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Seniors looking after one another

Guideline casts light on community care culture in rural nursing homes

By LI LEI | China Daily Global | Updated: 2024-02-21 08:54


On a recent afternoon, dozens of elderly farmers were playing chess in a courtyard awash with sunshine, a common scene at the Madongchuan Township Zhaotai Village Mutual Support Nursing Home.

Situated behind them was their dormitory — rows of cave dwellings, a unique form of residence in Yan'an, a hilly part of Northwest China's Shaanxi province.

There are no caregivers in sight. Instead, the residents look after one another at the self-service nursing facility, which was repurposed from a deserted primary school in Madongchuan township.

The younger ones grow cabbages and other vegetables in a small patch of land nearby. They cook outdoors using a shared kitchen, and the food is delivered to those with mobility issues. After meals, many play chess or chitchat at their leisure.

Local authorities also hired a retired village doctor to oversee the facility so that the residents no longer have to travel to a nearby county for less severe health problems such as cold and fever.

"They were enjoying themselves in the moment, and leading rather independent lives," Zhao Liwen, secretary-general of Taikang Yicai Foundation, said of her first impression about the residents during a visit in 2019.

The Beijing-based charity donated 1 million yuan ($139,000) to the nursing home to help expand its space a year earlier.

When she arrived, the seniors, all empty-nesters in their 80s and 90s who are either childless or have children working in big cities, huddled together to wrap dumplings in anticipation of Chinese New Year.

The scene was a sharp contrast from life in the area more than a decade ago. Village elders used to live lonely lives, scattered among the rugged terrain and unable to access hospitals and other public services.

Then in 2013, a flood washed their crumbling homes away, forcing them to move into the nursing facility.

"I have been working in the charity sector for some years, but the elderly people in Yan'an had left me with very deep impressions," Zhao said.

The nursing home in Yan'an is one of the best examples of China's ramped-up efforts to tap the strength of "relationship-based communities" in rural areas to ensure fast-graying residents are cared for.

Compared with a more transactional or rule-based society in urban areas, rural communities in China are known to operate through personal connections and mutual trust.

The self-sufficient, interdependent culture embodied by the nursing home is being bolstered by authorities to cope with aging in the countryside, a decades-long issue that has been exacerbated by an exodus of younger residents.

Resolving shortage

In a recent document issued by the Ministry of Civil Affairs and 11 other central government organs, authorities are looking to older adults to care for even older ones in rural areas to address a nationwide shortage of caregivers.

While briefing reporters about the guideline late last month, Li Yongxin, deputy director of the ministry's elder care service department, said the department is working to entice younger retirees and others with the "strength and willingness" to work as caregivers, start related businesses and offer voluntary services in the countryside.

"Working in the sector requires both professional precision and compassionate warmth," Li said, adding that it is a respectable profession that helps ease social and family burdens.

In rural areas, older people usually rely on family members for care because commercial services are either scarce or unaffordable.

However, the age-old arrangement is facing challenges as younger people have left rural hometowns for better paid jobs in coastal areas.

Despite recent government efforts to vitalize rural areas and create jobs in the countryside, more than 176 million rural workers left home to find jobs elsewhere last year, a year-on-year increase of 2.7 percent.

The mass migration creates large numbers of so-called left-behind seniors and empty-nesters in need of socialized care services.

Zhao, the secretary-general of Taikang Yicai, said rural areas may lag in terms of economic prosperity, but their closely-knit communities may lend them some strength when it comes to elder care.

The success of the nursing home in Madongchuan, she said, was partly because the project has mobilized local human resources that would otherwise have been overlooked.

Rather than relying on caregivers from outside the village, the approach is more economically sustainable.

Zhao said her foundation is working with a local university and authorities in Yan'an to find out if the project can be replicated in other hollowed-out villages.

"We're eager to see if the model can function in the formerly impoverished places without much government funding," she said.

Cafeteria program

Another area harnessing the familial atmosphere of rural communities to care for seniors can be found in Yangxi village in the southern part of Gansu province, which was home to some of the country's most intractable poverty.

Jing Lizhong, a social worker, witnessed firsthand how a nonprofit cafeteria had greatly improved the health of local empty-nesters and offered seniors an area where they can gather for fun or receive services such as haircuts or blood pressure checks.

Jing, who works with a charity in Gansu, was first brought to Yangxi by a project to promote drip irrigation technology and expand the profit margin of local apple farmers.

During his stay, the 35-year-old was stunned by how older people there make do with instant noodles and other convenient foods.

"There's a type of dried food called 'lazybones noodles'. When it comes to meal time, seniors would boil the noodles, serve them in sour soup and make do with it," he said.

Over time, such food began taking a toll on the elderly people's health.

"Some say they do not even have the strength to walk around," Jing said.

In 2022, a cafeteria was built in the village as part of a charity project called Amity Papa and Mama's Canteen. The project was initiated by the Amity Foundation and Alibaba Philanthropy in 2014 and now has more than 200 cafeterias in 28 provincial-level jurisdictions.

For just 2 yuan, older villagers can have a proper lunch in Yangxi, enjoying foods such as steamed buns, braised chicken legs and deep-fried pancakes, and the menu changes daily. The program covers the bulk of the meal costs.

The program was launched with an investment deemed modest by even local standards.

The construction of the more than 100-square-meter facility cost just 100,000 yuan because many younger farmers came back from urban factories and contributed labor.

Elderly farmers known for their culinary skills were recruited to cook there, and they were happy to accept the positions because even though the pay was low, they wouldn't have to venture out of the village to find jobs.

Voluntary services offered by the diners helped mitigate the need to hire sanitary workers and administration staff.

"The village's older people's committee created a duty roster to do the cleaning after lunch," Jing said.

Over the past two years, the cafeteria has morphed into a complex where older people can get haircuts free-of-charge, which are given by their peers. This has saved them the trouble of visiting a nearby county for the service, because the village had no barbershop.

They can also get their blood pressure tested with equipment stored at the cafeteria.

When someone passes away, the facility becomes a makeshift memorial hall, where villagers can pay their respects to their deceased neighbors.

"When some older people miss a meal or two, others call their children or make house calls to make sure no accidents have happened," Jing said.

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