
Treated With Dignity: The Nurses Taking Care to Homebound Patients
Lang Zhizun looked down at the 84-year-old woman lying prostrate on the bed. Her left leg had been so ravaged by vasculitis, a condition that causes inflammation in the blood vessels, that it looked like a burned stick.
With surgical scissors, Lang carefully cut away the dead tissue on the elderly patient’s shin, calf, and ankle and applied a fresh dressing, something he’s done almost every day for more than a year.
As a home care nurse in Beijing, Lang has performed minor procedures like this, as well as provided myriad other health services, for some 5,000 elderly and disabled clients across the city. Some of his clients are completely paralyzed, while most others are severely restricted in their movement due to chronic or debilitating illness.
Beijing is home to 698,000 people aged 80 or above, according to the latest data from the capital’s Civil Affairs Bureau. More than 99% of them still live in the family home, while 23% are legally categorized as disabled.
Lang, 31, is part of an army of trained nurses operating citywide, from the urban center to the rural suburbs. He has witnessed firsthand the hard work and suffering of not only his patients but also their family members, who also often serve as the primary caregivers.
Heart of the matter
Lang believes that aging is the great leveler — urban, rural, rich, or poor, no one can escape it.
However, when caring for elderly people with long-term ailments, it’s easy to ignore the person at the center, he says. Conversations with relatives will focus only on how the patient is aging, about the decline in their mental state and motor functions — the fact they have a name and their own personality is often forgotten. In his daily work, he makes sure to acknowledge the “unique human” in every case.
He recalls one male patient who left a deep impression on him. The man had been unable to urinate for two days, and Lang was called to install a catheter, a procedure that is deeply uncomfortable, usually causing the patient to writhe and resist. However, this man made not a single sound; he didn’t even frown as the drainage bag filled with about a liter of urine. “Even holding onto 500 milliliters would’ve been hard, so his pain must have been unimaginable,” Lang says.
As they chatted, the nurse discovered that his patient was a distinguished naval officer who had fought in the Battle of Dongshan Island in 1965, when the People’s Liberation Army defeated Nationalist forces in waters off the eastern Fujian province. He was a tough guy — war had not beaten him, and nor would old age.
Lang actually began his career at the other end of the spectrum, as a preoperative nurse at a public children’s hospital in Beijing. It was long hours and intense work, “but kids are resilient, and there’s always hope that they will get stronger and stronger as time passes.” However, with elderly care, families often carry a sense of unstoppable decline.
“We deal with so much death at the hospital that we understand it’s nothing out of the ordinary,” he says. “But we can’t show indifference to the families, we can’t splash cold water on their faces, especially when the atmosphere is already somber. We need to provide emotional warmth to the patient and their relatives.”
During painful procedures, Lang will take the elderly person’s hand and offer words of encouragement, or attempt to soothe their nerves. Often, his patients and their family don’t want him to leave, asking him to stay for lunch and dinner.
Perhaps his compassion comes from seeing the situation from both sides. In 2019, while taking time off to recover from a work-related back injury, he experienced the death of his 94-year-old grandfather after a long period of sickness. And being an only child, he naturally worries about his parents as they grow older.
“If it were my parents lying there, it’d be completely different taking care of them. While they are suffering from disease, I’ll be bearing pain in my heart,” he says.
On the move
After more than 10 years at the children’s hospital, in 2019, Lang decided to quit and set up a private home care service with Wang Zhen, a former classmate from nursing school. They together hired five other trained professionals from tertiary hospitals. In addition to visiting patients, Lang also handles calls and distributes orders among the team.
The nurses charge a call-out fee of 219 yuan ($30), excluding the costs of any procedures and medicine, and almost every day they are fully booked. “We provide a simple, convenient, and safe service, helping solve the problems of elderly disabled people and their families,” Lang says.
On an average day, Lang deals with seven or eight cases, often traveling more than 200 kilometers. Things can get even busier during extreme weather, such as on April 12, when Beijing was hit by its strongest winds for a decade. Not only did this force the closure of parks and scenic spots, and the cancellation of many outdoor activities, it meant many elderly and disabled people were unable to make their hospital appointments, requiring medics to instead come to them.
Even on good-weather days, making it to the hospital can be challenging for many infirm elderly residents.
In late April, Li Zhongshi, an 82-year-old retired professor, was half sitting, half lying on his bed, and had just had an intravenous drip inserted in his right hand by Wang. Li has been battling prostate cancer for the past seven years and recently had to undergo a minimally invasive surgery that left him weakened.
The doctor prescribed a daily intravenous drip, but this would mean visiting the hospital as an outpatient every day, potentially causing bleeding from his wound. With the community health clinic shorthanded and unable to provide home visits, Li’s son contacted Lang’s nursing service.
