As China gets older, innovative elder-care scheme forms twilight communities – but are they sustainable?

Xinsi village is located in Fengxian district, Shanghai – one of China’s fastest-ageing municipalities, where the average life expectancy was over 83 years in 2022, according to official figures. The average Shanghai resident lives more than a half-decade longer than the national average of 77.93 years.

Among Xinsi’s 3,500 residents, 1,400 are older than 60, village party secretary Ye Feiyu told the Post.

Throughout China, the ageing trend is intensifying at a faster rate than most elsewhere in the world. And the shift is predominantly being driven by those who reside in the nation’s vast rural areas, where the lack of young people is more pronounced, social security benefits are poorer, and residents often form greater attachments with acquaintances than their urban peers do.

The availability of community-based elder-care services has increased significantly in China’s urban areas over the past decade, but Lu’s new home serves as a pioneer project for villages in the outskirts of Shanghai, even though they are among the nation’s most affluent rural areas with the narrowest urban-rural wealth gap.

It is a simple two-storey home with five two-bed rooms, rebuilt from another villager’s house just a few hundred metres away from Lu’s own. Two female villagers in their fifties keep the home clean and cook for the women. If any residents were to become incapable of caring for themselves, they would need to return to their families, according to party secretary Ye.

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“Younger senior villagers looking after older ones – that’s how things work here,” said one of the two workers, surnamed Wang.

After retiring three years ago, she worked as a part-time librarian in a nearby town before taking this job in May when the village committee opened the pilot facility.

China’s retirement ages, unchanged for decades, are among the world’s lowest – 60 for men, 55 for white-collar women and 50 for blue-collar women. Plans to raise the ages have been discussed for years, but nothing has been officially announced.

Lu said the subsidised facility costs her roughly 50 yuan (US$6.83) a day, which her pension nearly covers. Rural residents in Shanghai get a basic monthly pension of 1,400 yuan and a negligible extra sum based on their own contribution before retirement.

It is a relatively meagre sum compared with the average monthly salary of more than 12,000 yuan for urban workers in Shanghai. Retirees in Shanghai’s urban areas get at least twice the pension as their rural counterparts, at 3,000 yuan.

About 17.7 per cent of China’s rural population was aged 65 or above, compared with 11.1 per cent in urban regions, according to the 2020 national population census. And for every 100 working-aged individuals between 15 and 64, there were 28 seniors to support in rural areas, compared with 16 in cities, it showed.

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To Lu, using her pension to pay for a facility near her home is money well spent.

“I like it here. I don’t need to learn to get along with strangers like at a nursing home [farther away] in town, and my children needn’t worry about me,” she said.

He Xuefeng, dean of Wuhan University’s School of Sociology, whose research focuses on rural development, reaffirmed that rural residents are largely reluctant to leave their villages and sever ties with their social networks.

“Village-based elder-care services provide rural elderly people with what they basically need without forcing them to leave their acquaintances, setting their mind and their families’ at rest,” He said. “They’re fun, convenient and affordable. They should be promoted all over the country.”

The dean added that while the facilities would not be able to accommodate the seriously infirmed, “they could solve 80 to 90 per cent of the problems in rural elder care”.

The pilot project is not open to the sick or disabled because it lacks costly medical services, but a village doctor gives the residents regular physical check-ups, according to Ye, the village party secretary.

However, a big question is whether these types of facilities are financially sustainable and deployable by grass-roots cadres nationally, with adequate oversight to prevent abuse.

Zhu Qin, who specialises in population ageing at Fudan University’s School of Social Development and Public Policy, said that what’s been done in Xinsi is an innovative, goodwill experiment for rural regions, but the absence of long-term healthcare is a major flaw.

“What’s most needed is the caring of those without self-help abilities, who often are invisible in society,” he said. “The ultimate goal of elder care is akin to offering fuel in a snowstorm, not adding icing on the cake.”

Registered as a non-governmental organisation with support from the village committee, Xinsi’s programme appears to be running in the red.

The two helpers are each paid 2,690 yuan a month – the lower salary limit set by the municipal government – compared with the roughly 7,500-yuan income from the five residents, not including rent and utility costs. It can accommodate up to 10 coed residents.

Sustainability and the end game

So, how could such an elder-care programme ever be a viable option for widespread implementation, especially in poorer areas?

Village head Ye said the long-term plan is to encourage older residents to transfer ownership of their properties to the village committee, which would rent them to third parties.

Regarded as collectively owned, property in rural China can be traded only among residents of the same village, according to Chinese law.

“The elder-care service would then be free of charge for them,” he said. “Meanwhile, they get part of the rent [from their former homes].”

But he said most people remain unenthusiastic about moving, making it more difficult for the initiative to gain traction.

“Most of them feel obliged to stay in their own homes, even if it’s an empty nest,” Ye said. “We need time for their thinking to change.”

Initially reluctant to move, the 84-year-old Lu has not yet transferred her home to the village committee, and she sometimes returns on the weekends, since it’s so close.

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When it comes to social security, unlike urban employees who must jointly contribute to a pension scheme with their employers, rural residents are covered by a completely different scheme that is optional, much cheaper and mainly supported by public finances.

“The logic of policymakers is that rural residents have land – a long-lasting resource that they can supposedly take advantage of throughout their life, including after retirement,” said Zhu, the Fudan University professor. “But the reality is that, under current policies, such resources are barely a means to create liquidity [for rural residents]. Xinsi is having a meaningful go at it, in this sense.”

Cai Fang, a demographer and academician with the Chinese Academy of Social Sciences, is among those calling for reforms to tackle the widening economic divide between hinterlands and cities as the nation’s populous gets collectively older.

Different economic realities, unequal social security schemes, and disparate policies have created in China a yawning “dual structure”, under which the average disposable income of rural residents was still only 40 per cent of those in cities last year, according to official figures.

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“Amid the new normal in the demographic make-up, which for rural areas entails a quicker drop in total population, a deepening of population ageing, and a slowing increase in incomes, we urgently need to reflect on and change many existing policies,” Cai urged in a September article.

The government should reform land policies to ensure that farmers earn more income from their property, noted the article, published in the Chinese Cadres Tribune, an official monthly journal of political theories.

Over the 2012-22 period, only 2.9 per cent of rural residents’ income increases came from what they earned off their land, known as their net property income, he said.

Public welfare must be more equal, including the rural pension scheme, he said, calling for it to cover all residents, regardless of whether they’ve made paid into the social security system, and to be gradually increased.

For Shanghai, the Xinsi trial is just a start. Similar services are being launched next year in three neighbouring villages, and they are expected to cover all other villages in the town within three years, Ye explained.

Constructing the facilities will be a relatively quick undertaking, he said, but “making the ideas work will be a long process”.