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| BEIJING — The hospital in southern Beijing advertised itself as specializing in vascular tumors, especially benign birthmarks that often appear in infants. |
| 北京——这家位于北京南部的医院宣传自己专门治疗血管肿瘤，尤其是经常出现在婴儿身上的良性胎记。 |
| But when a fire broke out there last month, killing at least 29 people, many of the victims had been there for another reason: They were older people with disabilities receiving nursing care, some of them staying at the private hospital for months or even years, even though it was not licensed as a provider of long-term elder care. |
| 但是，在上个月该医院那场造成至少29人死亡的火灾中，许多受害者是因为另一个原因来到这里：他们是接受护理的失能老年人，其中一些人在这家私立医院待了几个月甚至几年，尽管该医院没有提供长期老年护理的资质。 |
| The tragedy at Changfeng Hospital — the deadliest fire in China’s capital in more than two decades — has renewed scrutiny of a long-running problem. China’s population is rapidly aging, with 400 million people, nearly 30 percent of the population, expected to be over 60 by 2040. But medical resources have not kept up; there were only about eight million nursing home or elder care beds at the end of 2020, according to official statistics. |
| 长峰医院的悲剧是20多年来中国首都发生的最严重火灾，它令人们再次审视一个长期存在的问题。中国人口正在迅速老龄化，预计到2040年将有4亿人超过60岁，占总人口的近30%。但医疗资源并没有跟上；根据官方统计数据，截至2020年底，只有大约800万个养老院或老年护理床位。 |
| The authorities have recognized the urgency of addressing the shortage, with Beijing’s latest five-year plan pledging to raise that number to nine million beds by 2025. But many obstacles remain. |
| 当局已经意识到解决这一短缺问题的紧迫性，北京最新的五年计划承诺，到2025年将床位数量提高到900万张。但仍存在许多障碍。 |
| Social stigmas against retirement or nursing facilities are still widespread in a culture that emphasizes children’s caretaking duties toward their parents. Even for people who are willing to embrace care institutions, public facilities often have long waiting lists, and private ones — which are not covered by public medical insurance — can be prohibitively expensive. |
| 在一个强调子女对父母照顾责任的文化中，对退休或护理机构的社会污名仍然普遍存在。即使愿意接受护理机构，公共机构往往有很长的等待名单，而私人机构——不在公共医疗保险范围内——可能贵得令人望而却步。 |
| And then there is the problem of facilities becoming properly licensed to offer nursing care in the first place, a process complicated by bureaucratic requirements and a dearth of trained staff, according to experts. As a result, some private companies that want to meet the demand for senior care operate underground. |
| 专家表示，还有一个问题是，医疗机构首先要获得提供护理服务的资质，这个过程因官僚主义的要求和缺乏训练有素的工作人员变得复杂。因此，一些想要满足老年人护理需求的私营公司选择了地下运作。 |
| Local officials are now investigating whether Changfeng Hospital was illegally offering long-term elder care, according to state media reports. Some people who escaped the blaze told Chinese media that some patients’ limited mobility may have contributed to the death toll. |
| 据官方媒体报道，当地官员正在调查长峰医院是否非法提供长期老年人护理。一些从大火中逃生的人告诉中国媒体，一些病人行动不便可能是造成大量死亡的原因之一。 |
| There is no clear link between the potentially unlicensed care and the fire; deadly fires have also broken out at licensed nursing homes. But the fire has drawn public attention to the underground market and the reasons for its existence. |
| 可能存在的无护理资质问题和火灾之间没有明确的联系；有资质的养老院也曾发生致命的火灾。但这场火灾引起了公众对地下市场及其存在原因的关注。 |
| Some victims’ relatives and public health experts have urged the authorities to look beyond punishment and toward bringing the providers out of the shadows. |
| 一些受害者亲属和公共卫生专家敦促当局不要只顾惩罚，而是要让这些服务提供者从阴影之下现身。 |
| “This is just the peak of the iceberg,” said Sabrina Luk Ching Yuen, a professor at Nanyang Technological University in Singapore who studies aging, adding that there were likely many similar cases of underground care. “If the market is there, what is the government trying to do?” |
| “这只是冰山一角，”新加坡南洋理工大学研究老龄化问题的教授陆贞元说。她还表示，类似的地下护理案例可能还有很多。“如果这方面有市场，那么政府想做什么？” |
| Efforts by The New York Times to reach victims or their relatives directly were unsuccessful. Changfeng Hospital has been closed to visitors since the fire, and when Times reporters tried to interview victims or their relatives at other hospitals where the injured were transferred, they were blocked or escorted out by hospital staff. |
| 《纽约时报》试图直接联系受害者或其亲属，但没有成功。自火灾发生以来，长峰医院一直不对访客开放，时报记者试图在其他医院采访伤者或其亲属时遭到了医院工作人员阻止或带离。 |
| The authorities, as is common after disasters in China, have tried to control the narrative and prevent reporters from speaking with victims. They have said only that the patients who died ranged from 40 to 88 years old, with an average age of 71, and that most of the 21 seriously injured patients had chronic diseases. |
| 当局试图控制报道，并阻止记者与受害者交谈，这在中国发生灾难后很常见。当局只是表示，死亡的病人年龄从40岁到88岁不等，平均年龄为71岁，21名重伤者中大多数患有慢性病。 |
| But some Chinese news outlets managed to interview relatives of Changfeng Hospital patients, who described an elderly father who had been there since last summer because of disabilities after a cerebral hemorrhage, and another man, 76, who had no motor skills and lived there full time. |
