In Lianyungang, Jiangsu Province, a structural mismatch in elderly care resources has prompted a coordinated governance approach. On one side, township nursing homes scattered across rural areas offer accommodation but lack medical services, while some township health centers face a shortage of patients and idle beds. On the other side, elderly residents who finish picking up their grandchildren have nowhere to relax and end up sitting on small stools by the roadside, while some kindergartens have surplus space due to declining enrollment. Meanwhile, elderly care demand continues to grow — Lianyungang's registered population aged 60 and above reached 1.186 million last year, accounting for 22.6% of the total, and is projected to exceed 31% by 2034 — yet fiscal belt-tightening requires every yuan to be spent where it matters most. These intertwined structural contradictions pose a single question: how can limited resources be directed to where elderly people need them most?

The key to solving this problem lies in coordinated synergy. Since the beginning of this year, the Lianyungang Municipal Commission for Discipline Inspection and Supervision has used special rectification of prominent problems in the elderly care sector as a starting point, continuously promoting the integration of supervisory forces and urging functional departments such as civil affairs to work together. By consolidating scattered resources, clarifying responsibilities, and breaking down service barriers, the city is forging a new path of elderly care governance suited to local conditions.

Supervision Moves Downward, Problems Surface

"The supervision task force promptly sorted out prominent problems in the elderly care sector discovered through supervisory inspections and case investigations, providing precise targets for special inspections; the special inspection focused on five key areas including management of elderly care institutions and implementation of elderly-related projects, thoroughly identifying problems and referring leads..." In late July, the Lianyungang Municipal Commission for Discipline Inspection and Supervision held consultations with the municipal inspection agency to clarify the division of responsibilities for coordinated supervision in the elderly care sector.

To comprehensively uncover prominent problems in elderly care and systematically promote reform and governance, Lianyungang coordinated supervisory forces, launched a "inspection-discipline" linkage, and initiated special inspections in the elderly care sector. From August 5 to 31, at the height of summer heat, Huang Wen, head of the municipal inspection team, led three deputy leaders deep into the frontlines of elderly care. In less than a month, they visited all 105 registered elderly care institutions across the city and inspected 108 grassroots elderly care service stations and meal assistance points. "By visiting the sites and observing the mental state of the elderly and care staff, you can intuitively sense whether an institution is well-run," Huang Wen said. She and her colleagues visited sites during the day and held debriefings at night. For suspicious points found during supervision, the inspection team dug deeper; for matters requiring further analysis, they compiled and analyzed them collectively, immediately connecting with the municipal commission's inspection and supervision office and relevant dispatched discipline inspection groups.

Beyond the "inspection-discipline" linkage, professional forces from finance and audit were also deeply involved, closely monitoring elderly-related fund management, procurement of goods and services, and project bidding to thoroughly identify problems and risks. Such collaboration ran through the entire special rectification effort. The Seventh Inspection and Supervision Office of the municipal commission led the establishment of a supervision task force, coordinating discipline supervision, supervisory supervision, dispatched supervision, and inspection supervision — the "four types of supervision" — connecting city and county functional divisions and linking with people's congress supervision, fiscal supervision, audit supervision, and other forms of oversight.

As supervision moved downward, problems gradually surfaced. With a comprehensive sweep of new clues, a number of "termites" who eroded elderly care funds and harmed elderly interests were uncovered. Problems included leakage and waste in institutional elderly care funds, community elderly care that emphasized construction over services, and home-based elderly care services that did not match price with quality. Behind these cases, issues such as regulatory gaps, chaotic fund management, and "contracting out to shirk responsibility" or "contracting out to amass wealth" were exactly the targets of the special rectification.

Focusing on the deep-seated causes behind cases, the Lianyungang Municipal Commission for Discipline Inspection and Supervision pressed entities to fulfill their primary responsibilities and ensured the "second half" of rectification was done properly. It issued five discipline inspection recommendations and pushed for the rectification of 554 problems. At the same time, it identified institutional loopholes, targeted the establishment and improvement of regulations, and strengthened coordinated supervision mechanisms to truly convert case-handling results into governance effectiveness.

