At age 32, Zhang Jianing holds a good-paying job at an international construction firm that allows her to travel and keep an apartment in pricy Beijing. As a rising young professional, she is living a life that previous generations in China couldn’t imagine.
But over lunch at a café recently, Zhang’s thoughts wandered to her home province of Jilin, where her mom, at age 61, is living alone in a remote village.
“I am always thinking of my mother,” she said. “What is going to happen to her? Who will take care of her?”
Millions of people ponder that question regularly in China, a country with a demographic crisis that its leaders are only starting to confront. According to United Nations figures, nearly 200 million Chinese are now over age 60. Roughly half are “empty nest” parents living alone in rural areas. In the next 15 years, nearly one in four Chinese – more than 320 million people – will be 60 and older, including tens of millions of disabled seniors.
In the past, Chinese elders could be assured that, when they were frail and no longer able to work, their children would look after them. But because of the government’s one-child policy and the migration of young people to urban jobs, China’s traditional system of elder care has been shredded.
“The old people in their own homes are often not getting checks from their own children,” said Timothy Beardson, author of “Stumbling Giant,” a 2013 book that examines China’s looming challenges, including its demographics. “It is not a happy picture. It is a very gloomy picture.”
China’s Communist Party seems well aware that in a nation that is increasingly silver-haired and vulnerable, elder neglect is an ugly side effect of the nation’s economic miracle. In 2013, the government even felt compelled to pass a controversial law, Protection of the Rights and Interests of Elderly People, that spelled out the obligations of young offspring.
Yet unlike most industrialized countries, China doesn’t have an insurance safety net like Medicare to provide medical treatment for seniors. Nor does it have anywhere near enough nursing home beds to ensure care for the seriously infirm.
In 2013, Chinese state media reported that there could be a 100-year wait to get into Beijing’s top-ranked nursing home, as some 10,000 applicants were waiting for 1,100 available beds. The nation currently has about 4 million nursing home spots. There are roughly 30 million Chinese age 80 or older.
“There are a lot of smart people in the Communist Party,” said Beardson. “But are they going to be able to respond effectively to the challenges China is facing? I am not sure.”
A graying population is just one of the bumps China’s encountered as it speeds through the 21st century. As Beardson notes in “Stumbling Giant,” the percentage of young people in China is shrinking, and with it, the work force that has powered the Chinese economy in recent decades. And while the Communist Party has recently loosened its one-child policy, surveys suggest that young urban families – facing high rents and concerns about college costs – have little interest in rearing more than one or two children.
All that poses questions for China’s leaders: Can they keep the nation’s economic engine running without a large pool of low-paid workers? And how will it pay for health care and living costs of hundreds of millions of people who will enter their golden years in the decades ahead?
Zhang, whose work often keeps her apart from her mother, says she regularly frets about her small family’s situation. Her parents divorced when Zhang was less than 1 year old. Her mother raised her, working odd jobs and saving for her college education. Zhang says her mother is currently in decent health, yet if and when that changes, she will face hard choices between family and career.
Two years ago, Zhang registered a website, which she hopes to build into a clearinghouse on senior services and elder advice. (The website is called www.justforbama.com, which plays off a Chinese word – “bama” – that means dad and mom.)
“There’s a lot of advertising in China reminding people to take care of their parents,” she said. “But there’s not one easy place to go to get help.”
China’s graying crisis also has caught the attention of U.S. and international companies, including some tech firms. One of them is Intel, the giant Silicon Valley computer hardware manufacturer. Several years ago, Intel promoted Eric Dishman to head the company’s Proactive Health Research Division, and for the last five years, he and his deputies have been talking to Beijing about creating a new model of senior care in China.
Chinese developers are already building huge blocks of senior housing in big cities. The goal, Dishman said, would be to design such communities so seniors could live independently, without vast construction of institutional nursing homes. At the center of these communities would be “care networks” of trained, digitally linked family and neighbors to help manage needs of elders. Higher-cost doctors and nurses would only get directly involved if seniors had acute ailments.
Dishman says China is uniquely positioned to catch up with its demographic challenges, and unlike some analysts, he thinks the commitment is there.
“They can do this, they know they need to do this, and they are on the way thinking about how they will do it,” he said during a visit to Beijing late last year. “And once they implement their plan, the rate at which they can scale up their projects is unequaled.”
Other senior-care experts, however, see numerous hurdles.
Three years ago, Jim Biggs relocated from El Dorado Hills in Northern California to help a Chinese company, Honghui Senior Living, launch an assisted-care facility in Tianjin, a city of nearly 15 million. Called the Friendship House, the facility specializes in care for people who suffer from Alzheimer’s and other disabilities.
Biggs, who worked in the U.S. senior care industry for decades, said that business was initially slow. He said it was difficult to spark interest in a community that offered assisted nursing case, an alien concept in China. In addition, he said, some families are wary of the stigma attached to dementia, and so were wary to acknowledge it.
Two years later, the 33-bed facility is more than 80 percent occupied, and Honghui is planning a second and third phase. At Friendship House, many residents are elderly couples, with one spouse bedridden and the other leading a relatively independent lifestyle.
On a recent weekday, Chen Li could be seen painting landscapes in one of the Friendship House’s recreation rooms. A 77-year-old retired engineering processor, Chen said he planned to devote much of his retirement to painting and other hobbies, until his wife became bedridden with a serious brain disease six years ago.
With the help of their son, who works for Western Digital in Irvine, Calif., Chen and his wife were able to move into Friendship House last year. They each pay about 10,000 yuan monthly – about $1,700 – for private rooms, home-cooked meals and 24-hour care.
“This place is nice,” said Chen, while dabbing ink onto paper. “I don’t have to spend my time cooking, and we are taken care of.”
In Shanghai, several companies have launched some of China’s high-end senior communities. One of the most successful is Xing Bao – “Starcastle,” in English – a joint venture between Fortress Investment Group, a publicly traded U.S. company, and Fosun, one of China’s leading investment groups.
Located in the Baoshan district of Shanghai, Xing Bao opened in May 2013 and features 189 independent living units, a restaurant, café, medical clinic, fitness center, mahjong rooms, tea house and other amenities. One of its 13 floors is an assisted-care center, devoted to seniors with dementia and other disabilities.
Lilly Ho Donohue, managing director of Fortress’ China operations, said Xing Boa is now fully occupied, with each resident paying 12,000 yuan per month, about $2,040. The company has two more similar projects in the works, totaling more than 1,500 units, she said.
Still, said Donohue, it took years of preparation and seven different government licenses to launch Xing Bao. When asked, she said she wasn’t sure if such projects could be easily replicated outside of Shanghai, which has a high percentage of seniors and many who are affluent and internationally savvy.
Given that per-capita disposable incomes in China are about $4,500 a year – about five times less than what Xing Bao charges annually per resident – it seems unlikely that private retirement communities will soon be a panacea.
“This is not a business where if you build it, they will come,” said Donohue. “The truth is, it is so damn hard.”