Future labour market demand in the

care economy:
case of LTC services in China
Zhang Bingzi
email: zhangbingzi@drc.gov.cn

Research Department of Social Development,

Development Research Center of the State Council, China
2018.9.17

1
Outlines
• Trend of population aging in China
• Forecast need on LTC worker
• Shortage of LTC workforce
• How to meet the need
• Jobs in care economy

2
Trend of population aging in
China
• Growth of senior people and
vulnerable elder
– People over 60 will growth from 220m in
2015 to 255m in 2020, and 377m in 2030.
– 150 million elders suffering from chronic
diseases , 40 million suffering some
function lost, with 10 million
disabled.(National health and family
planning commission)

3
 thousand

Disabled
Semi-disabled
Healthy

Chinese Population at 60 + and their health status

Source: National Bureau of Statistics, and World Population Prospects, 2017. 4

%

China/World China/Asia

Proportion of china’s elderly (65+)

Source: National Bureau of Statistics, and World Population
Prospects, 2017. 5
• Weakening of family care
– Shrinking of children and family size
– Migrations and high labour participant rate
– 2010, 37% of elderly do not living with any adult
child (single elder family 15%,elder couple18%,
elder with minor 3%)

Average Family Size

6
• Income and attitude change
– wages and pension are important sources of
elderly income, which accounted for a proportion
of 23% and 30% respectively in 2015; proportion of
dependence on other family members was only
36%, decrease from 48% in 2000.
– 13% would like to living in a care home(Gallup,
Tsinghua University,2017)
• Social elder care system will be more
and more important

7
Forecast ：need of care workers
• Method 1: based on development planning of the
elderly care service system
Service Provision Framework of elderly care system
– Home-care
• basic daily care (meals-on-wheels， cleaning， shopping， etc)
• medical and health care/ legal services /emergency help/assistive devices
– Community-based care
• Supporting home-care
• Day-care center with beds
• stay-over beds
• mutual-aid community-based centers
– Institution-based care

8
 For
Nursing disabled
beds
Number of For semi- Care
beds disabled workers
Non-nursing
beds

• One thousand elderly will have 35-40 beds (13th Five-Year Plan for the
Development of Civil Affairs)
• 30% nursing bed (13th Five-Year Plan for Senior-care System)
• Proportion of disabled and semi-disabled elderly senior（age-
specific data from 1% population survey in 2015）
• the ratio of the elderly care worker to residence, not less than
– 1:20 for healthy residents;
– 1:10 for semi-disabled
– 1:4 for disabled
（ Code of Conduct for Life Care of Elderly-care Institutions）
9
 workers for disabled elderly
workers for semi-disabled elderly
workers for self-care elderly

Forecast of the demand for elderly care workers (Method 1)

•In 2020 China needs about 640 thousand elderly care workers, and by 2050 will need
about 1.24 million workers
•Almost a half take care of self-care elderly, but drop from 48% to 47%
•Workers take care of disabled elderly account for 18% in 2020, and 20.7% in 2050
10
Method 2: based on needs of disabled
and semi-disabled elderly

• Only consider the needs of disabled

and semi-disabled elderly
• No matter where will they live
• the ratio of the elderly care workers
to senior , not less than
– 1:10 for semi-disabled
– 1:4 for disabled

11
 workers for semi-disabled elderly
workers for disabled elderly

Forecast of the demand for elderly care workers (Method 2)

•In 2020 China needs about 5.2 million elderly care workers, and by 2050 will need
about 13.14 million workers
•In 2020,1.8 million (34.5%) for disabled elderly , 3.4 million for semi-disabled elderly.
•In 2050, 5.1 million (39.2%) for disabled elderly, 8 million for semi-disabled elderly.

12
• Huge demand on care workers
– Workers in method 2 include all formal and informal, paid and
unpaid, full-time and part-time workers
– in method 1，all workers are paid work employed by
organizations
– elderly care system should more focus on disabled elderly
• The total need of care worker would be higher
– Ratios of the elderly care workers to senior just fit the minimum
requirement on national level, much more workers might be
needed for better services

Healthy Semi-disabled Disabled

Shandong 1:8-10 1:4-6 1:1-3
National 1:20 1:10 1:4

13
 Shortage of Care-workers in China
• Formal employee in institutions is 263 thousand in 2016
• Difficulties on recruiting care worker
– Working-age population in China has dropped significantly
– Care job are not attractive
• Migration worker, over 40+, female , low education
• Tough work with poor working condition
– Low paid, low social security
– High turnover
– Little training or emotional/ social support
– No promotion
• Low skill and Low quality on services
• Worse in rural areas institutions

