An Industry in the Making: The Emergence of Institutional Elder Care in Urban China

Demographic shifts in China pose unprecedented challenges in the care of a rapidly growing older population. Sporadic reports suggest the recent emergence of institutional elder care in China, but little is currently known about this phenomenon. This study documents the growth, ownership, financing, staffing, and resident characteristics of elder care institutions using survey data collected in 2009 from Nanjing, China, supplemented with government registry data from seven additional major Chinese cities. Between one-half and two-thirds of facilities operating in these cities were founded in the last decade, primarily in the non-government sector. In Nanjing, government ownership dominated homes built before 1990 (96%) but was increasingly rare in the 1990s (60%) and in the 2000s (23%), a pattern observed in the other seven cities as well. In Nanjing, the average home now draws more than 80% of its daily operating revenues from private-pay or other non-government sources, and this share increases sharply with the recency of facility establishment. The majority (85%) of non-government-owned homes are receiving ongoing per-bed subsidies from the government. The lack of clinical staff characterizes the majority of study facilities; most care staff are rural migratory workers. There is considerable variability across facilities in the case-mix of residents in terms of functional dependence and acuity levels. These findings portray the emergence and rapid growth of a nascent industry of institutional long-term care in urban China and a fundamental shift in institutional ownership, financing, and clientele.