China is undergoing a major demographic shift as it becomes an aging society, with longer life expectancies and fewer births leading to a rapidly growing elderly population.

By the end of 2023, China's population aged 65 and above reached 217 million, or 15.4 percent of the total, according to the Ministry of Civil Affairs. As the UN classifies a society as deeply aging at 14 percent and super-aging at 20 percent, China is already a deeply aging society, quickly approaching super-aging status.

The aging situation in rural areas is more severe compared to cities. According to the fifth nationwide household survey program on the lives of urban and rural senior citizens, elderly individuals in rural areas face more serious issues in terms of age structure, empty nest rates, and health status. Additionally, disparities in income and access to care services, along with village depopulation and returning elderly migrant workers, exacerbate the problem.

This demographic shift in rural areas brings both challenges and opportunities. With more seniors, there's a greater need for healthcare services, better social security, and improved elderly care facilities.

To address these needs, the Chinese government has recently released a set of guidelines to accelerate the development of elderly care services in rural areas. This comprehensive and systematic national plan, the first of its kind, includes initiatives to encourage community-based care, enhance pension systems, and promote family support for elderly care.

"Rural areas are experiencing a higher degree of aging than cities due to urbanization," said Zhou Shaojie, a professor at the School of Public Policy and Management, Tsinghua University, and deputy director of the Institute for Contemporary China Studies.

"The accessibility of elderly care services in rural areas is significantly different from urban areas. While some wealthy rural regions have community care centers, many rural areas lack accessible services due to high costs and scattered residences."

"For the elderly population, basic services include dining and general life care. Some elderly people are disabled or suffer from dementia, making rural care services crucial for them," said Zhou, who is also the director of the Center for People's Livelihoods and Health Policy Research.

"Strengthening these services is a future priority. It requires officials, especially at the village level, to focus on collecting basic population data in order to design financial assistance programs and provide subsidies, he noted.

"A smooth working mechanism is essential to effectively address these issues, which is the key significance of the recent policy introduction," he told CGTN.

Addressing healthcare needs for rural elderly

During the 14th Five-Year Plan period (2021-2025), China is enhancing rural elderly care facilities, focusing on building and renovating public institutions like rural nursing homes to improve care capabilities. The Ministry of Civil Affairs, in collaboration with the National Development and Reform Commission and the Ministry of Finance, has implemented a project to upgrade rural nursing homes, aiming to improve facility conditions and disability care equipment.

Currently, there are 16,000 rural nursing homes with 1.68 million beds and about 145,000 mutual-aid elderly care facilities in rural areas, according to the Ministry of Civil Affairs. While a comprehensive service network is gradually forming, the convenience and accessibility of these facilities still need improvement.

The guidelines set a 2025 goal to improve the rural elderly care network with several key measures. For instance, each county having at least one institution providing disability care for impoverished residents and township-level elderly care centers covering at least 60 percent.

Additionally, mutual-aid elderly care will be tailored to local conditions, addressing needs such as disability care, medical services, meal assistance, visiting care, and recreational activities. The guidelines also encourage state-owned and private enterprises to operate elderly care facilities in rural areas.

Collaboration needed to support China's aging population

Zhou also mentioned the issue of rural pensions. Rural elderly income comes from labor and pensions, but current pension levels are relatively low, leaving many elderly reliant on their children for support. Future increases in pension levels are necessary.

In response to this issue, the guidelines propose strengthening pension security for the rural elderly. Human resources and social security departments will improve the financing and benefit adjustment mechanisms for basic pension insurance. Rural residents are encouraged to participate in personal and commercial pension plans. Also, medical security departments will promote the construction of a long-term care insurance system to address long-term care needs for the disabled, including rural elderly.

Additionally, the guideline emphasizes a framework for rural elderly care services that includes Party leadership, government guidance, departmental responsibility, social participation, mutual aid, and family accountability. It also promotes educating children about their legal obligations to support their parents, as outlined in the Civil Code and the Law on the Protection of the Rights and Interests of the Elderly.

Zhou noted that many children of rural elderly people move to cities for work or study, and while the elderly don't want to burden their children, their income levels are relatively low. The situation varies by region. Some elderly have children who bought insurance, while others do not.

"While developing rural elderly care services is important, fiscal expenditure alone cannot meet the needs. Therefore, rural elderly care should fully utilize family support, emphasizing the responsibility of children," said Zhou.

"In other words, managing this demographic shift requires family, society, government, and market forces to collaborate."