Ageing Populations and Their Solutions

Ageing Phase

With increasing life expectancy and decreasing fertility and mortality rates, Viet Nam has a rapidly ageing population. In 2011, the country entered an ageing phase, the population composition shifted towards older, rather than younger, ages. By 2050, Viet Nam will have a super-aged population, in which over 20% of the population will be over 65. This is a global trend, with China, the US, Germany, and the UK all expected to each have over 20 super-aged cities by 2035. 

Viet Nam’s Older Generation – Who, Where, What.

In 2019, people over 60 accounted for 11% of Viet Nam’s population, increasing from 8.6% in 2009. Thanks to our Power BI data, we can visualise the composition of Viet Nam’s elderly population;  where they are, the gender and rural-urban split and how this can be linked to changing household compositions.

Most of Viet Nam’s elderly population live in northern provinces. Seven of the ten provinces with the largest over-60 populations are in the North. Ha Noi has over one million over-60s; Thanh Hoa has more than 514,000; Nghe An over 408,000, and Thai Binh has 347,830. Southern provinces such as Ho Chi Minh City and Dong Nai have 841,005 and 278,159 over-60s, respectively.

Viet Nam, like many other countries, is also experiencing a feminisation of ageing, when the population of elderly women exceeds the number of men. The extent of the feminisation of ageing in Viet Nam has been the highest amongst ASEAN countries for many years, and until 2035 is expected to be second only to Cambodia. In both countries, this is due to females having a longer life expectancy and the large number of young male casualties during the conflicts of the 1970s. Currently, females account for 58% of over-60s.

Rural/urban dynamics are important. The majority, or 67%, of over-60s live in rural areas. This number also jumps exponentially for those 85+, more than 73% live in rural areas. This raises the question, have rural/urban migration patterns changed the way Viet Nam’s (mostly rural) elderly population live?

According to Viet Nam’s General Statistics Office, the number of elderly people living alone or with just their spouse increased from 18.3% in 2009 to 27.8% in 2019. Several factors are driving this, but Viet Nam’s rural/ urban migration rates play a role. For example, Nghe An, Thai Binh, and Nam Dinh provinces are mostly rural and have some of the largest elderly populations in the country. They also have high levels of migration. Nghe An has a net migration rate of -30%, Nam Dinh -38%, and Thai Binh has a rate of -27%, people leaving the provinces exceeds those arriving. Some care home residents say they prefer living in elderly accommodation because their children left to work in other provinces.

Housing Solutions for Viet Nam’s Ageing Population

Housing with care solutions are residential facilities, often with care services, for older people. This market is largely untouched in Viet Nam. However, there are increasing numbers of private offerings, and the government has acknowledged that more needs to be done to support the ageing population.

Confucian principles guide government solutions, and families shoulder a large amount of responsibility. While there have been changes to policy and a ten-year plan to improve elderly care is in place, most care continues by families and communities. Out of the country’s 63 provinces, only 32 have specialised facilities for the elderly. Although the government aims to have at least one facility in each province by 2025, this does not reflect the rapid growth of Viet Nam’s ageing population. Other government-backed initiatives include the Intergenerational Self-Help Club (ISHC), a project that facilitates communities in caring for the elderly. Care is primarily at home and is provided by volunteers. The idea of ‘ageing in place’ underlies most of these policies and initiatives.

There are some limited and expensive private sector offerings. Private nursing homes such as Thien Duc Nursing Home or Lotus Nursing Center charge roughly VND 15 million for a single room or VND 19 million for a double room per month. Some facilities, like Tuấn Minh Paradise Resort, which is currently under construction, will be a “resort for the elderly” with residential villas, five-star facilities, and an international standard hospital. Even the more ‘modest’ facilities are out of reach for most.

Mr Matthew Powell, Director of Savills Hanoi, said: “The senior living and medically-assisted living healthcare sector is well-established in many countries globally, where there is a growing elderly population. This sector has evolved to provide a professional and pleasant environment for those that need care, a relief to family caregivers who often do not have a specialised understanding of elderly care or the facilities to do so. It has also led to the emergence of an interesting liquid real estate investment opportunity akin to specialised ‘branded residences’ with rental pools or serviced apartments appealing to large investors, developers, and individuals.”

What is Important for Elderly Care?

Healthcare

The provision of healthcare for the elderly is a top priority for families, care homes and government policy. On a public level, healthcare services for the elderly are integrated within the existing medical system, and the aim is for at least 70% of the elderly to have access to annual medical examinations by 2030. Elderly people also prioritise their health in terms of spending, a recent Cimigo study showed that people over 50 spend as much as 13% of their monthly income on healthcare.

In a VNExpress International article by Ms Phan Duong, we hear from Mr Nguyen Ngoc Thanh, who decided to put his mother in a nursing home: “My mother has been suffering from dementia for years. There was one occasion when I had to rush home from a business trip to look after her. Her health deteriorated after her stroke, she had bedsores and refused to let us help her. The professional care that a nursing home can provide was the only option.”

Private facilities realise there is a gap in the system and know that families do not have the skills or capacity to provide comprehensive care to their elderly relatives. A medic at Dien Hong Nursing Home told Mr Long Nguyen - VNExpress International: “To deal with these problems, you have to be well-prepared and have the skills to take care of seniors. We often see the signs of strokes in our patients, and we can hospitalise them immediately. If they were in their homes, their families would be unable to see these indicators.”

By utilising Power BI, we assessed the ratio of the number of healthcare facilities and the number of people over 60. The ratios fare better in the South. Binh Duong with a ratio of 1,647 elderly users per healthcare facility, Can Tho with 1,662, and Ba Ria - Vung Tau with 1,446 users, have some of the best ratios in the country. Some of the worst performers are Bac Giang with 10,596 users per facility, Nam Dinh with 8,429, and Hai Phong with 6,857. While there is a need for housing with care solutions throughout the country, there is a larger gap for providers to fill in the North.

Community

Sense of community is an important factor in senior care solutions. With increasing levels of economic activity, urbanisation and modernisation, there have been changes in how communities are structured. Nuclear families are becoming more common, and the prevalence of "tu dai dong duong" families (four-generation homes) is declining. The number of elderly people living alone is increasing and people are working more than ever.

A resident at one of Ha Noi’s nursing homes, interviewed by Mr Long Nguyen, said, “I moved here because I wanted to have someone to talk to. My daughter is in Germany, and my son is too busy to come home and have dinner with me. It is better for me to live here so that I have my friends around me." Another said, “My children are too busy to talk to me. They told me to come here so that I would not be lonely and so that they could feel less guilty.”

The Paradox of Housing with Care

There appears to be a paradox in the idea of housing with care in Viet Nam. While the population is ageing, communities are changing, and the elderly need comprehensive healthcare, there is still a stigma attached to housing with care solutions. Even when they are needed, the notion of familial obligation complicates the decision. Mr Nguyen Ngoc Thanh’s brother called the idea of putting their mother in a nursing home a “dereliction of their duty.” Some residents at Dien Hong Nursing Home said that they had been sceptical and against the idea before moving to the home. While they have now changed their opinion, they imagined that living in a nursing home meant their children did not love them.

There are two sides of the housing with care coin in Viet Nam. The reality of an ageing and changing society with a need for elderly care, the other the longstanding belief of ageing in place and the obligation that families feel to care for their elderly relatives.