A nursing assistant takes care of a patient under the guidance of a nurse in Changsha, central China's Hunan Province, July 28, 2025. (The Fourth Hospital of Changsha/Handout via Xinhua)

China's hospitals are piloting "companion-free" care services to ease the heavy caregiving burden on families.

In the colorectal and anal surgery ward at Xiangya Hospital in central China's Hunan Province, nursing assistant Lu Zhidun carefully checks the ostomy bag of a bedridden patient under postoperative care.

"Our daily work involves providing round-the-clock non-medical care for inpatients, such as feeding, dressing, basic hygiene and repositioning to prevent bedsores. Monitoring the patients' condition is also a key part of our role. If we notice that a patient is uncomfortable, we must alert the doctors and nurses immediately," Lu told Xinhua.

Xiangya Hospital launched the service in April 2025, earning praise from patients' families. "Thanks to the professional nursing assistants, my wife has recovered very well," said Xie, whose wife was undergoing treatment in the inpatient department. He added that the initiative has greatly eased the heavy burden of caregiving for families.

Previously, families of inpatients, overwhelmed by the challenge of balancing work and caregiving, had to hire private caregivers, whose services were often costly and lacked professional standards.

To address this issue, Chinese health authorities began allowing hospitals to hire and train nursing assistants in 2023. In 2024, they introduced national standards to tighten qualification requirements for this new occupation.

Under the standards, aspiring nursing assistants seeking entry-level certification must complete a minimum of 150 hours of combined theoretical training and practical hands-on experience.

Xiangya Hospital requires aspiring nursing assistants to undergo on-the-job training and allows them to start working only after passing the certification exam, explained Yue Liqing, head of the hospital's nursing department, adding that this initiative helps caregivers transition from informal helpers to professional caregivers.

"After these caregivers are hired, I also organize a nursing lecture for them every two weeks to help improve their skills and prevent issues that occurred in the past," said Su Si, head nurse of the colorectal and anal surgery ward at Xiangya Hospital.

Su noted that the turnover rate among informal caregivers had been high. They previously had no dedicated space for rest or meals, leading to an unsatisfactory situation. To address this, the department repurposed an idle area for caregivers to eat and rest, reflecting a more human-centred approach and helping improve the quality of their service.

Zhu Guifang, another nursing assistant at this hospital, said, "Now, we can only provide services to patients in this one department, which gives us a sense of belonging. At the same time, we are more familiar with the doctors and nurses in the department, making communication more convenient."

Earlier, the cost of one-on-one patient care could reach 320 yuan (about 44.96 U.S. dollars) per day. However, a 2024 national guideline introduced government-regulated pricing for hospital-provided services, significantly reducing costs and helping to close gaps in inpatient care.

"Now, with government-regulated pricing, the service at Xiangya Hospital costs 154 yuan per day, significantly reducing inpatient expenses," Yue said.

In Changsha, the Fourth Hospital of Changsha has been offering "companion-free" care services since 2010, making it the first hospital in Hunan Province to provide this service.

Tan Liming, president of the hospital, said that over the past 15 years, the "companion-free" care service has delivered remarkable results. "It has not only eased the burden on patients' families but also improved their hospitalization experience. In the past five years alone, we have provided this service to around 200,000 patients, significantly reducing their caregiving burden," Tan added.

At present, six hospitals in Changsha offer this service, and all public hospitals in the city are set to fully implement it, according to Wan Sheng, deputy director of the municipal health commission.

So far, many big cities and provinces, including Beijing, Shanghai, Guangdong, Jiangsu, Sichuan, Fujian, Hebei, Shanxi, Shaanxi and Anhui, have already introduced related pilot programs. More regions are expected to follow suit in the near future.