In Shanghai, a Splash of Comfort in Elderly Care: Home Bathing Services

SHANGHAI — Chen Juqing hums a joyful tune as she soaks in a warm bath on an early winter morning.

For Chen, who is celebrating her 90th birthday in two months, a bath is one of life’s great pleasures — a way to relax after a stroke 14 years ago left her partially paralyzed and bedridden.

“At her age, verbal communication is difficult, but we know she’s in a good mood when she’s humming,” Chen’s daughter, surnamed Zhu, told Sixth Tone.

Chen’s age, limited mobility, and absence of a bathtub at home make bathing somewhat problematic. Fortunately, her community center put her family in touch with an outside bathing service that sends professional carers to her home in downtown Shanghai.

The carers, who visit every 20 days or so, provide everything she needs for a bath, including a portable tub. They also check her vital signs and may even give her hair and nails a trim.

“In the first decade after my mother’s stroke, I was only able to bathe her in bed with towels, or I sometimes even had to take her to a hotel for a bath, with the help of my sister, which was quite inconvenient,” said Zhu, 68, whose own health makes labor-intensive tasks difficult. “Sitting in warm water improves my mother’s health by increasing her blood flow and facilitating better bowel movements.”

Amid an aging population, bathing services tailored for the elderly are gaining in popularity in China, where ordinary apartments tend to have only showers. Government-led initiatives and the emergence of commercial operators have helped related services expand.

China’s aging population has increased demand for in-home care services. As of 2022, China had over 280 million people aged 60 years or older, with nearly 44 million living with various forms of disabilities, according to the 2021-22 Senior Industry Development Report published by the China National Committee on Aging in August. Approximately 40% of those above 80 suffer some disability, the report said.

Of the daily tasks that seniors have to perform, bathing is the most challenging, along with getting dressed and going to the toilet, the report said. It also noted that bathroom accidents, such as falls, are among the biggest risks to the elderly.

The government’s 14th Five-Year Plan last year addressed rising demands in the elderly care system and highlighted the need for bathing assistance and other vital services. This month, China’s Ministry of Civil Affairs issued guidelines on standards for bathing assistance services aimed at the elderly.

The need for elderly care is particularly acute in Shanghai, China’s most rapidly aging city. The registered number of people 60 years and older was 5.5 million people as of 2022, accounting for 37% of the total registered population, compared with about 20% across the country.

Commercial orders for bathing assistance services on the online platform Meituan in September increased 442% from a year earlier, while the number of vendors providing bathing services on the platform surged 936%.

Xu Ying, a nurse in a bathing team, said professionals can give the elderly safer baths than most families can provide. A home visit typically involves an elaborate procedure that takes up to 90 minutes. The first half hour is dedicated to a health check of the patient’s blood pressure, blood oxygen levels, and body temperature to ensure there are no risks when bathing, Xu said.

Her team had to cancel one bath just a few weeks ago when Chen’s blood pressure exceeded the recommended range of 140-160. On the most recent visit, the soft-spoken Xu suggested that Chen refrain from humming while in the bath lest the extra effort increase her blood pressure.

While Xu checks Chen’s vital signs, her colleagues prepare the bathtub, ensuring the water and room are at the right temperatures. Once everything is in place, Chen is gently moved from her bed to a stretcher in the tub. The bathtub is equipped with various elastic belts and buffers for protection. One of the caregivers washes Chen’s hair and massages her scalp, while others keep ladling water over her to keep her warm.

“The seniors will stay in the bath for between 15 and 20 minutes. Any longer and it could pose risks to their health,” another caregiver, Xiang Keshu, told Sixth Tone. After the bath, Chen’s hair and body are carefully dried, and then she is gently moved back to her bed, where she is changed into clean clothes.

The concept of bath visits was introduced to China from Japan, which also has an aging demographic. Zhao Rong started a bathing services company for older people in 2021 in the northern city of Tianjin after working in a similar sector in Japan for five years. At the time, few people were aware of the service, according to Zhao.

“We had to keep explaining our services to clients in the first year of operation,” he said. “But with greater public awareness and word-of-mouth recommendations, we reached the milestone of our 1,000th client this October.”

One of the biggest hurdles to overcome is resistance to outside help for something as personal as bathing. Many seniors are reluctant to have strangers or sometimes even family members performing such a private activity.