| 但一些中国新闻媒体设法采访了长峰医院病人的亲属，他们描述了一位年迈的父亲，因为脑溢血导致失能，他从去年夏天开始就住在那里；还有一位76岁的老人，已失去行动能力，一直住在那里。 |
| The relatives reportedly said they were drawn to the hospital because of its ability to provide medical care for their loved ones with disabilities. In contrast, nursing homes in China historically have provided little to no medical care. |
| 据报道，亲属们说，他们选择这家医院是因为它能够为他们的失能亲人提供医疗服务。相比之下，中国的养老院历来很少，甚至不提供医疗服务。 |
| The relatives also appreciated that bed turnover was less of a concern at private hospitals, which, though significantly more expensive than public ones, were less crowded. According to one report, one woman said that her father had been forced to shuttle between several different institutions before she found Changfeng Hospital. |
| 亲属们还表示，私立医院不那么在意床位周转率的问题，它们比公立医院贵得多，但病房没那么拥挤。根据一份报告，一名女性说，在她找到长峰医院之前，她的父亲辗转更换了几家设施。 |
| That woman said she was paying about $870 a month in nursing fees for her father. Some online advertisements for a nursing facility at the same address as Changfeng Hospital listed fees as high as $1,400 a month. The average monthly pension in Beijing was 4,157 yuan, or about $600, in 2019. |
| 她说她每个月要为父亲支付大约6000元的护理费。一些与长峰医院有着相同地址的护理机构的网络广告显示，收费高达每月10000元左右。2019年，北京人均月养老金为4157元。 |
| Private hospitals have many incentives to try to capitalize on the unmet demand for long-term medical care, said Bei Wu, a professor of global health at New York University who has studied aging in China. Even before the coronavirus pandemic, many struggled to draw enough patients to make money, because of their heftier price tags. |
| 纽约大学研究中国老龄化问题的全球健康教授吴蓓表示，私立医院有很多动机去利用未得到满足的长期医疗护理需求。甚至在新冠大流行之前，许多私立医院就已经难以吸引到足够多的病人，因为它们价格更高。 |
| Then, under China’s three years of strict Covid restrictions, people who could avoid hospitals did so. Out-of-town patients, who often traveled to major cities like Beijing for care, dwindled as the country sought to limit movement. |
| 然后，在中国三年严格的新冠限制下，人们尽量避免去医院。随着国家试图限制人们的行动，经常前往北京等大城市寻求治疗的外地患者减少了。 |
| The publicly traded parent company of Changfeng Hospital lost more than $14 million between 2020 and the first half of 2022, according to public filings. It did not respond to multiple requests for comment. |
| 公开文件显示，从2020年到2022年上半年，长峰医院的上市母公司亏损近1亿元。该公司没有回应多次置评请求。 |
| “I can see some ways this pushed private hospitals to say, ‘Hey, we can provide the care for these older adults with disabilities because this can be a potential revenue-generating source,’” Dr. Wu said. |
| “我可以看出，这在某种程度上促使私立医院说，‘对啊，我们可以为这些失能老年人提供护理，因为这可能是一个潜在的创收来源，’”吴蓓说。 |
| The government has, in fact, promoted the integration of medical and elder care, encouraging nursing homes to build medical facilities and hospitals to offer more nursing services. |
| 事实上，政府已经推动医疗和养老的融合，鼓励养老院建设医疗设施和医院，提供更多护理服务。 |
| But China, like many countries, has a dire shortage of staff trained to care specifically for older patients. And the government departments that oversee medical care and nursing care are separate, further slowing the approval process, said Professor Luk, in Singapore. |
| 但与许多国家一样，中国严重缺乏受过老年患者照护训练的工作人员。新加坡的陆贞元表示，监管医疗和护理的政府部门是分开的，这进一步放慢了审批过程。 |
| “The intention is good,” she said of the integration plan. “But, in reality, it’s really hard to implement.” |
| “意图是好的，”她谈到整合计划时说。“但在现实中，这确实很难实施。” |
| She said she hoped one outcome of the fire in Beijing would be a call to action for the government: Either it should provide more long-term care facilities itself, or make it easier for private companies to do so. |
| 她说，她希望北京大火的一个结果是呼吁政府采取行动：要么政府自己提供更多长期护理设施，要么让私营公司更容易做到这件事。 |
| Indeed, the need is only going to grow. The number of older Chinese with disabilities is expected to more than double this decade, reaching 100 million by 2030, according to official statistics. |
| 事实上，这种需求只会越来越大。据官方统计，中国失能老年人的数量预计将在这个十年增加一倍以上，到2030年达到1亿。 |
| The facilities are especially important to the lucky few who have found spaces for their relatives there. Hua Ailing, a post office accountant in a small county in Anhui Province, chose to send her 89-year-old mother to a private hospital licensed for long-term care last year, after her mother lost the ability to walk. She said she felt more comfortable sending her there than to a traditional nursing home, where medical care could be unreliable. |
| 这些设施对于为亲人在那里找到住处的少数幸运者来说尤其重要。华爱玲（音）是安徽省一个小县城的邮局会计。去年，在89岁的母亲失去行动能力后，她选择将母亲送到一家有长期护理资质的私立医院。她说，把母亲送到那里比送到传统的养老院更让人放心，因为后者的医疗服务可能靠不住。 |
| If the option had not existed, she and her siblings would not have known what to do. “After a time, we couldn’t care for her ourselves,” Ms. Hua said. “After all, we’re all in our 60s, too.” |
| 如果没有这个选择，她和她的兄弟姐妹就不知道该怎么做了。“再过一段时间，我们自己也照顾不了她了，”华爱玲说。“毕竟，我们也都是60多岁的人了。” |
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