Over the past six months, employees of Shanghai-based elder care services company Fuxing Fenglin have been waging a vigorous PR campaign to win over residents of a neighborhood in the northwestern part of the city, meeting with community representatives 16 times and making hundreds of house calls. Their mission? To convince residents that the company’s proposed new nursing facility is a rehabilitation and temporary care center, not a hospice.

They've had no luck. Members of the community have mobilized to obstruct construction work at the site; some residents even stole the facility’s blueprints, used Photoshop to label one of the rooms a “mortuary,” and then pasted the fake plans on the door of every home in the neighborhood.

“The whole program’s been suspended, and we’re losing money every day,” an employee at the firm, surnamed Tang, told me.

Shanghai’s 13th Five-Year Plan for Elder Care Services Development, released in 2016, set an ambitious goal for expanding the city’s elder care infrastructure. Faced with a looming demographic crisis, city officials have ordered 500 new neighborhood elder care centers to be built between 2016 and 2020, with the goal of eventually having at least one in every subdistrict and township citywide. Yet, rather than welcome this development, so-called NIMBYs — an acronym for “not in my backyard” — across the city are doing everything they can to stop it.

Shanghai’s new neighborhood elder care facilities operate as part of a public-private partnership. City bureaucrats auction the rights to a program site or sites to private companies or NGOs. The winner is then responsible for renovating or constructing the facility, managing it, and offering affordable elder care services to the local community. In return, the city provides land — either developed or undeveloped — and a performance-based operating subsidy.

These facilities are generally small — between 10 and 49 beds — reflecting how scarce land is. Intended to be cost effective and convenient for elderly community members to access, most are located on previously idle properties, such as shuttered factories, kindergartens, or government office buildings.

Unlike traditional long-term elder care facilities, neighborhood elder care centers only house patients for a maximum of three months. They are a way station where community members can undergo evaluation and treatment before deciding on the next step. If their health improves, they can move back home. If they require long-term assistance, the center will refer them to a nursing home.

As of late 2015, almost 15% of Shanghai residents aged 60 or older were living with a physical or cognitive disability, according to the Shanghai Research Center on Aging. This number could rise as the city’s over-80 population booms over the next decade.

At the same time, traditional caregiving models centered on the family are eroding, increasing the burden on the city’s already strained welfare system. The fourth National Survey on Urban and Rural Chinese Older People’s Livelihood shows that almost 65% of Shanghai residents over the age of 60 prefer to age within their communities. In short, there is a real need and desire for more elder care facilities in the city. So why are so many residents opposed?

Between May 2017 and December 2018, my colleague and I visited 49 neighborhood nursing homes located across Shanghai. Of these, 37 reported being the subject of varying degrees of boycott. In one extreme case, the city had to dispatch the People’s Armed Police — a paramilitary police force — to maintain order.

In recent years, as residents have grown increasingly aware of, and interested in exercising their civic rights, Shanghai has seen the emergence of an active NIMBY movement. NIMBY sentiment often spikes in response to undesirable development in a neighborhood. NIMBY activists often claim they aren’t against the development itself, merely its proposed location near their homes.

Over the past decade, NIMBY movements have largely focused their ire on industrial or infrastructure projects that pose environmental or health risks to nearby communities. But that doesn’t explain why so many Shanghai residents oppose new neighborhood elder care facilities.

Based on interviews with residents, program managers, and government officials, as well as field research in a suburban township in southwestern Shanghai, I found that the most commonly cited reason for boycotting elder care facilities is indeed related to health and safety. Residents view elder care centers as medical institutions bringing concentrations of sick elderly people and medical waste into their communities. They also worry that the facilities will increase both car and foot traffic — and draw in strangers who could pose security risks. 

But the government officials and program managers I spoke to dismissed these concerns as excuses based on ignorance. “First, neighborhood elder care facilities exist mainly to provide older people with a space for functional and cognitive rehabilitation,” one official with a district-level elderly services office said. “They have neither the permits nor the equipment needed to cure diseases. And second, most nursing home residents hail from the community itself and are not likely to bring with them an influx of strangers.”

When I raised these points with a 61-year-old community representative, he acknowledged that he was aware such complaints were ill founded. “But, it’s a place full of dying people, right?” he asked. “The yin energy found (in such a facility) will destroy our neighborhood’s feng shui and cause us residents to feel strange.”

When I asked where he would go should he become incapacitated, he hesitated. “Who knows?” he replied. “I can’t count on my daughter, because she’s abroad. My wife and I might live in the facility several blocks away from here.”

Others expressed more material concerns: that the establishment of an elder care facility could negatively impact housing prices in the neighborhood. This is understandable. Many Shanghai residents spend years saving up — and some even rely on loans from family members — to be able to afford a home.

Certain communities are also more prone to resistance than others. During the course of my fieldwork in the above-mentioned suburban township, a member of the local homeowners’ committee told me that the area has a history of pushing back against public projects. Several homeowners’ committee members are professors at the nearby university, and together they have planned and carried out effective community action on a number of occasions.

The township’s residents first organized themselves in 2017, when a local infrastructure project broke the community’s water pipeline. Residents complained that the new pipeline was of inferior quality, and demanded an investigation and compensation, to no avail. “Since then, we’re cautious when it comes to government projects supposedly in the public interest,” one member of the homeowners’ committee told me.

Public resistance to neighborhood elder care centers is grounded in a web of misinformation, ageism, individual interest, and distrust of the government. The city remains committed to meeting its five-year plan goals, and the likelihood that public pushback will deter it is nil. Yet, these facilities require the support of their respective communities if they are to function as intended. And that, in turn, will require far more than a shiny new building or the promise of new services.

Editors: Cai Yiwen and Kilian O’Donnell.

(Header image: An internal view of an elder care facility in Xiaokunshan Town, Shanghai, Dec. 27, 2017. Courtesy of Yang Fan)