China's 'Demographic Tsunami'

The one-child policy makes caring for the elderly a looming concern

A lucky couple at the high-end Cherish-Yearn nursing home in Shanghai Qilai Shen/Bloomberg

By Frederik Balfour

Wang Fuchuan lies in bed wearing a quilted black jacket, with two comforters pulled up to his chin to keep out the chilly November air. The heating at the Beijing Songtang Caring Hospice is broken, and the 90-year-old’s nostrils are stuffed with toilet paper to stop perpetual dripping. Cockroaches scurry across the floor of his room, which has no toilet or running water. His possessions, a few articles of clothing, are in a plastic bag under his bed next to a pink plastic wash bowl with a sliver of soap. His only entertainment is a transistor radio.

Wang counts himself lucky. While he has no family or savings, he fought against the Japanese and the Kuomintang in the 1940s, so the government pays the clinic’s monthly fee of 2,000 yuan ($315). His 200-yuan pension buys food. “A lot of people my age can’t afford to be here,” Wang says. “The food isn’t too good, but I have nothing else to complain about.”

The latest government census shows 178 million Chinese were over 60 in 2009. That figure could reach 437 million—one-third of the population—by 2050, the United Nations forecasts. In the past the elderly would have been cared for by their children, but urbanization and the one-child policy have eroded this tradition. “It’s a demographic tsunami,” says Joseph J. Christian, a fellow at Harvard University’s Kennedy School of Government who specializes in housing issues for seniors in China. “The whole multigenerational housing model has disappeared.”

The challenge is similar to that faced by Japan in the 1990s, with one difference: China will grow old before it gets rich. With millions of parents left to fend for themselves, the government has yet to come up with a strategy. While the latest five-year plan gives families primary responsibility for elderly care, policymakers are looking to the private sector, nongovernmental organizations, and communities for a sustainable solution. “The Chinese government has all the financial capabilities and capacity to protect the basic needs of the elderly,” says Li Zhihong, research department director at the National Committee on Aging.

So far only a handful of companies provides service comparable to the West, and even care like the kind offered by the clinic where Wang Fuchuan lives is relatively rare. “Elderly health care is in its infancy,” says Ninie Wang, founder of Beijing-based Pinetree Senior Care Services, whose 500 nurses provide in-home care to 20,000 seniors.

China has about 38,000 institutions with 2.7 million beds serving the elderly, enough for about 1.6 percent of the population over 60, according to the World Bank. That compares with about 8 percent in developed countries, the bank says. Some are fully staffed government clinics for senior officials or private hospitals catering to the new urban elite. Most are boarding houses with few medical facilities, concentrated in the largest cities. In towns and villages, the situation is far worse. “If we can’t help people in Beijing, you can forget about any opportunities for helping the rural old people,” says Jing Jun, a professor of anthropology at Tsinghua University.

A 2009 survey by a group of Chinese academics of 140 nursing homes in Nanjing found that fewer than a third employed a doctor or a nurse. Most of the staff were rural migrant workers with minimal training. “The goal at these homes is subsistence for residents whose children can’t take care of them,” says Zhanlian Feng, a gerontologist at Brown University who wrote a paper based on the survey in the Journal of the American Geriatrics Society. Many clinics refuse people who require full-time nursing. Others may force out residents once they become too needy, he says.