【经济学人 | 泛读】日本养老院专业在哪里？

日本养老院专业在哪里？

《及人之老》

中国社会对专业老年照护的需求巨大，尤其是针对有脑部退行性疾病的老人——预计到2030年中国将有2300万名痴呆症患者。日本首相安倍访华时也指出，两国可在养老领域开展合作。如今，中国在老龄化曲线上大约处在日本1987年时的位置。中国能从这个亚洲对手身上学到很多经验。日本最大的老年痴呆护理院运营商美邸（MCS）正在这一领域靠着专业技能在中国展现软实力。

茶馆

Chaguan

及人之老

Respecting their elders

Japan's expertise in old-age care becomes a source of soft power in China

日本在老年照护方面的专业技能助其在中国展现软实力

在为丈夫挑选养老院的过程中，退休高校教师李望珂（Li Wangke，音译）被压力和悲伤笼罩。过了好一会儿她才明白过来，为什么其中一家养老院特别能唤起老伴活泼、爱说笑的一面。她也去看过其他地方，它们伙食好、设施豪华，把两人的家乡广州的富庶展露无遗。但这家新开的养老院却与众不同，因为它缓解了（至少是稍微缓解了）大脑严重受损的丈夫的病情。这里的员工并不为她83岁的丈夫代劳一切，而是先对他罕见的神经退行性疾病做评估，然后温和而坚定地鼓励他尽量自己动手。他们哄着他说话、锻炼，甚至还打乒乓球。李女士说，他看上去像“变了一个人”。

AMID（在...中） THE stress and sadness of choosing an old-age home（养老院） for her husband, it took Li Wangke, a retired academic, a while to realise why one facility was so good at reawakening his playful, chatty side（他活泼、爱说笑的一面）. She had visited other homes that had fine food and lavish amenities（设施豪华）, reflecting the affluence of the couple’s southern Chinese home town, Guangzhou. But one newly opened home stood out for easing—at least somewhat—the symptoms of the disease ravaging his brain（大脑严重受损）. Rather than pampering（呵护；代劳一切） her 83-year-old husband, its staff assessed his rare neuro-degenerative illness, then with warmth and firmness pushed him to do as much for himself as possible. They cajoled（哄着） him to talk, exercise and even play ping-pong. He seems a “different person”, says Ms Li.

去过几次之后，她发现这家养老院的照护方法是从日本引进的。因为战争年代留下的宿怨，一般认为老一辈中国人都痛恨日本。去年10月底，同为退休高校教师的丈夫全天住进了那里。“在这儿我了解到，日本真是把老年人照顾得很好。”她说。

After several visits she discovered that the home’s methods had been imported from Japan, a former wartime foe that older Chinese are commonly thought to detest（痛恨）. Her husband, also a retired academic, moved in full-time in late October. “It’s from here that I learned that Japan takes really good care of its elderly,” she says.

这家养老院由中国的一家国有投资机构和日本最大的老年痴呆护理院运营商——美邸养老服务公司（MCS）——合办。美邸于2014年在南通开设了它在中国的首个护理院，今年10月在天津开设了第三家。它还计划扩展到北京、西安，甚至南京（南京大屠杀的记忆至今仍深深影响着两国关系）。

The home is a joint venture between a Chinese state-owned investor and Medical Care Service (MCS), Japan’s largest operator of dementia-care homes（老年痴呆护理院）. MCS opened its first Chinese facility in Nantong, a city near Shanghai, in 2014. A third opened in the northern port of Tianjin in October. It has plans for more in Beijing, Xi’an and even in Nanjing, the site of a Japanese wartime massacre, memories of which plague the relationship（深深影响两国关系） to this day.

