Tough work

For patients, high-quality nursing care is an alternative option, but the price has risen in line with improved standards. The United Family Healthcare in Beijing provides home healthcare for chronically ill patients and the elderly from qualified doctors and nurses. An initial assessment and six visits a year costs 10,888 yuan, but five home visits a week costs 178,888 yuan per annum.

For those unable to afford the cost, hugong are the only choice, according to Luo.

Cheng Jianhua, 43, from Sichuan province, was once a freelance hugong. She is now a full-time employee at the intensive care unit of the Peking Union Medical College Hospital in Beijing. Zhang Wei / China Daily

"Taking care of patients is tough work and sometimes a dirty job," said Luo, referring to cleaning patient waste and the dangers of becoming infected. "Most hugong are from the countryside and lack proper education and skills."

She also said few hugong have personal insurance or receive any welfare, such as insurance or holiday pay. Their working day may be as long as 24 hours, but the wages remain low. Unless they are fired for a misdemeanor, once they are employed, the hugong don't stop working until the patients are discharged from the hospital.

In fact, hugong are often regarded as de facto servants and so their social status is low. Lang told of how a patient poked him with a stick every night to wake him when his urine bag needed changing.

Now, however, Peking Union Medical College Hospital, one of Beijing's biggest hospitals, is trying to restore the role of qualified nursing assistants. Six work in the hospital's intensive care unit, including Cheng Jianhua, 43, from Sichuan province who has been working in the ICU for more than a year.

She was originally a freelance hugong, but now she's a fulltime hospital employee, which provides her with medical training and welfare. "I make 2,100 yuan a month, about the same salary I got before," she said. "But it's more stable and I only work eight hours a day. Before, I often stayed up all night taking care of the patient, and the next day I still needed to do all the work by myself."

Huang Xiaobin, 52, is in charge of training nursing assistants at the hospital. She admitted that even though the hospital provides welfare, few people are willing to take the job. "Some people quit after a few days, saying there's too much work and that it's too intense or too dirty, or the wages are too low," she said. "We are trying to teach them to become qualified healthcare workers, but we also need to keep them."

Given China's aging population, the demand for nursing assistants is growing in many regions across the country, according to Huang Renjian, director of the Chinese Nurse Association.

Having helped write a textbook for nursing assistants, Huang is adamant that more people should take the course and gain the certificate. To facilitate that, she urged the government to subsidize training and wages to increase income and prestige.

"As their skills improve and their income grows, the stereotype of the nursing assistant will change and reflect what it once was; a stable, professional and decent job," she said.