Public hospitals expand patient ward care to relieve families of caregiver duties

When 72-year-old Wang Laibin fractured his leg in Shanghai last month, he chose to move into the new "no-family care ward" at Renji Hospital, relieving his children of the need to juggle work shifts or hire a private caregiver to provide care.

"I don't want to burden my children, and outside caregivers can be unreliable," said Wang, a retired teacher. "Let professionals handle this."

His choice highlights a growing shift in Chinese public hospitals, where trained nursing aides now give 24/7 medical care, and family members visit only to provide emotional support.

Unlike hospitals in most Western countries, families in China commonly supplement daily hospital care for loved ones – a reflection of inadequate staffing levels and long-held filial tradition.

Family members mainly perform duties like feeding patients, assisting with toilet and bathing, and providing emotional support. Nurses focus on medical care, but care assistants managing multiple patients don't have the time to offer a high level of personal attention. This is where families come in.

In Western hospitals, professional staff handle all patient care, from providing meals and daily medicine, to getting patients to hospital tests, assisting in bathing and organizing physiotherapy. The UK's National Health Service employs a mix of nurses and orderlies to provide care.

This new model in China, now expanding in cities like Shanghai, Chengdu and Xiamen, addresses the growing health care challenges created by China's aging population and shrinking family sizes.

The National Health Commission projects over 400 million people in China will be aged 60 or older by 2035, making up more than a third of the population. It estimates that over 40 percent of urban families face burdens in providing elderly care during hospital stays.

In many households, a family member's hospitalization disrupts daily routine, forcing relatives to adjust work schedules to provide that care. And when family members can't help, they often resort to costly private outside caregivers with varying levels of service quality.

The "no-family care ward" system, backed by government policy reforms, aims to standardize care, cut costs and free families from exhaustion.

In contrast with public hospitals, international and private hospitals in Shanghai said they have already adopted "no-family care wards," in line with international practice.

Officials from Shanghai United Family Hospital said such wards do not eliminate family involvement; rather, they combine professional nursing, daily care and psychological support into one seamless service. A professionally trained nursing team provides 24/7 comprehensive care to meet the needs of patients and their families.

Without the need for direct family involvement in daily care, the burden on families is reduced, and patients can enjoy a quieter, more restful environment, with nurses providing professional and personalized services to help patients recover faster, the hospital said.

At Renji, a public hospital in Shanghai, the "no-family care wards" program is being trialed in the thoracic and urology departments.

Studies show that the model, initially implemented during the pandemic, lowers infection outbreaks in hospitals by reducing visitor frequency.

A nurse-in-charge at the hospital explained that the model works best with short and relatively simple surgeries.

Chen Wudi, whose father recently stayed in one such ward at Renji, said the cost for eight days of stay was 534 yuan (US$74), plus a daily service fee of 150 yuan.

Chen's father was admitted for surgery in the hospital's urology department and stayed in a three-person room with a private bathroom.

"The care provided by medical attendants employed by the hospital was professional, although not as personalized as family care," Chen told Shanghai Daily.

The "no-family care ward" operates on a set schedule, with visiting hours from 3pm to 5pm, during which only one family member is allowed.

However, Chen said her father craved more family involvement and that created emotional strains.

Her father received care from a designated aide, who was responsible for up to eight patients. While the aides were attentive, Chen said she still felt uneasy about his father's care during non-visitation hours, particularly when it came to navigating hospital tests.

"I queued for my father when he had to take tests and let him rest in the hospital lobby," she said. "Otherwise, he would have had to walk all the way by himself because the caregivers didn't provide that service."

An elderly man surnamed Li, who was diagnosed with lung cancer, is another patient who benefitted from the "no-family care ward" at the hospital.

His children live abroad, and his wife is too frail to assist him. Initially, Li was hesitant to undergo surgery due to the difficulties in coordinating care. After learning about the hospital's "no-family care" service, he opted for it.

"I feel at ease," Li said after his surgery. "I don't have to bother my family, and I can rest peacefully here. The staff is always available if I need help."

Scaling up the "no-family care" model in China faces significant challenges, primarily due to a shortage of trained medical caregivers.

China has just 4.7 nurses per 1,000 people, far below Japan's 13. Most nursing aides are rural migrants aged 40 to 50, with limited education. High turnover is common due to grueling workloads and low wages averaging 3,000 yuan (US$413)-4,000 yuan per month.

To address the shortage of caregivers, hospital leaders have suggested using pilot hospitals as training bases for improved clinical training, staff management and workforce standardization.

They also recommend that third-party agencies and vocational schools increase training efforts for high-demand roles, creating detailed programs to meet societal needs.

At Chongqing Jiulongpo District Hospital, for instance, aides working in "no-companion" wards must undergo monthly skill tests and wear smart wristbands to alert them during emergencies.

Cultural barriers also play a role in hindering the widespread adoption of the model.

A 65-year-old retiree in Shanghai rejected the "no-family care ward" for her hospitalized mother.

"It's a child's duty to care for parents," she said. "Outsiders can't replace family. What if no one notices when my father needs help?"

Similarly, 81-year-old Gu in Hangzhou turned down a "no-family care ward," and her children felt they couldn't oppose her wishes.

"Relatives would say we're unfilial," her daughter explained.

Experts emphasize the need for a standardized system that defines caregiver duties, sets wage tiers and enhances professional responsibility and skills.

"Filial piety isn't just a tradition; it's emotional security," said Peking University medical ethics professor Wang Yue.

"A quiet environment is crucial for patients to rest peacefully, so I believe its full adoption is the future, but the key is effective hospital management and involving families in evaluating caregivers to prevent disputes."

Despite the challenges, early data of the "no-family care wards" approach show promise. For example, Fuzhou Second General Hospital's pilot wards report 99 percent patient satisfaction and shorter hospital stays. And, at Xiamen Cardiovascular Hospital, infections dropped 4 percent after limiting family visits.

Policymakers are pushing reforms. Last October, the National Healthcare Security Administration set pricing for "no-family care" services, laying the policy foundation for its expansion. Experts urge broader insurance coverage.

The Shanghai Health Commission has launched trials at additional city hospitals to explore the potential for further expansion.

"This isn't just about convenience. It's about redefining care in an aging society," said Zhu Tongyu, a health policy scholar at Fudan University.