中国的需求巨大。脑部退行性疾病常被误认为精神病。患者被关在家里，由基本上来自农村、未经护理培训的外来务工妇女照顾。一些家庭讲述了把亲人送进精神病院、目睹他们被绑在床上和强喂药片的经历，深感内疚。估计有超过1000万中国人患有某种类型的痴呆症。“这是一个大到简直吓人的数字。”在美邸的广州养老院担任总经理的和手明（Akira Wate）说。

China’s needs are vast. Degenerative brain diseases are too often confused with mental illness. Sufferers are shut away in family homes with unskilled helpers, typically migrant women from the countryside. Some families share guilty tales of sending relatives to psychiatric wards（精神病院）, where they are strapped to beds and fed pills. More than 10m Chinese are estimated to have some form of dementia. “That is a big, almost frightening number,” says Akira Wate, the general manager of MCS’s home in Guangzhou.

预计到2030年中国将有2300万名痴呆症患者——几乎相当于澳大利亚的总人口。10月日本首相安倍晋三访华时，两国政府指出可在养老领域开展合作。在眼下特朗普掀风作浪的时期，中国和日本正尝试拉近彼此的距离。其中一个纽带关乎人口构成。中国65岁以上人口几乎占到九分之一，如今，中国在老龄化曲线上处在日本在1987年达到的位置。中国能从这个亚洲对手的过往学到很多经验。

By 2030 China is projected to have 23m dementia sufferers—almost the population of Australia. During a visit to China in October by Shinzo Abe, Japan’s prime minister, the two governments named old-age care（养老领域） as an area for co-operation. China and Japan are trying to edge closer in these stormy, Trumpian times（特朗普兴风作浪的时期）. One bond involves demographics. With almost one in nine citizens over 65, China is at the point on the ageing curve that Japan hit in 1987. It has a lot to learn from its Asian rival’s experience.

中国的老人和日本的养老院运营者都对彼此有了新的认识。美邸开在南通的护理院有106张床位，刚开业时它信心满满。半年后，只有六张床位睡了人。虽然两个亚洲邻国都敬老尊老，中国和日本实则差异很大。突出的一点是，中国是个信任度极低的社会。但美邸的老板们在看到子女们探望父母的频率和对父母的关切后认为，在中国，家庭责任的羁绊要比日本更深。

Chinese old folk（老人） and Japanese care-home operators have discovered revealing things about each other. MCS was full of confidence when it opened its 106-bed home in Nantong. Half a year later, just six beds were filled. For Asian neighbours that revere the old（尊老敬老）, China and Japan turn out to differ—a lot. Notably, China is an exceptionally low-trust society. But bonds of family duty are stronger than in Japan, say MCS’s bosses, noting the frequency of visits and the solicitude（关切） of residents’ children.

和手明说，在秩序井然的日本，入住一家养老院很简单。老年人显现出痴呆症状后，会有人给老人及其家人推荐养老院，子女们可能会挑一家前往看看，然后院方办理接收。在中国，人们一上来就先怀疑，毕竟国内新闻充斥着养老院失火致死或虐待老人的报道。李女士就主动提到，她在银行担任要职的女儿提醒过她，对于私营企业说的话不能只听表面。

In orderly Japan, entering a home is straightforward, says Mr Wate. An older person shows signs of dementia, facilities are recommended, their child might visit one, admission follows. In China, suspicion is the starting-point, with the domestic news full of stories of fatal fires or bullying at nursing homes. Unprompted（主动提到）, Ms Li relates how her daughter, a banker, warned her against taking private firms’ promises at face value（表面）.

中国消费者无时无刻不在担心被坑。刚进入中国时，美邸按照日本的标准设置了较高的价格和单间，提供日本退休老人要求的隐私和安静。但中国老人却希望有人作伴，喜欢热闹，美邸的中国区老板格蕾丝·孟（Grace Meng）说。她说，他们质疑美邸强调自理，抱怨说，“我花了钱，你得帮我都做好啊。”美邸后来改变了模式，设置了多人间，降低了价格，并推出了日付费来让人们感受其方式。南通的护理院现在已实现盈利。

Chinese customers worry constantly about being ripped off（被坑）. When it entered China, MCS set its prices high and built single-bed rooms to Japanese standards, offering the privacy and calm that pensioners（退休老人） in Japan demand. But Chinese clients wanted company and the lively din（热闹） known as renao, relates Grace Meng, MCS’s boss in China. They questioned the emphasis on doing things for themselves, grumbling（抱怨） that, “I paid money, so you have to do everything for me,” Ms Meng says. Her firm changed its model, building shared rooms, lowering prices and offering day rates to demonstrate its methods. The home in Nantong is now profitable.

