As China's young head to cities, elders find new appeal in old age homes

A World Living Longer: Global aging is one of the greatest challenges of the century. And this is not just a “Western” problem. Politicians and policy makers around the world are rethinking healthcare networks, urban design, nursing care, and pension systems to prepare for it. The elderly themselves are key players to help turn this from challenge to opportunity.

For more in the Monitor's look at global aging issues and solutions, please visit our series homepage.

It may not be his preference, but Sheng Qinzhai, an 84-year-old retired Chinese medicine doctor, has grown accustomed to his new life in a retirement home, Happy Elder House, on the outskirts of Shanghai.

He and his 80-year-old wife, Zha Xueqin, moved in 10 months ago. The arthritis in her knees was worsening and made walking difficult. The couple needed more care than their two adult daughters, who have grandchildren to help raise, could provide.

“I thought about it for a while,” says Mr. Sheng, who recalls looking after his parents when they were old. “That’s how it was for generations, but people’s minds have changed.”

With 30 full-time residents and dozens of others who come for meals and activities, Happy Elder House embodies a new approach to caring for China’s huge – the largest in the world – and rapidly aging population. For centuries, filial piety has formed the bedrock of elderly care across the country. But analysts say the pressures of modern life, especially in China’s expanding cities, make it difficult for working-age children to fulfill their filial obligations.

Chinese families have typically shunned dedicated nursing homes for fear of losing face, especially in rural communities where traditional beliefs are deeply entrenched. But now they are giving such facilities a second look, as elderly and their families alike find tradition challenged by the demands of modernizing Chinese life.

“Society is changing,” says Peng Xizhe, a professor of population and development at Fudan University in Shanghai. “On the one hand, it's important to maintain the Chinese traditional culture, maintain the traditional arrangement for elderly support. But on the other hand, we have to find new ways of dealing with this.”

A crumbling support network

In China, more than 220 million people, or 16 percent of the population, are over the age of 60. Demographers predict their numbers will grow to 490 million by 2050.

Therese Hesketh, a professor of global health at University College London, says rapid urbanization and the one-child policy have exacerbated the problem. While she expects last year’s introduction of a two-child policy to help, she maintains that China’s aging population remains one of its greatest challenges this century.

The challenge is especially acute in rural areas. About half of people age 60 and older live apart from their children, according to the China Research Center on Aging. A study published in 2014 estimates that the proportion of empty nesters in rural areas will grow to twice that of urban areas by 2050.

“It’s a huge problem,” Professor Hesketh says. “There are some very vulnerable people completely isolated and dying in appalling conditions.”

While nursing homes and retirement communities have long been acceptable solutions to help care for aging societies in the West, China has been slow to adopt them, preferring instead to promote traditional filial piety. In 2013, the government went as far as to turn the ancient virtue into a law aimed at compelling adult children to visit their aging parents.

Policymakers across the country have developed creative new ways to encourage it over the past year. The central province of Henan established a law that allows only children to take 20 days leave each year to care for their sick parents. A new regulation in Shanghai instructs children to “visit or send greetings often” to their parents or risk having their credit score lowered. And a village in Sichuan Province has taken to naming and shaming neglectful children by plastering their faces on billboards.

Yet faraway children will never be able to provide elder parents with the daily care many of them will require as they grow older, says Du Peng, director of the Center of Aging Studies at Renmin University in Beijing. He says society as a whole must work to fill in the gaps.

“We will have more and more old people who need long-term care, especially in rural areas,” he says. “Local communities are the best place to provide the support they need.”

'It's easier here'

It was that sort of thinking that inspired the creation of Happy Elder House, a 49-bed nursing home, in a dilapidated block of Yanjing. The owners leased 10 empty buildings and renovated them, installing handrails and wheelchair ramps. They turned one single-story house into a cafeteria; another became a community center.

Jiang Qiuyan, one of the three co-founders of Happy Elder House, says new residents are often skeptical when they first move in. “Some think they come here to wait to die,” she says, adding that others feel abandoned by their children. Eventually most seem to come around.

Ms. Jiang was born and raised in Yanjing as an only child. She had the idea for the nursing home when she noticed how lonely her parents had become in the village – and when she recognized her own limitations in caring for them as they get older. By opening Happy Elder House in Yanjing, Jiang hopes to helps its residents, many of whom are from the village or nearby towns, feel at home. There’s even a small garden for them to farm.

Sheng, the retired doctor, spends most of his day taking walks, reading old medical books, and chatting with his wife and other residents. His daughters try to visit once a week. “It’s easier here,” he says.

Jiang says her intention isn’t to replace family-based care, but rather to help empty nesters maintain a familiar lifestyle while giving peace of mind to their children. For some of those children, visiting their parents provides them a glimpse of their own future.

“I want to come here when I get older,” says Chen Guoqiang, who took time off from his government job to run errands and visit his father. “I have one child, a daughter. I don’t want her to have to take care of me.”

• Qiang Xiaoji contributed to this report.

For more in A World Living Longer, the Monitor's look at global aging issues and solutions, please visit our series homepage.