Gap between supply and demand for elderly care workers will
become increasingly prominent, especially for rural elderly 14
Other LTC jobs also on shortage
• Directly or indirectly jobs on providing LTC services
– Direct care-givers:
• care workers, nurses, doctors, social workers,
managers and other professionals;
• family members, friends, volunteers, etc
– Indirect jobs:
• varieties of workforce in care economy
• All kinds of R&D, production & manufacturing,
and sales jobs of products and services
especially for elderly
15
 Doctors and nurses

• Lacking of doctors and nurses in whole health

system
• Only a very few care home have full-time
doctors,many residents in care home use
public community health center
– Too expensive for small care home
– Lower paid on elder care home than in hospital
– Working experiences in care home are week in
Professional Assessments and Certifications
• Lack of training and education for geriatric
diseases and geriatric rehabilitation

16
 Social workers
• Elderly care has become one of the
important fields for social workers.
• Mainly young social workers with
limited practical experience.
• On social worker education system,
few specific degree or curriculum
setting on social workers for the elders/
disabled/ kids

17
 Informal care-givers
• Family members, most likely young senior
taking care of old senior
• Economic, physical and emotional stress
• Little support from the government
– Home care receive less subsidy from
government comparing with those in institutions
– Limited community services
• Lack of knowledge
• Struggle on family and work
– Recent local reform: employee from one-child
family can enjoy 20 days of paid-leave a year if
their parents over 60+, Henan province ,2016

18
 Indirect care jobs
• Jobs on other sliver industries
– productions for mobility
• assistive-technology; mobility furniture&fixture; barrier-
free reconstruction
– productions for care services
• smart care；monitoring devices;
– Silver housing, tourist, financing, shopping etc.
• Immature market of silver economy
• Few professionals in other industrials have
knowledge and experiences on elderly care

19
 How to meet the need

• Appling new technology

• Skill development
• Importing LTC workers

20
 New technologies
• Direct and efficient ways to alleviate the
shortfall of elderly care workers
– Improve the autonomy and quality of life of the
elderly
– Save the workload of elderly care workers
– Decreasing marginal cost
– Improve working condition and change the
negative stereotypes
• Attempts on supportive policy
2017, the Ministry of Industry and Information Technology, the
Ministry of Civil Affairs, and the National Health Commission jointly
issued the Action Plan for the Development of Smart and Healthy
Senior-care Industry (2017-2020).
• Call for inter-disciplinary talent and skill-
update of care worker

21
 Skill development
• Training
– Especially for migrant workers，poverty， unemployed
– Vocational skills training subsidies from local government
• Shanghai's certified elderly care workers can receive 80% subsidies for
the training fee;
• Nanjing provides subsidy of 500-3,000 yuan to qualified senior elderly
care workers who work for more than two years
• Education：
– Courses revised and new courses/major set up, like senior services
and management, senior health care etc
– Secondary education
• Major Catalogue of Vocational Schools (Revised in 2013),
• Major Catalogue for Secondary Vocational Schools (Revised in 2010).
– Tertiary education
• Teaching Standards for the major of Senior Services and Management
in Higher Vocational Schools (2012)
• Major Catalogue for vocational colleges (2015)
22
 Importing LTC workers
• Recruiting LTC worker oversea is an
important solution in many aged
countries
• Benefit both the import and export
counties
• More efforts should be taken to attract
oversea workers
– Recognition of professional qualifications
– Comprehensive training program
– Decent work for migrants
23
 Jobs in care economy
• Develop with externalization of family work,
– More female workers, with high proportion of informal
and part-time jobs and high turnover rate.
– Highly emotion-related
– Lack of professionalism or professionalism can hardly be
recognized by the public.

• Increasing job opportunities

– Demographic change
– Lifestyle change
– Specialization on services
– Not easy to be placed by machine

24
Supportive strategies for care jobs
• Education and Training
– Professional knowledge research and education
system development
– Other subjects will introduce a perspective of care
like city-planning, auto-design
– Lifelong learning, with using of new technology
– cognitive and non-cognitive knowledge

• Labor protection
– Non-standard work protection with new labor
standard
– Work and life balance
– Emotional and mental protection

25
Thank you!

26