中国人对日本由来已久的不信任倒没有成为一个大问题。美邸既不夸耀也不隐瞒自己的出身。它在广州的护理院除了中式书房和麻将桌外，还有一个日式的屋顶花园，布置了长凳和石灯，还有一棵造型雅致的松树。有着中日两国血统的和手明承认，一些入住者拒绝与来访的日本高管说话。但大多数人更讲求实用主义，觉得日本代表良好的服务。

Historical distrust of Japan has not been a big problem. MCS neither boasts of nor hides its origins. As well as a Chinese scholar’s study and mahjong tables, its home in Guangzhou has a Japanese roof garden with benches, stone lanterns and an artfully trained pine（一棵造型雅致的松树）. A few residents refuse to speak to visiting Japanese executives, admits Mr Wate, who is of mixed Chinese and Japanese ancestry（血统）. Most are pragmatic, associating Japan with good service.

最好的那类技术转移

The best sort of technology transfer

由家庭状况引发的难题可比民族主义要多。在日本，慷慨的政府保险覆盖了大部分养老院费用，这给了老年人很大的自主权。在中国，很多有照护需要的人要么需要卖房，要么得向子女张口。美邸的广州护理院平均一个月的费用为1.4万元，高于一般的退休金水平。这样一来，入住养老院就成了需要四五个家庭成员共同做出的决定。此外还得给老年人做思想工作。很多老人都想把攒下的钱留着帮衬小辈。尽量在家养老是常态，因此美邸中国护理院里的老人平均年龄为85岁，比它在日本的痴呆症相关养老院里的老人年长10岁左右。

Family dynamics（家庭状况） cause more headaches than nationalism. In Japan, generous government insurance covers most care-home costs, giving old folk much autonomy. In China many in need of care must either sell property or ask children for help. Average monthly fees at MCS’s home in Guangzhou are 14,000 yuan ($2,224)—more than a typical pension. That makes entering a home a collective decision by as many as four or five family members. The elderly also need convincing. Many want to preserve their savings to help the young. Because trying to stay at home is the norm, the average age of MCS’s residents in China is 85, about a decade older than at its dementia-related facilities in Japan.

尽管如此，中国人拥抱变化的速度可能还是快过外界预想。李女士记得一句老话：“养儿防老。”但孩子们工作很忙，她很不愿意要他们为自己抽出空来。雇人照顾也不是个办法。如果丈夫大便失禁，没有保姆会帮他清理，她很直接地说。那些保姆“非常没耐心”。她承认，中国人曾经认为只有不孝顺的子女才会把父母送进养老院。“我们再也不那么想了。”

Still（尽管如此）, China is quicker to embrace change than outsiders might suppose. Ms Li recalls the traditional line: “Raise children to care for you when you get old.” But her children have demanding jobs（工作很忙）, and she hates asking them to take too much time off. Nor are hired helpers the solution. When her husband loses control of his bowels（大便失禁）, no hired helper will clean him, she says matter-of-factly（实事求是）. Such helpers are “very impatient”. The Chinese once believed that only bad children send their parents to care homes, she concedes（承认）. “We don’t think that way anymore.”

诚然，能住得起日式养老院的中国人少之又少。但这并不表示日本在这方面的专业技能就不相干了。如果中国的宿敌能让和善、悉心的痴呆症照护方式受到更多关注，那么这本身就将是具有历史意义的睦邻友好之举。

Rather few Chinese will ever be able to afford Japanese-style homes, it is true. That does not make their expertise irrelevant. If China’s old enemy can raise the profile of kindly, attentive（悉心） dementia care, that alone would be a historic, neighbourly act. ■