The old looking after the even older in China.

Sixty-eight year old Zhang Guosheng spends his days caring for an 81-year-old fellow villager — washing his clothes, bringing meals to his bed and keeping him company — a routine he will keep up until he himself needs the type of care he is now providing.



“Living here is better than staying at home alone. We help each other and have a common language,” said the spritely Zhang, an enthusiastic dancer. “We are very happy here.”

With younger villagers who would traditionally have looked after their parents and grandparents flocking to the booming cities to seek work as part of Beijing’s urbanization drive, Qiantun village in northern China’s Hebei province has had to pioneer a new model — the old looking after the even older.

Surrounded by green wheat fields that stretch across a flat plain, Qiantun is unremarkable among countless rural Chinese communities, but its old-age care model is now a prototype cited by central government as a solution to the daunting challenge of caring for a vast and rapidly graying rural population.

One of every four Chinese will be older than 60 by 2030, according to the Ministry of Civil Affairs.

Massive rural-to-urban migration will further strain the rural areas’ ability to provide care for the elderly, as personal savings and family support remain the primary pillars of old-age care.

“Migrants to urban areas are mainly young adults, leaving mostly the elderly in villages with children,” said Wang Dewen, an expert with the World Bank’s Beijing office. “The formal elder-care system in rural areas is very weak, and basically a blank spot in many places.”

As a result, the gap between the number of elderly in rural and urban areas is expected to balloon over the next 15 years, to 11 percentage points from today’s 1.24 percentage points, the ministry projects.

Cheaper alternative

The costs of caring for China’s rapidly expanding elderly population are likely to be too heavy a burden for the government, forcing Beijing to find cost-effective and creative ways to provide care in myriad localities. The self-help model practiced among the 1,500 residents of Qiantun offers a cheaper and streamlined alternative to a state-run system.

More than 95 percent of China’s rural elderly still adhere to the traditional practice of seeking old-age care within their families, Wang said. But families are no longer able to cope, as youth and even middle-aged people heading to cities to find work, leaving the elderly behind to fend for themselves.

In their search for affordable elder-care models, Beijing’s leaders have turned their attention 280 miles to the south in Hebei’s Feixiang county, where Qiantun lies. The practice of old people taking care of each other posed a simple and attractive solution.

Labeled “mutual assist elder care”, the Feixiang model is set to be expanded to the rest of rural China, with 3 billion yuan ($490 million) set aside by the central government to get it started over the coming three years.

“The light of Feixiang will shine across China,” Li Liguo, minister of civil affairs, declared enthusiastically during a trip to Feixiang in 2011. “Feixiang has set an example for the whole country.”

“As people get older, they don’t tend to get healthier. So if you have somebody in their 60s caring for somebody in their 90s, are they going to be able and trained and strong enough themselves to care for somebody who has chronic conditions?” said Tony Buccheri, a manager with Right at Home International, a U.S.-based senior home care provider that offers services in China through a partner.

Buccheri’s concern echoes that of Cai Qingyang, pioneer of the model and Qiantun’s village chief.

“Old people with critical illnesses need more than the very basic care provided here, and we will have to think of other ways to care for them,” said Cai, a 61-year-old former soldier, watching several old villagers dancing in the yard.

“But this really is the only feasible way given the local elder-care situation. The village and the government simply can’t afford proper institutional care for every aged rural resident,” Cai added.

In 2008, Cai sought to do something about the lack of care for the rural elderly. He turned an abandoned brick house into an old-age home, where 25 elderly villagers moved into 11 rooms, keeping one another company, sharing meals, as well as farming and doing housework.

His innovation has thrived under state support, and more than a dozen other provinces have replicated the model.

Urban vs. rural divide

What separates China’s aging pattern from that in other Asian societies, such as Japan, South Korea and Singapore, is that the country is still relatively poor on a per-capita basis. The phrase “getting old before rich” reflects the fact that even though China’s economic growth remains robust, its demographics work against it.

Those in the emerging middle class have more options among at-home care providers — and public as well as private senior homes — and are more likely to find them affordable.

The rural elderly have fewer resources and fewer choices, while youth migration patterns unstitch the traditional family safety net. And despite years of efforts by China’s leaders, the income gap between urban and rural residents has increased. A report published by the World Bank last year noted that rural elderly have “remained consistently poorer than the urban elderly over time.”

That is not likely to change. Two-thirds of elderly Chinese live in rural areas, and though migration patterns cloud demographic estimates, many demographers believe the majority of China’s elderly will remain in the countryside.

To meet the challenge, says the World Bank’s Wang, China must make its urbanization an equalizer of basic social services for urban and rural residents. To do that, he adds, it must reform the household registration system that ties social services to people’s registered home, to facilitate family migration to cities and receive care there.

But in the short term, rural areas such as Qiantun, which has three times as many elderly residents as young adults, can only make do with the resources they have. The government provides 600 yuan ($97.68) a year in subsidies for each of the 30 elderly Qiantun villagers at the center. Their average age is 75.

By contrast, offering professional care at an old-age care institution would cost at least 10 times as much, 6,000 yuan a year, according to government estimates, offset by a mere 120 yuan annual subsidy from the government.

At the Qiantun villager center, “old” Zhang, as he is known, talks about the future as he brings a bowl of dumplings and medicine to the bedside of his charge, bedridden by a broken thigh bone.

“He can’t move around now, I help him,” said a still spry Zhang. “When I can’t move, someone will also care for me.”

Via Washington Post