A former colleague had urged Li to enter a nursing home that cost 450,000 yuan a year, saying it had good conditions and specialized medical staff. But Li refused. “First of all, staying at a nursing home might hamper my freedom, plus the financial burden would be quite heavy. My own place is in a good location. Why should I leave and spend a lot of money on a care home?”
Lang says that this attitude is common among the elderly. He recalls he once visited a home in one of Beijing’s traditional hutong alleyways, where an elderly man was living alone in an outdated, decrepit property. He said he had the money to renovate it, but didn’t want the hassle and didn’t want to move.
Nostalgia is another important factor. Lang says an aging couple in a rundown building had refused to relocate to a brand-new property bought for them by their children “because they’d been in that small apartment all their lives — every scratch on the wall, every object held some precious memory.”
The place was poorly lit, and was so cluttered that it was hard for him and his colleague to turn around, let alone carry out their work. On one stained wall that had long since lost its original color, someone had plastered “Remember to take your medicine!” in big, bold characters.
Family support
Before even entering the front door and putting on his blue shoe covers, Lang can usually tell whether a patient is being cared for in hygienic conditions and gauge the atmosphere among the family, which tends to determine an elderly person’s quality of life. If it’s a clean, tidy, and vibrant home, the patient is likely to be well cared for — but not if it’s dirty, smelly, and crowded.
The most extreme situations come when elderly people live alone.
In November 2021, a community worker in the capital’s Fengtai District asked Lang to help an elderly man struggling with an ulcer. Divorced and estranged from his son, the patient had had only a caregiver hired by the community management office to support him.
As soon as Lang entered the corridor leading to the apartment, he was struck by the odor of rotting flesh. When he eventually went inside, the man was unconscious and extremely thin. Large, scarlet bed sores covered his body, and a wound on his lower back was stained with feces and badly infected. Lang could do nothing but ask the community management office to send the patient to the hospital.
Those unable to afford full-time caregivers are mostly looked after by their children or relatives and friends. However, some have also been quick to adopt new technology to improve their living conditions.
In March, Lang was called in to help an 85-year-old woman who had been unable to defecate for about two weeks. She lived with her 90-year-old husband, and was in relatively good shape, but the couple’s children all lived overseas. Finding it difficult to buy groceries and cook, they had been relying on food delivery apps for their three meals a day.
Human instinct
Aging ultimately has the power to transform an independent, dignified person into a childlike figure at the mercy of their caregivers. Lang says it’s not uncommon for him to find bedridden patients in back-to-front shirts and cardigans — making it easier for the caregiver to put on and take off — with bare backs, no pants, and only a diaper to protect their modesty.
Those who still have the capacity to care for themselves will often do as much as they can to maintain their dignity and control over their bodies, he says.
One of the most hated procedures among this group is catheterization, which is essential for those who are mobile but have difficulty urinating. With a two-liter bag attached to their clothes to collect the urine, many patients complain of a strong sense of shame.
Wang said he once had to repeatedly visit an elderly man to insert and remove his catheter, as the patient insisted on trying to go to the toilet unaided, although was always unable to. It took his family days of persuasion to convince the man to keep the device.
To raise awareness about some conditions and procedures, Lang has started making short videos with consenting patients to post on social media. Today, he has around 87,000 subscribers on Douyin, the Chinese version of TikTok, and 44,000 on the lifestyle platform Xiaohongshu, or RedNote.
He explains that one procedure that causes a lot of disagreement among family members is installing a nasogastric tube, which is inserted through the nose, down the throat, and into the stomach to help feed patients who have difficulty eating. Relatives are often divided, he says, sometimes wondering out loud whether it would be better to let their loved ones pass on naturally.
Patients who are able to communicate will themselves also sometimes resist intubation or even remove the tube.
A woman in her 70s, living near Beijing’s central Chang’an Avenue, pulled out her nasogastric tube and went without eating for more than seven days. When she became dangerously weak, Lang attempted to re-insert it, but she waved her hands to show her defiance.
Yet, her husband never gave up. While seeking alternative solutions, Lang noticed that the woman was congested, meaning that her nose was blocked, the nurse therefore installed the tube orally, allowing her to finally eat. Before he left, the woman held Lang’s hands tightly for a long time.
“Survival is a human instinct,” Lang says. “Most people who are conscious want to live.”
(Due to privacy concerns, Li Zhongshi is a pseudonym.)
Reported by Liu Siwei and Wang Yuanzheng.
A version of this article originally appeared in The Beijing News. It has been translated and edited for brevity and clarity, and is republished here with permission.
Translator: Eunice Ouyang; editors: Wang Juyi and Hao Qibao.
(Header image: 500px/VCG)