Supervisor: Meifang Chen, Assistant Professor of Health Policy
Student Researchers: Di Li (Class of 2025), Yuhan Wang (Class of 2026), Dong Ding (Class of 2026), Yuxi Wang (Class of 2025)
About the Project:
China has one of the fastest growing aging populations in the world, with an estimation of 400 million older adults (aged 60 and over; counting for 28% of its total population) by 2040, a nearly 60% increase in the size of the older population compared to 2019. Moreover, the health status of the older adults in China has not been good. In 2019, around 75% of older people in China suffered from non-communicable diseases (NCDs) such as cardiovascular disease, diabetes and hypertension, and had multiple comorbidities. It is projected that 248.3 million Chinese older adults will be totally dependent on others in their last stage of life in 2035, which implies a heavy long-term care load for families and society.
The WHO Global Strategy and Action Plan on Ageing and Health and the WHO-led United Nations Decade of Healthy Ageing have pointed out the importance of delivering person centered, integrated care and primary health services responsive to older people, and providing access to long-term care for older people who need it. Since China became an aging society in 1999, the Chinese government has outlined a plan for a “9064” three-tiered long-term care system, which emphasizes on having home-based care and support services provided by family members as its long-term care foundation (90%) with supplementary support from communitybased services (6%) and institutional care (4%). However, the eroding availability of informal and family support and growing care needs have resulted in an urgent need to increase care and support services provided by non-traditional family and health care professionals – “hu gong”, personal care workers (caregivers) who are formal workers providing long-term care services at home or in institutions (other than hospitals) and who are not qualified or certified as nurses.
The aim of this proposed study is four-fold. Firstly, it attempts to use data from various sources to map and describe the composition, migration, and trends of the “hu gong” workforce for long-term care in China. Secondly, it purports to use mixed methods (combing survey, indepth interview and observation data collection methods to collect both quantitative and qualitative data) to describe the working content, conditions, challenges, and employment status among the “hu gong” population. Thirdly, it attempts to review the long-term care policies aimed at the long-term care workforce (especially those related to “hu gong”) and examine the impact of the policies on the attrition and retention of the “hu gong” in China. Lastly, it aims to conduct interviews with key informants to describe the role and responsibilities of different sectors in the “hu gong” workforce development. The findings from this project will be compared to international and national guidance for long-term care workforce development as well as the workforce development in other countries (like Japan and US), in order to identify the gaps in policy and workforce development for long-term care and provide the system- and service-level recommendations for improving coordination across sectoral boundaries and between formal and informal caregivers, and establishing a quality, effective, and sustainable long-term care workforce to provide person centered, integrated long-term care service to the older population in China.
