To address issues such as inconsistent management standards, blurred responsibilities, weak services, and safety concerns in township and street-run nursing homes, Enyang District of Bazhong City has fully adopted a direct management reform model for public elderly care institutions at the district level. By streamlining the system, building a stronger workforce, and establishing long-term oversight, the service quality of the district's five public nursing homes has significantly improved, with resident satisfaction rising from 90% to over 96%.

Streamlining the district-level direct management system. Targeting problems like inconsistent town-level management standards, blurred accountability, and scattered resources, the district has unified the personnel, finances, assets, and services of all five regional elderly care centers under the direct management of the District Civil Affairs Bureau, achieving "four uniformities." A district-level elderly care service guidance center was established with 10 public service positions. The heads of each nursing home are appointed from public finance-supported staff, solving the long-standing issue of "management without authorized positions and weak performance" at the grassroots level. Additionally, staff salaries, daily operations, and facility maintenance costs are now fully covered by the district-level fiscal budget, completely reversing the disorder in grassroots management. Concurrently, four small, scattered, remote, and high-risk nursing homes were shut down and rectified, optimizing the service layout into a "five-center network covering the entire district." Over 2 million yuan was invested to eliminate all fire safety hazards, strengthening the baseline for safe operations.

Cultivating a professional service team. To address high staff turnover and weak professional skills, the district now conducts unified recruitment, training, and performance evaluations for all staff. Priority is given to hiring young professionals, reducing the average age of the workforce to 41.6 years. Staffing ratios are strictly standardized, with dedicated positions for nursing, fire safety, logistics, and social workers. Regular vocational skills training is provided, pushing the rate of certified nursing staff to 60%. Salaries for nursing staff have been uniformly increased by over 40%, with full social security guarantees provided by the fiscal budget. A dynamic salary adjustment and performance-based pay system has been implemented, ensuring compensation is based on workload and quality of performance.

Improving the routine oversight system. Internal supervision mechanisms within the institutions have been strengthened, with regular public disclosure of financial income and expenditures, material procurement, and service fees, and open channels for public oversight. A "point-to-point" liaison and supervision mechanism has been fully implemented, involving district-level leaders, members of the Civil Affairs Bureau's leadership team, and the primary Party and government heads of the towns where the institutions are located. These officials conduct regular on-site inspections of key areas like operational services and safety management, addressing difficult issues on the spot. A long-term funding mechanism for safety expenses has been established, with costs for fire system maintenance and safety rectification included in the fiscal budget. Through a multi-pronged approach combining administrative supervision, institutional self-discipline, family participation, and social oversight, the quality of elderly care services has been comprehensively improved.