Chinese still reluctant to place loved ones in hospice

On March 11, Li Ying, aged 108, died peacefully at the Beijing Songtang Hospice. According to Zhu Lin, vice-president of Songtang, all the nurses lit candles that night to bid farewell to Li.

"Grandma Li lived the longest among the elders at Songtang. She lived here for more than 10 years," said Zhu. "Grandma Li saw Songtang grow from a small and marginalized hospice to what it is now."

Currently, more than 200 elderly as well as late-stage cancer patients live in the three-storey hospice, waiting out their final days. They are looked after by 120 nurses or nursing workers and hundreds of volunteers.

"Although Songtang has become a well established institution, the hospice idea is yet to be fully accepted by Chinese society," said Zhu.

Despite 20 years since the first hospice started, China's hospices are still rare and located only in major cities. Some oncology hospitals do have a few wards but they are limited to less than 30 beds.

According to Zhu, the pursuit of longevity is inherent in Chinese culture; people are ashamed to mention death, let alone a place to await death.

Since 1987, when Songtang was established in a corner of the Fragrance Hills in the western suburb of Beijing, it has moved 11 times. Some moves were prompted by strong protests from local residents who complained that there were often coffins outside the hospice.

Li Ling of the nursing department of Zhangye People's Hospital in the northwestern province of Gansu, agreed with Zhu's views.

"In most regions, elderly Chinese prefer to die in their homes with their children beside them. Children who send their parents to hospices to wait for death are widely seen as lacking in filial piety," Li told China Daily during a telephone interview.

Li published a paper summarizing China's hospices in the August 2005 issue of the journal Foreign Medical Sciences.

"Our hospice charges are low, just a little more than 1,000 yuan (US$125) per month. Most elderly persons are not covered by medical insurance, and they do not have pensions or they are very low," Zhu said.

Besides, current medical insurance only covers treatment and medicine costs, but for a hospice, much expenditure is incurred in the care of the elderly and this is not covered by insurance, Zhu said.

Zhang Danuo, a Songtang volunteer, said: "The most frequent words I hear from the elderly are that they have spent too much money of their children."

Zhang always comforts them saying: "You have spent so much to raise them and they should spend for you in return."

Jiang Yongqin, director of the nursing department of the Tianjin Cancer Hospital, was among the first batch of registered nurses to promote hospice, or palliative care, in China in the late 1980s.

"Compared with the elders, palliative care for late-stage cancer patients is more challenging. Most of them are in serious pain," said Jiang.

A major obstacle in providing hospice care is the lack of registered nurses. According to a speech made by Vice-Health Minister Ma Xiaowei in late 2005, the ratio between wards and nurses even in first-level hospitals in China is only 0.26 to 1 while in developed countries, it is often 1 to 1.

Given this shortage, elders in the hospices could only be tended by their family members or by unprofessional nursing workers who are mostly from the rural areas.

At Songtang, the number of registered nurses is 25 and of nursing workers, 90. "We have no choice but to train nursing workers to provide all non-medical services to the patients and the elders, ranging from washing clothes to chatting with them to ease their pain," said Zhu.

"We do not have enough psychiatrists in the Western sense, but in our own way, every nurse or nursing worker plays such a role," he added.

Ma has promised that his ministry will solve the problem of nursing shortage in the near future.

According to Jiang, although the idea of filial piety may have impeded the development of palliative care in the beginning, with the right information this could become common in China.

"After we have convinced family members that it is better for the patients to stay in our palliative care wards, they often visit them and talk with them. This gives patients the greatest relaxation and comfort," said Jiang.

Source:China Daily