"Elderly care is not just the civil affairs department's business," said Bian Guangyao, deputy director of the Seventh Inspection and Supervision Office of the Lianyungang Municipal Commission for Discipline Inspection and Supervision. Whether elderly people eat well, have convenient access to medical care, and receive their pensions on time often involves multiple departments. "We need to twist scattered forces into a single rope." Under the coordinated leadership of the municipal party committee, a "dual task force" mechanism was established, comprising special supervision by the municipal commission and special governance by the municipal civil affairs bureau. A list of problems, tasks, and responsibilities in the elderly care sector was compiled, and relevant functional departments were organized for collective consultation and analysis to clarify who leads and who supports, sorting out and rectifying issues one by one. Supervision followed in step, monitoring responsibility and progress. For those who passed the buck or conducted perfunctory rectification, timely talks and reminders were given, and on-site verification of rectification was conducted at the frontlines.

Space Vacated, Services Moved In

At 11 a.m. on September 11, in Kuihua Community of Lunan Street, Haizhou District, Lianyungang, 72-year-old Miao Meili held a brush and carefully traced a Peking opera mask. Her "old sister" Zhang Junmei leaned over to look and joked with a smile: "Isn't this eye painted too small?" The two chatted back and forth, with colorful pigments spread across the table. Seeing a reporter approach, Miao Meili put down her brush and talked about her life now. "I used to just lie at home scrolling through short videos until my eyes blurred," she said, turning to look at the room full of laughing elderly people. "Now this is our second home. We come every day and are very happy."

Next door at the Baisui Restaurant, several groups of elderly people had already been served. Some had just finished classes, while others were having their blood pressure checked at the service point. Activities, meal assistance, and health services formed the fabric of a day for the elderly. The Kuihua Community in Haizhou District provides one-stop "elderly care plus childcare" services, with 12 functional rooms and various specialty courses, effectively addressing the cultural and leisure needs of elderly residents in the area. In the photo, elderly people and their grandchildren participate in educational games together in the community's puzzle room. Photo by Chen Qiuling.

This space was originally a supporting facility for a kindergarten. Kuihua Community is located in the core of the old city, with over a thousand elderly residents accounting for about one-third of the population, and activity space has always been tight. Community party branch secretary Chen Qiuling recalled that in the past, elderly people who picked up their grandchildren found it troublesome to go home and would sit on small stools near the kindergarten waiting, sometimes gathering by the roadside to play cards — neither convenient nor safe. On one side, elderly people had nowhere to go; on the other, kindergarten enrollment was declining year by year, leaving some space idle. With supervisory momentum, community coordination, and support from relevant departments, this space was transformed into the city's first "intergenerational care" service complex, providing a one-stop solution to both elderly care and childcare challenges for residents. It has already benefited over 30,000 residents.

These changes respond precisely to the common problems identified during special rectification. In Lianyungang, over 90% of elderly people choose home-based or community-based elderly care. But downward supervision revealed that many communities lacked activity spaces for the elderly. Some communities had built facilities and put up signs, but operations could not keep up and services could not connect. Some offered only monotonous activities that elderly people were unwilling to attend; others lacked professional service teams, operating intermittently with fewer and fewer visitors. How to solve the "construction over operations" dilemma and ensure elderly people have places to go, things to do, and a comfortable life? Lianyungang did not take a piecemeal approach. Instead, it considered standardized operations, resource integration, and service quality improvement as a whole, with systematic planning and coordinated advancement.

In Haizhou District, for example, elderly care and childcare fall under different supervising departments. Rather than simply "adding" resources, the district established a cross-departmental coordination mechanism, allowing resources and services from civil affairs, medical care, and social institutions to truly reach the frontlines, extending community sites from a single "kindergarten conversion" model to "intergenerational integration" services. Since the beginning of this year, four related sites have been newly built.

Hailian Community is one of them. Earlier this year, the Haizhou District Commission for Discipline Inspection and Supervision conducted on-site research in Xin Hai Street, to which Hailian Community belongs, collecting opinions and suggestions on elderly care services based on actual needs. The Xin Hai Street discipline inspection committee, responding to the district commission's research feedback, pushed the street to improve daily supervision mechanisms for community elderly care, pressed community party organizations to fulfill their primary responsibilities, and worked to resolve inefficient and idle community resources. Now, a former early childhood education building has been converted into a neighborhood center with over 2,000 square meters of space, serving four surrounding communities. Walking in, a reporter felt more like entering a one-stop life service complex: the first floor has a cafe, restaurant, and an experience area for elderly-friendly products, while upstairs are community health stations, childcare, doorstep employment service stations, dance and yoga rooms, and baking spaces. "Before the doors even open at 8 a.m., elderly people are already lining up outside," said Li Xiaona, party secretary of Hailian Community, with a smile. People come to check their blood pressure, exercise in the dance room, eat lunch in the cafeteria, play cards and get physical therapy in the afternoon, and after picking up their grandchildren, they can spend time with them in the children's play area. "Here, elderly people can truly have a fulfilling day."