The situation demands sensitivity and respect for an individual’s dignity, according to Wei Xiaojun, 32, who runs her own in-home services company in Shanghai. She said the personal hygiene of one of her clients, who lives in a luxurious apartment, was in a terrible state when carers arrived. Her nails and hair were long and in need of trimming, and her underwear needed changing.

“The granddaughter of the client told me that her grandmother is stroppy when family members offer to change her underwear,” said Wei. “She was just sleeping in her clothes day after day.” Wei said the woman was just too embarrassed to let others help her with personal care and feared her children would look down on her.

To address such sensitive issues, Wei said carers sit down and talk with clients, carefully explaining the help they can give in an empathetic manner. In home bathing services, it is common for outside teams to include both male and female members. That allows teams to handle clients of different genders. Additionally, male carers are better when it comes to the smooth lifting and moving of the elderly during the bathing process, according to Wei.

“Throughout the bathing process, clients’ bodies are discreetly covered with towels so that they don’t feel embarrassed,” she said.

Another significant challenge in expanding in-home care services is the cost. Bathing services available on the market vary. Some are home visits like the one Chen receives. They typically cost between 200 yuan ($28) and 500 yuan. There are also services provided in private or community bathhouses, or by mobile bathing vehicles. Prices can range from tens of yuan to a few hundred.

Elderly bathing assistance primarily relies on government support. China has included such services in the nation’s long-term care insurance pilot, a state-backed program that has reached 49 cities to provide the disabled and other needy adults with affordable basic services.

Sometimes, local governments purchase elderly in-home services at a bulk discount rate, allowing seniors access for free or little cost. Special consideration is given to those with low incomes or who are in a poorer physical condition.

With government support, commercial services are prospering in top-tier cities like Beijing and Shanghai. Xu works for Fushoukang, a Shanghai-based family care company that serves both self-funded and subsidized clients. Of the four clients seen by Xu’s team on a Friday in November, two were commercial clients — including Chen who paid 499 yuan for the visit — and two had their fees paid by the government.

Mei Jiagan, an 83-year-old bedridden patient, tried the service after receiving free introductory coupons from his local community. His 81-year-old wife told Sixth Tone that they are considering continuing the service in the future, though it would no longer be free.

Senior bathing services say they face the same shortage of qualified professional staff as others in the elderly care sector. Wei said demand is greatest for carers who can proficiently handle activities like bathing and who have some medical knowledge.

“Seniors, especially those above 80, can be very fragile,” she said. “It’s important for carers to have professional training in how to handle them. Some of the elderly may have medical devices, such as colostomy bags or pacemakers.”

To address the gap between need and carers, Shanghai Open University began offering an undergraduate degree in senior care in 2017. “While most of the students are from government-backed senior care centers, we have seen an uptick in candidates from all walks of life,” said Liu Shuhan, head of the university’s senior care arm.

Many are middle-aged students who entered elderly care after hitting roadblocks in their career trajectories — a trend that has become more pronounced in recent years, Liu said. Other students are motivated by personal commitments to care for loved ones, she added.

The job is undeniably tough. Xu and her colleagues work on a tight schedule that involves laborious tasks such as moving tubs and patients, connecting water pipes, and disinfecting equipment. The challenges they face escalate when older residential buildings don’t have elevators or when water heaters aren’t working properly.

“To make the best use of our time, we usually have lunch in the car on our way to visit the next client,” said Xiang.

Still, Wei said she believes that the market potential makes senior care an area worth tapping. Formerly a designer, she ventured into family services as a side job after giving birth to her daughter. First engaged in maternity care, she decided to shift to senior care after receiving countless inquiries from that demographic.

Caregivers or other people engaged in domestic services often suffer from a prevailing social stigma that theirs is a “low-status” profession. Wei, who holds a master’s degree in education from Nanjing Normal University, said young people seeking fulfilling work shouldn’t judge a job by its salary, nor should they be judged by the salaries they earn.

She said she takes personal pride as a younger person involved in an industry where most practitioners are in their 40s or 50s.

“Another driver that sustains me is the sense of fulfillment I feel after giving baths to the seniors,” said Wei. “I feel a deep connection with the clients because I, too, have elderly family members at home. Every time a client thanks me, I feel that my work is truly worthwhile.”

(Header image: Bath assistants care for Mei Jiagan at her home in Shanghai, Nov. 24, 2023. Li Xin/Sixth Tone)

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