(Repeats story first published on Sunday. No changes to text)
By Li Hui and Maxim Duncan
QIANTUN, China May 19 Two years short of 70,
Zhang Guosheng spends his days caring for an 81-year-old fellow
villager - washing his clothes, bringing meals to his bed, and
keeping him company - a routine he'll keep up until he himself
needs the type of care he is now giving.
"Living here is better than staying at home alone. We help
each other and have a common language," said the spritely Zhang,
an enthusiastic dancer. "We are very happy here."
With younger villagers who would traditionally have looked
after their parents and grandparents flocking to the booming
cities to seek work as part of Beijing's urbanization drive,
Qiantun village in northern China's Hebei province has had to
pioneer a new model - the old looking after the even older.
Surrounded by green wheat fields that stretch across a flat
plain, Qiantun is unremarkable among countless rural Chinese
communities, but its old-age care model is now a prototype cited
by central government as a solution to the daunting challenge of
caring for a vast and rapidly greying rural population.
One of every four Chinese will be older than 60 by 2030,
according to the Ministry of Civil Affairs.
Massive rural-to-urban migration will further strain the
rural areas' ability to provide care for the elderly, as
personal savings and family support remain the primary pillars
of old-age care.
"Migrants to urban areas are mainly young adults, leaving
mostly the elderly in villages with children," said Wang Dewen,
an expert with the World Bank's Beijing office. "The formal
eldercare system in rural areas is very weak, and basically a
blank spot in many places."
As a result, the gap between the number of elderly in rural
and urban areas is expected to balloon over the next 15 years,
to 11 percentage points from today's 1.24 percentage points, the
The costs of caring for China's rapidly expanding elderly
population are likely to be too heavy a burden for the
government, forcing Beijing to find cost-effective and creative
ways to provide care in myriad localities. The self-help model
practiced among the 1,500 residents of Qiantun offers a cheaper
and streamlined alternative to a state-run system.
More than 95 percent of China's rural elderly still adhere
to the traditional practice of seeking old-age care within their
families, Wang said. But families are no longer able to cope,
with youth and even middle-aged people heading to cities to find
work, leaving the elderly behind to fend for themselves.
THE "LIGHT" OF FEIXIANG
In their search for affordable eldercare models, Beijing's
leaders have turned their attention 450 km (280 miles) to the
south in Hebei's Feixiang county, where Qiantun lies. The
practice of old people taking care of each other posed a simple
and attractive solution.
Labelled "mutual assist eldercare", the Feixiang model is
set to be expanded to the rest of rural China, with 3 billion
yuan ($490 million) set aside by the central government to get
it started over the coming three years.
"The light of Feixiang will shine across China," Li Liguo,
minister of civil affairs, declared enthusiastically during a
trip to Feixiang in 2011. "Feixiang has set an example for the
But not everyone is as optimistic about the model.
"As people get older, they don't tend to get healthier. So
if you have somebody in their sixties caring for somebody in
their nineties, are they going to be able, and trained and
strong enough themselves to care for somebody who has chronic
conditions?" said Tony Buccheri, a manager with Right at Home
International, a U.S.-based senior home care provider that
offers services in China through a partner.
Buccheri's concern echoes that of Cai Qingyang, pioneer of
the model and Qiantun's village chief.
"Old people with critical illnesses need more than the very
basic care provided here, and we will have to think of other
ways to care for them," said the 61 year-old former soldier Cai,
watching several old villagers dancing in the yard.
"But this really is the only feasible way given the local
elder care situation. The village and the government simply
can't afford proper institutional care for every aged rural
resident," Cai added.
In 2008, Cai sought to do something about the lack of care
for rural elderly left behind as young adults sought better
paying work in cities. He turned an abandoned brick house into
an old-age home, where 25 elderly villagers moved into 11
rooms, keeping each other company, sharing meals, as well as
farming and doing housework.
His innovation has thrived under state support and more than
a dozen other provinces have replicated the model.
OLD BEFORE RICH
What separates China's ageing pattern from that in other
Asian societies such as Japan, South Korea and Singapore is that
the country is still relatively poor on a per capita basis. The
phrase "getting old before rich" reflects the fact that even
though China's economic growth remains robust, its demographics
work against it.
Those in the emerging middle class have more options among
at-home care providers, and public as well as private senior
homes, and are more likely to find them affordable.
The rural elderly have fewer resources and fewer choices,
while youth migration patterns unstitch the traditional family
safety net. And despite years of efforts by China's leaders, the
income gap between urban and rural residents has increased. A
report published by the World Bank last year noted that rural
elderly have "remained consistently poorer than the urban
elderly over time".
Nor is that likely to change. Two-thirds of elderly Chinese
currently live in rural areas, and although migration patterns
cloud demographic estimates, many demographers believe the
majority of China's elderly will remain in the countryside.
To meet the challenge, says the World Bank's Wang, China
must make its urbanization an equalizer of basic social services
for urban and rural residents. To do that, he adds, it must
reform the household registration system that ties social
services to people's registered home, to facilitate family
migration to cities and receive care there.
But in the short term, rural areas such as Qiantun, which
has three times as many elderly residents as young adults, can
only make do with the resources they have. The government
provides 600 yuan ($97.68) a year in subsidies for each of the
30 elderly Qiantun villagers at the centre. Their average age is
By contrast, offering professional care at an old-age care
institution would cost a minimum of ten times as much, 6,000
yuan a year, according to government estimates, offset by a mere
120 yuan annual subsidy from the government.
At the Qiantun villager centre, "old" Zhang, as he is known,
talks about the future as he brings a bowl of dumplings and
medicine to the bedside of his charge, bedridden by a broken
"He can't move around now, I help him," said a still spry
Zhang. "When I can't move, someone will also care for me."
($1 = 6.1428 Chinese yuan)
(Editing by Ben Blanchard and Ian Geoghegan)