The ageing population is a global crisis and has profound implications for the healthcare system. Over the past few weeks, I have been working with a team of Chinese nursing educators from Fujian Medical University of China who have great interests in New Zealand’s aged care management system. A major surprise to them was the beautiful environment, quality, comfort and extent of the cares and services offered by aged care facilities in New Zealand.
Thus, the question was raised: Can the New Zealand government make aged care sustainable?
I found this question difficult to answer. As we all know, the efficiency and sustainability of the New Zealand healthcare system is challenged by increasing life expectancies and the prevalence of chronic diseases. The New Zealand population is ageing rapidly. According to Stats New Zealand (2015), at the time of the 2013 Census, the proportion of people aged over 65 was 14.3 percent of overall population, and it is estimated to be 26.7 percent of the population in 2063. The cost of aged care is substantial. According to Ministry of Health (2016), DHBs spend more than 900 million every year on services for older people, and residential care is the largest part of the budget.
Many reports, such as ‘In Safe Hands’, a research report by the New Zealand Nurses Organisation and E tū, have revealed that our elderly is not getting the care they deserve due to unsafe staffing levels. Although the New Zealand government is committed to promoting positive ageing, the new version of the New Zealand Healthy Ageing Strategy issued in 2016 acknowledged that New Zealand faces many challenges in aged care as a result of the diverse population, health inequities and significant workforce shortage.
Population ageing is not a phenomenon unique to New Zealand. China has the largest population and the largest elderly population in the world. According to the Sixth National Population Census of the People’s Republic of China, there were 118.8 million people aged 65, accounting for 13.26 percent of overall population.
Professor Lin, Director of Affiliated Hospital of Fujian Medical University stated, “we will not abandon our aged parents in rest homes, as long as we have the ability to look after our parents”. She further mentioned that China has developed filial-support laws as a way of meeting older people’s needs. The filial-support law, stemmed from social welfare laws, has created a statutory duty for adult children to support their elder parents both financially and spiritually. China’s Law for the Protection of the Rights and Interests of the Elderly (2012 Revision) strongly encourages adult children to consider the spiritual needs of their older relatives in terms of family connectedness.
Four Asian countries – Bangladesh, China, India and Singapore – have developed filial-support laws as a way of influencing families to provide care to the needs of their elderly. Although such laws cannot address all of the problems associated with an ageing population, in healthcare resource-limited countries such as China, filial-support laws can help strengthen the sense of a social norm of being responsible for caring for the old, in addition to the traditional habit of elderly being cared for by the younger generation in their own homes. As the most developed Asian country, Singapore has also developed the Maintenance of Parents Act of 1995 that details the monthly allowance paid by adult children to their parents.
The influence of socioeconomic, interpersonal and cultural factors in promoting a happy and meaningful life have been acknowledged by the Chinese central government. The Chinese government endeavours to promote healthy ageing through prioritising and establishing a suitable health service system for older people. In 2016, the central government and state council issued the outline of the Healthy China 2030 Plan, which aims at developing new types of health services including home-based care services and primary healthcare services. Promoting fitness, leisure and sport industry are also examples of China’s endeavours to promote a healthy ageing environment.
The Chinese government envisions a “90-7-3” system, where 90 percent of the city’s elderly people will be living with family, 7 percent may need to visit community centres and 3 percent will be staying in residential care facilities, paid either by the government or themselves, in the case of private rest homes.
For centuries, Chinese people have benefitted from deep-seated views of filial piety founded by the accent Chinese philosopher Confucius. These views have created such strong family-support mechanisms and remained a cornerstone of aged care in Chinese community for more than 2,000 years. According to Confucius, caring for the old is a fundamental family virtue. The key to ageing well is to develop an in-depth understanding the overarching cultural, political and socioeconomic systems within which the aged care philosophies are constructed. Cultural, although it is complex to conceptualize, is perhaps the most pervasive influence on human behaviour, and these prominent cultural expectations may very well alter the provision of aged care significantly.
International Labour Organization. (2019). Law of the People’s Republic of China on Protection of the Rights and Interests of the Elderly (2012 Revision) (Order No. 72 of the President of the PRC). Retrieved from http://www.ilo.org/dyn/natlex/natlex4.de HYPERLINK “http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=&p_isn=92671″t HYPERLINK “http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=&p_isn=92671″ail?p_lang= HYPERLINK “http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=&p_isn=92671″& HYPERLINK “http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=&p_isn=92671″p_isn=92671
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