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China Issues Eldercare Resource Guide as 60+ Population Balloons

A woman pushes an elderly woman holding a rainbow fan on a street in Beijing, March 5, 2023. China's State Council has issued official "Guidelines for Facilitating the Building of the Basic Elderly Care System" and announced a "List of Basic National Elderly Care Services."

As China yearns for babies, the State Council has issued official "Guidelines for Facilitating the Building of the Basic Elderly Care System" and announced a "List of Basic National Elderly Care Services."

The guidelines for 16 services come as a response to a demographic crisis marked by a ballooning elderly population, a declining birth rate, and a shrinking cohort of working-age citizens.

China is not alone in facing this issue. A study published in October 2020 in The Lancet, a medical journal, warned of the "jaw-dropping" economic, social and geopolitical effects on nearly every country as fertility rates fall, people age, and populations shrink.

Exacerbating the predicament in China is that while Beijing is now pushing couples to have as many as three children, the fallout from the one-child policy implemented in 1979 means those only children, now middle-aged, must care for their elderly parents.

The list included a senior allowance for people aged 80 and older, income-pegged subsidies for seniors who need to make their homes barrier-free, public nursing home priority for elderly people with only one child, and special training with subsidies for family members caring for disabled elderly relatives.

'Torture to all of us'

Shu Min, an only child in an eastern Jiangsu province city, is struggling to provide care for her father. He's in his 80s, has mild Alzheimer's disease, and in April 2021 fractured his hip in a fall.

Since hip replacement surgery, Shu Min has shuttled him among different hospitals for rehabilitation because China's Health Insurance Bureau limits this kind of stay to about 20 days.

"Every time when my father gets familiar with the environment, the doctors and nurses, we have to go somewhere else all over again," said Shu Min, who asked VOA Mandarin to use a pseudonym for fear of government harassment. "This process takes too much energy; this is a torture to all of us."

One of China's official media outlets, Xinhua, reported that the guidelines are "to facilitate the building of the basic elderly care system, making clear that the focus through 2025 is on tackling difficulties that could hardly be overcome by families or individuals on their own involving older people incapable of performing self-care, those with disabilities, and those having no one to take care of them."

"By 2025, China is expected to have a relatively sound institutional system in place, bringing its entire elderly population under coverage, according to the document," Xinhua reported on May 23.

"Provincial governments are asked to formulate their own basic elderly care plans and lists on the basis," Xinhua added. "Region-specific lists should at least cover the items on the national list."

Veteran Chinese media personality Ah Qiang, who used a pseudonym for fear of official reprisal, told VOA Mandarin in a phone interview that the list released May 21 will likely be categorized as a "nonpolitical task" by the local governments charged with enforcing it and probably ignored.

Financially strapped by pandemic-related expenses in a crisis that saw a decline in revenue, local governments are prioritizing the fulfillment of mandatory "political tasks" such as "returning forests to farming," according to Ah Qiang.

"Policies to help the people have never been a political task in China, so many of them are actually not implemented after they are issued," said Ah Qiang.

Xinhua reported there were 280 million people aged 60 and older in China at the end of 2022, accounting for 19.8% of the population. The figure is expected to exceed 300 million by 2025, and 400 million by around 2035. China's National Health Commission described the situation in 2035, with 30% or more of the total population over 60, as a stage of "severe aging."

An elderly man passes an outdoor mural in Beijing, May 10, 2023.
An elderly man passes an outdoor mural in Beijing, May 10, 2023.

Shu Min is particularly angry about the guidelines for family members to attend caregiving training. She said that in her case, she and her father are the only ones left in her family. If she goes to training, who will care for him and do household chores? "Even if the family had more than one child, don't they have to go to work? Training for the disabled must be specialized training, this is no way to solve the problems. This really makes me angry, I'd rather them not mention this at all."

Shu Min said all she wants now is a stable hospital environment so she doesn't have to keep moving from one hospital to another. She said the government-issued guidelines are just "a bunch of nonsense that sounds good-intentioned."

She believes that for a country with a population of 1.4 billion, it is "absurd" that the government is only now focusing on eldercare shortcomings. "When the system is finally established, I don't know how many generations will have passed," Shu Min said. "I think for myself, my generation, there's no hope."