expand the supply of services. We need to increase central and local government investment and strengthen support for basic elderly care through the direct provision, purchasing, and contracting of services by the government as well as cooperative public-private funding. Localities with the requisite conditions should optimize preferential elderly care policies, support non-government entities in the provision of basic elderly care, and utilize the market’s strengths in allocating resources and raising efficiency. We must leverage the fundamental role of state-run elderly care institutions in providing basic elderly care and better define functions for “meeting people’s basic needs” in the new era. We must continue to serve the public interest, improve how state-run elderly care institutions operate, and provide better services for elderly people facing special difficulties, such as those who live alone. We will encourage and support training and nursing institutions affiliated with Party and government agencies and state-owned enterprises in transitioning to public-interest elderly care facilities. We will increase support for elderly care from the state-owned sector and strengthen its provision of basic elderly care services. We will boost the training of personnel in the field of elderly care and refine policies and measures on education and training, compensation and benefits, career development, and recognition awards for elderly care personnel. We will adopt multiple approaches to attract people and train the elderly care workforce to support the high-quality development of basic elderly care. We will also improve overall regulation of, and further standardize, basic elderly care services to guarantee quality and safety.

We will improve areas of weakness in basic elderly care in rural areas.

In recent years, the aging population gap between urban and rural areas has gradually widened, with rural areas aging more than urban ones, leaving them facing more pressing and prominent issues. To make elderly care available to the entire elderly population, we must thoroughly implement President Xi’s instructions concerning the pursuit of a proactive national strategy in response to population aging and the rural revitalization strategy. We must coordinate the provision of elderly care between urban and rural areas and between regions and tilt the balance of resources toward rural areas to achieve equal access to elderly care services. We need to shore up weaknesses in basic elderly care in rural areas and create a strong care network with links at the county, township, and village levels. We need to strengthen the provision of care services to functionally impaired seniors and ensure that each county (county-level city, city district, or banner) has at least one county-level facility that specializes in caring for people who are functionally impaired or face special difficulties by 2025. We shall transform elderly care facilities with the necessary conditions into township elderly service centers or complexes and develop mutual elderly care services in rural areas in accordance with local conditions. We will strengthen the operational and leadership roles of primary-level Party organizations, continue to disseminate experiences of “CPC organizational development plus rural elderly care,” utilize the self-management functions of villagers’ self-governance organizations and other social organizations, and promote the formation of concerted forces for the provision of rural elderly care services.

We will make basic elderly care more convenient and accessible so that all eligible persons are aware of and receive appropriate benefits.

Many elderly people in China have a diminishing capacity to look after themselves, limited educational attainment, and insufficient access to relevant information, which makes it more difficult for them to obtain basic services when required and has a direct impact on the effectiveness of the system of basic elderly care. We need to increase publicity in ways favored by seniors. We should publish policy information in public areas, online, and in the media to ensure that it reaches people in their homes, care homes, and communities and that the elderly and their families are aware of available basic elderly care services and how to apply for them. We need to conduct comprehensive assessments of the abilities of elderly people to accurately determine their functional impairments and service requirements. We need to establish mechanisms for the precise identification and management of seniors who face special difficulties and strengthen efforts to seek out the people who can benefit from policies and services so that they can quickly access them without searching for them, thereby linking the supply and demand sides of elderly care services. We will optimize the layout of elderly care facilities so that people can access services within 15 minutes of their homes, provide more services in areas with concentrations of senior citizens, and implement supporting policies on the construction of elderly care facilities in residential areas, so as to ensure that elderly people always have quick and easy access to the care they require. We will improve and simplify the process of applying for basic elderly care, increase barrier-free support that better meets the needs of the elderly, and simultaneously offer traditional and smart services. We will also use innovative means to remove obstacles to the implementation of policies and provide more convenient, accessible, and considerate basic elderly care to the elderly population.

(Originally appeared in Qiushi Journal, Chinese edition, No. 23, 2022)