Mao’s Last Nursing Home

The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of communism is the equitable sharing of miseries – church

There is a nursing home in Wuxi called Liang Xiao (name changed). It is located in a side alley of a busy street not far from the central railway station. Like most intensive care facilities in China, it’s a dreary, gray place with little apparent security and totally inadequate patient supervision. I don’t know when Liang Xiao was built, and the dilapidated nature of the buildings offers little clue; most public facilities (with the notable exception of major government offices) are poorly built, could as easily be 10 years old as 30 years old. On the whole, Liang Xiao seems as hopeless and miserable a place as her dejected and helpless patients; frailty seems the least of his evils since the patient’s quality of life is non-existent. However, to be fair, Liang Xiao had an unusual amount of activity and the kind of movement that design suggests; but it was not clear at the time what it was.

I was invited to visit Liang Xiao as a result of one of his nurses contacting me through Weibo, the Chinese Twitter. We arranged our visit and timed the trip to arrive early in the afternoon. Our hosts were the doctors and nurses who run the facility and, we were told, the “President” of the company. This last piece of information was curious as I was under the impression that all nursing homes were state owned. The purpose of our invitation was to see if we had any opportunity to consult and assist Liang Xiao with his interest in improving his geriatric care program.

Shortly after our arrival and the ceremonial exchange of business cards, the fanfare of well wishes, the obligatory sip of tea, and the taste of fruit over, we were offered a tour of Liang Xiao which we graciously accepted and were given. said that Mr. Chang would be slightly delayed. Twenty minutes into our tour, the president arrived with a 6-man entourage taking his calls, carrying his 3 briefcases, and generally making a scene about his arrival. Clearly, the impression this activity was intended to convey was that Mr. Chang was extremely important and too busy a person to trifle with. Our tour guide noticed Mr. Chang’s entrance and nervously led us off our route to the courtyard in the center of Liang Xiao where a short introduction and photos would be taken. One of his assistants handed our brochure to Mr. Chang, and as he read it aloud, he shook each of our hands. Once the presentation was complete, Mr. Chang insisted that our tour be postponed until later that afternoon and that we all immediately go to lunch that had been specially prepared for us.

Our lunch cleared up the mystery of the “President” as well as Liang Xiao’s remarkable buzz, and opened a door to what may well be the future of nursing homes in China. Calling Chang a businessman is an understatement, as he is more aptly described as one of China’s new breed of hungry entrepreneurs, a new breed of savvy and savvy capitalists who can spot opportunities a mile away. Mr. Chang’s story begins a couple of years ago when the 12th 5-year plan was being drafted and the government began allocating funds for the development of facilities for the elderly. Through what I can only imagine is a carefully constructed and meticulously maintained healthy network of political and business contacts (guangxi must be legendary!) in Wuxi, Mr. Chang created an opportunity out of the ruins of Liang Xiao. And while Mr. Chang knows nothing about nursing care or even running such a facility, we must always remember the Joy Longevity Club’s fourth philosophy… General Tsao’s mock chicken with savory sauce.

Through the grants made available through the Ministry of Civil Affairs and, most importantly, private investment, Mr. Chang is slowly transforming Liang Xiao and, although it may not seem like it today, he has been in many other homes of elderly in China for the past two years. , Mr. Chang is clearly on the power curve of his industry. What is even more curious is that Mr. Chang has also “bought” shares in Liang Xiao and, through his private company, “owns” a substantial minority stake. I use the quotes for effect here as I have no idea of ​​the internal machinations of how he accomplished this or the details of the structure; Like many things in China, the means justify the end and it’s probably all arranged informally between him and his friends in the local government. Despite these details, the point here is the big picture: Mr. Chang is moving an industry that has long been mired in the stone age of China’s bleak legacy of anemic public health. Mr. Chang and his successors in Wuxi (not to mention the other 39,545 public nursing homes in China) will undoubtedly benefit handsomely from his efforts and should; yours is truly a herculean task.

