BEIJING, April 10 (Xinhua) -- For octogenarians Mr. Zhang and his wife, who live in Beijing, caring for the husband -- a brain hemorrhage survivor left partially paralyzed -- was once a struggle.

The simple task of changing the husband's catheter meant a hospital visit, which required multiple helpers to lift him in and out of a car, deft navigation of the packed clinic hallways, and plenty of patience as they queued up to wait for his name to be called.

Now, with a few taps on a smartphone, a licensed nurse arrives at their apartment to deliver personalized care, right at Zhang's bedside.

Zhang's wife still vividly remembers their first experience with the nurse-on-demand service.

In 2022, she was introduced to an online platform partnered with Beijing Shijitan Hospital -- Zhang's regular healthcare provider -- that offered home visits by qualified nurses. The first appointment, which cost 369 yuan (around 51 U.S. dollars), saw a nurse on their doorstep in under an hour.

Clad in full protective gear, the nurse meticulously reviewed Zhang's medical history, carried out the procedure with care, and took her time explaining key points for daily care. Her professionalism left a lasting impression, and the Zhangs have relied on the service ever since.

Their story is far from unique. Across China, more people are embracing a transformative model of healthcare that combines digital ease with hands-on, in-home medical support.

Beyond the elderly, patients recovering from surgery, the bedridden, and new mothers are among those benefiting from China's "Internet Plus Nursing Service" initiative.

Launched in 2019 as a government-backed pilot, the initiative was first trialed in six major provincial-level regions, including Beijing, Guangdong and Zhejiang. The program was later expanded nationwide.

As of mid-2024, more than 3,000 medical institutions in China offered over 60 types of on-demand services, from wound dressing and post-op recovery to mental health support.

For a rapidly aging nation, the implications are considerable. China is home to roughly 45 million elderly individuals living with disabilities or cognitive decline, according to 2021 data. That figure is expected to rise as the share of citizens aged 60 and over in 2024 climbed to 22 percent from 18.9 percent in 2021.

What makes the shift even more urgent is where most of these elderly individuals live: 90 percent remain in their own homes, relying heavily on family caregivers. Yet, the workforce to support them is thin: just 500,000 certified eldercare workers serve the entire nation, leaving families strained and the broader healthcare system stretched.

"Procedures like subcutaneous injections, wound dressing, and catheter replacement require professional skill and clinical judgment," said Liu Lihui, director of the Nursing Department at Beijing Shijitan Hospital. "These are not tasks that family members or untrained caregivers can manage. Trained nurses are needed."

Beijing Shijitan Hospital introduced its nurse-on-demand program to the public in 2021 through a partnership with a third-party digital platform, one of several operational models emerging nationwide. Some hospitals run their programs through official apps, and others integrate with government smart healthcare systems.

The core mechanism is similar across all models: an online platform connects patients with qualified nurses nearby, functioning much like food delivery or ride-hailing services.

These nurses must have at least five years of clinical experience and hold primary professional titles and above, per the 2019 national guidelines for the pilot program. They accept appointments during breaks, after hours, or on their days off.

SERVICE IN HIGH DEMAND, SYSTEM STILL EVOLVING

As demand for home nursing services grows, so too does the need for effective solutions to tackle challenges such as ensuring service quality, motivating nurse participation, and lowering costs for customers.

In Zhejiang province -- one of the country's most vibrant regions -- 635 medical institutions and more than 56,000 nurses now offer 91 services. In 2024 alone, over 580,000 home visits were recorded.

The coastal city of Ningbo in Zhejiang logged 94,000 home care visits in 2024, marking an 80 percent surge over the previous year. Nursing consultations rose by 53 percent.

One local nurse, Shao Jieqiong, has completed roughly 500 home visits in just under three years. "It cuts into my rest days," she said, "but the sense of being needed keeps me going."

However, not all share Shao's stamina. Many nurses report struggling to take on extra work after long hospital shifts.

Hospitals are responding. One of the earliest providers of the nursing-on-demand program, Guangzhou First People's Hospital in southern China's Guangdong, regularly trains and assesses nurses to ensure consistency and quality of services.

According to head nurse Jiang Yaoying, the hospital offers financial bonuses to participating nurses, and arranges two nurses on each home visit and buys insurance for them to ease their safety concern.

Beijing Shijitan Hospital offers tangible rewards: nurses retain most of the service fees, receive performance points toward career advancement, and are publicly recognized for exceptional work. Roughly half of the hospital's 600 nurses have signed up for the nurse-on-demand program.

For people in need of home-visit nursing services, affordability remains a challenge. The current pricing model combines standard medical fees with an additional home visit surcharge. Most nurse-on-demand programs of public hospitals remain outside China's basic medical insurance system, with costs starting around 100 yuan per visit.

As nurse Liu Lixia from the southwestern city of Nanning in Guangxi noted, many patients value the convenience but wish the services were easier on their wallets.

Liu Lixia is part of a 3,600-member nurse team registered on a government-initiated digital platform launched in 2022. The system has facilitated over 20,000 visits, serving 270,000 users and offering more than 140 services.

Local governments are stepping in to address the public concern. In late 2023, Nanning introduced subsidies of 60 yuan per visit for seniors over 65, children under six, and officially recognized disabled individuals. Thousands have benefited, saving collectively significant sums.

"We're working to make care not just accessible, but affordable," said Zhang Zan, a local health official in Nanning.

Taizhou City in Zhejiang has integrated home nursing into its insurance system. In Ningbo, specific procedures -- such as PICC line care, catheter management, and nasogastric tube services -- are now eligible for insurance coverage.

Experts argue that institutional support to the sector's sustained development must go further.

They call for comprehensive legal frameworks to clarify the responsibilities of patients and service providers, protect nurses' rights, and define liability in case of medical disputes. Industry standards for home-visiting nursing practices need strengthening, along with systems for pricing, managing risk, and regulating service quality.

"Nurse-on-demand services in China are still a work in progress," said Lin Xianping of Zhejiang University. "But the sector's future is definitely bright."