AMID THE stress and sadness of choosing an old-age home for her husband, it took Li Wangke, a retired academic, a while to realise why one facility was so good at reawakening his playful, chatty side. She had visited other homes that had fine food and lavish amenities, reflecting the affluence of the couple’s southern Chinese home town, Guangzhou. But one newly opened home stood out for easing—at least somewhat—the symptoms of the disease ravaging his brain. Rather than pampering her 83-year-old husband, its staff assessed his rare neuro-degenerative illness, then with warmth and firmness pushed him to do as much for himself as possible. They cajoled him to talk, exercise and even play ping-pong. He seems a “different person”, says Ms Li.
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After several visits she discovered that the home’s methods had been imported from Japan, a former wartime foe that older Chinese are commonly thought to detest. Her husband, also a retired academic, moved in full-time in late October. “It’s from here that I learned that Japan takes really good care of its elderly,” she says.
The home is a joint venture between a Chinese state-owned investor and Medical Care Service (MCS), Japan’s largest operator of dementia-care homes. MCS opened its first Chinese facility in Nantong, a city near Shanghai, in 2014. A third opened in the northern port of Tianjin last month. It has plans for more in Beijing, Xi’an and even in Nanjing, the site of a Japanese wartime massacre, memories of which plague the relationship to this day.
China’s needs are vast. Degenerative brain diseases are too often confused with mental illness. Sufferers are shut away in family homes with unskilled helpers, typically migrant women from the countryside. Some families share guilty tales of sending relatives to psychiatric wards, where they are strapped to beds and fed pills. More than 10m Chinese are estimated to have some form of dementia. “That is a big, almost frightening number,” says Akira Wate, the general manager of MCS’s home in Guangzhou.
By 2030 China is projected to have 23m dementia sufferers—almost the population of Australia. During a visit to China last month by Shinzo Abe, Japan’s prime minister, the two governments named old-age care as an area for co-operation. China and Japan are trying to edge closer in these stormy, Trumpian times. One bond involves demographics. With almost one in nine citizens over 65, China is at the point on the ageing curve that Japan hit in 1987. It has a lot to learn from its Asian rival’s experience.
Chinese old folk and Japanese care-home operators have discovered revealing things about each other. MCS was full of confidence when it opened its 106-bed home in Nantong. Half a year later, just six beds were filled. For Asian neighbours that revere the old, China and Japan turn out to differ—a lot. Notably, China is an exceptionally low-trust society. But bonds of family duty are stronger than in Japan, say MCS’s bosses, noting the frequency of visits and the solicitude of residents’ children.
In orderly Japan, entering a home is straightforward, says Mr Wate. An older person shows signs of dementia, facilities are recommended, their child might visit one, admission follows. In China, suspicion is the starting-point, with the domestic news full of stories of fatal fires or bullying at nursing homes. Unprompted, Ms Li relates how her daughter, a banker, warned her against taking private firms’ promises at face value.
Chinese customers worry constantly about being ripped off. When it entered China, MCS set its prices high and built single-bed rooms to Japanese standards, offering the privacy and calm that pensioners in Japan demand. But Chinese clients wanted company and the lively din known as renao, relates Grace Wang, MCS’s boss in China. They questioned the emphasis on doing things for themselves, grumbling that, “I paid money, so you have to do everything for me,” Ms Wang says. Her firm changed its model, building shared rooms, lowering prices and offering day rates to demonstrate its methods. The home in Nantong is now profitable.
Historical distrust of Japan has not been a big problem. MCS neither boasts of nor hides its origins. As well as a Chinese scholar’s study and mahjong tables, its home in Guangzhou has a Japanese roof garden with benches, stone lanterns and an artfully trained pine. A few residents refuse to speak to visiting Japanese executives, admits Mr Wate, who is of mixed Chinese and Japanese ancestry. Most are pragmatic, associating Japan with good service.
Family dynamics cause more headaches than nationalism. In Japan, generous government insurance covers most care-home costs, giving old folk much autonomy. In China many in need of care must either sell property or ask children for help. Average monthly fees at MCS’s home in Guangzhou are 14,000 yuan ($2,224)—more than a typical pension. That makes entering a home a collective decision by as many as four or five family members. The elderly also need convincing. Many want to preserve their savings to help the young. Because trying to stay at home is the norm, the average age of MCS’s residents in China is 85, about a decade older than at its dementia-related facilities in Japan.
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Still, China is quicker to embrace change than outsiders might suppose. Ms Li recalls the traditional line: “Raise children to care for you when you get old.” But her children have demanding jobs, and she hates asking them to take too much time off. Nor are hired helpers the solution. When her husband loses control of his bowels, no hired helper will clean him, she says matter-of-factly. Such helpers are “very impatient”. The Chinese once believed that only bad children send their parents to care homes, she concedes. “We don’t think that way anymore.”
Rather few Chinese will ever be able to afford Japanese-style homes, it is true. That does not make their expertise irrelevant. If China’s old enemy can raise the profile of kindly, attentive dementia care, that alone would be a historic, neighbourly act.