All of this somewhat reminds me of Li Cunxin’s gripping autobiography. Mao’s Last Dancer (and subsequent film adaptation by Bruce Beresford in 2009). In his book, Li Cunxin is born into a poor family community in a small rural town in Shandong province, where he is destined to work in the fields as a laborer. At first overlooked, but ultimately selected after the teacher’s suggestion of him during a school visit, Li seems taken aback by the brusque preliminary inspection in the provincial capital city of Qingdao. He is selected to travel to Beijing to audition for a place at Madame Mao’s Dance Academy and is admitted to Madame Mao’s ballet school after passing a series of physicals. Years of arduous training follow, until his initial mediocre performance is finally overcome due to the inspiration of a teacher’s devotion to classical ballet as opposed to the raucous and politically motivated form favored by Madame Mao. His determination and courage cause the Academy to reluctantly allow him to travel abroad to attend Ben Stevenson’s Houston Ballet company as a visiting student for three months. In the United States, he begins to question the dictates of the Chinese Communist Party in which he grew up, disassociates himself from his political past, flaws and flourishes as a dancer.

I see Mr. Chang as China’s health care Li Cunxin; a charismatic and determined soul who sees more and wants a better circumstance for himself and his business and is frustrated with the status quo. The big difference between Li Cunxin and Mr. Chang is that Mr. Chang no longer has to defect to fulfill his ambition; China has learned to provide opportunities to those who are motivated enough.

A Brief Introduction to the History of China’s Nursing Homes

In 2000, China’s Ministry of Civil Affairs announced the “Star Light (Xing Guang) Program” whereby the Ministry allocated 20% of the social welfare lottery fund to build community welfare facilities for the elderly. From 2001 to 2004, the Chinese government invested a total of 13.4 billion yuan in this program and built 32,000 “Star Light Centers for Seniors.” I want to thank Leung-Wing Chu, FRCP and Iris Chi for this information as they did a lot of research on it. The services of these centers are too broad with multiple functions and cover family visits, emergency help, day care, health care services and recreational activities for more than 30 million seniors. At the same time, the government also increased its investment in the construction of nursing homes to provide institutional care for the elderly in the “Star Light Program”. Another program, the “Beloved Care Engineering” program, began in 2005 and aims to increase the number of nursing homes and encourage good quality nursing home care through a government-sponsored Elder Care Foundation. . These facilities range from boarding houses for the elderly (apartments), nursing homes, and nursing homes for the elderly, serving to serve seniors with different functional abilities and economic backgrounds. The construction of residences for the elderly in rural areas was also promoted for people who can take advantage of the “5 guarantees” which, translated, are the basic needs of “food”, “clothing”, “lodging”, “health,” and “office service”. Those who can usually find their way into such accommodations are usually former Revolutionary Guards, government employees, or another “proud” occupation. At the end of 2005, there were 39,546 institutions providing very different types of services for older people, with most providing poor care, compared to their Western counterparts (an admittedly unfair comparison). In total these institutions provided 1,497 million beds.

If providing nursing homes were the only problem then China would be well on its way, however that is the least of worries. As with most endeavors on the continent, human resources or the lack thereof is often the problem that trumps the best plans. The main source of health workers are (often called “bao mu” in Chinese) laid-off workers in formerly state-owned factories, immigrant workers from rural towns, or unemployed ethnic minorities. Often, they do not have any training in elder care or nursing home care before starting work in nursing homes for older adults. For laid-off workers, some local government agencies, such as the Labor Bureau, Social Security Bureau, Chinese Committee on Aging, and Women’s Federation, provide 1-2 days of short-term care training free of charge. basic staff. However, none of these workers is required to have formal training in geriatric care before entering their job. As a result, the quality of care is dismal and dangerously low. These workers are often required to pay a fee for these training courses and, as this imposes great financial hardship, they generally do not enroll before starting work. Such work also presents other problems for working in nursing homes; different language or dialect, customs of the elderly in urban cities and cultural prejudices of patients who often do not like to be served “bao mu”.

We have not yet started our work with Mr. Chang, although I am confident that we will do a lot with him. And as you can imagine, the benefits of working with such a person extend well beyond simple contractual compensation. His highly choreographed performance to date in raising Liang Xiao from little more than a living graveyard to a real, if spartan, nursing home is nothing short of virtuoso.