Two Institutions Merged, Medical Care to the Bedside

At the Liji Township Regional Elderly Care Service Center in Guannan County, 71-year-old Miao Yuzhong, a recipient of the five-guarantee household support, hears medical staff remind him to take his medication on time every day. The elderly man has high blood pressure. In the past, after getting medicine from a nearby health center, he often took it based on how he felt. In June this year, he moved here from Mengxingzhuang Township Nursing Home, where he had lived for 11 years. Medical staff re-examined him and created a health record. When to take medication and how much — someone keeps track. If he feels unwell anywhere, someone follows up. His living space was originally the inpatient department of Liji Township Health Center. After being converted into a regional elderly care service center, it is gradually receiving nearly 100 destitute elderly people from nursing homes in five surrounding townships. The health center assigned nine medical staff, and 10 caregivers from the original township nursing homes also came here. Daily care and medical services are integrated here. The Liji Regional Elderly Care Service Center in Guannan County, Lianyungang, is divided into three functional areas — a living and wellness area, a rehabilitation area, and a medical treatment area — providing professional daily care, health and leisure services, and medical services for the elderly. In the photo, dedicated medical staff at the center measure blood pressure for an elderly person. Photo by Zhu Minmin.

These changes stem from the reform exploration of "co-building two institutions" and from the momentum of special rectification. Guannan County stretches long from east to west, shaped like a key. In the past, each township operated its own nursing home; some were remotely located and small in scale, requiring elderly people to travel far for medical care. During special rectification, residents frequently reported problems such as scattered township nursing home layouts, uneven resources, and inconvenient medical access. "Operating nursing homes separately wastes resources and makes it difficult to equip professional medical forces," said Liu Yun, director of the Aging Work and Elderly Care Service Section of the County Civil Affairs Bureau. On the other side, some township health centers had few patients and idle beds. Taking Liji Township Health Center as an example, it is less than 10 minutes by car from the county seat. When residents get sick, most go to the county hospital, and the bed vacancy rate once reached 60%. With medical resources lacking on one side and idle resources on the other, how can the two be integrated? Lianyungang used Guannan County as a pilot, integrating township nursing homes with health centers, with health centers entrusted to operate regional elderly care service centers, advancing "two institutions in one" co-building.

The changes are visible, but the process was not easy. Civil affairs, health, finance, and medical insurance belong to different systems; elderly care subsidies, medical insurance settlements, and destitute support were previously managed separately. After physical merger, invisible obstacles remained: after elderly people from several townships were centralized for support, how would subsidies originally issued by each township to their respective nursing homes continue? These cross-system challenges were brought one by one to special rectification progress meetings led by the county party committee and attended by multiple functional departments. Everyone sat together to study them item by item, clarifying responsibilities and solutions, while discipline inspection and supervision organs followed up and urged implementation. After multiple county-level consultations, it was decided to share operating costs based on the number of elderly people sent, allowing funds to flow smoothly along with the support relationship.

Building on existing exploration, Guannan is advancing a new "one body, three wings" medical-elderly care framework: the under-construction Xin'an Regional Elderly Care Service Center is the "leader," planned to begin operations in 2027; three regional centers in Xinji Township in the central area, Liji Township in the west, and Duigougang Township in the east serve as "pillars," built on health centers, integrating and consolidating scattered township nursing homes so that destitute elderly people can be centrally supported and receive nearby medical care. At present, while ensuring basic support, the locality is exploring opening surplus beds and extending services such as home visits and short-term respite care to surrounding areas, enhancing its capacity for "self-sustainability."

Building an elderly care service system is a long-term project. How community elderly care can move from "having facilities" to "having services," how to increase the supply of high-quality, professional institutional elderly care, and how to solve the incentive mechanism for care workers — these issues all need to be gradually addressed through development. A relevant official from the Lianyungang Municipal Commission for Discipline Inspection and Supervision stated that the commission will continue to deepen special rectification, persist in inspecting, rectifying, and improving simultaneously, and use strong supervision to ensure that various reform measures are implemented effectively, testing the ultimate effectiveness of the special rectification of prominent problems in elderly care through the tangible sense of gain of 1.186 million elderly people.