Ensuring a happy life in their later years for 120 million elderly people in rural areas.

　　The seventh census data shows that there are approximately 120 million elderly people aged 60 and above in rural areas of China, accounting for 23.81% of the total rural population. Compared with urban areas, the age structure, empty nest rate, health status and other indicators of the rural elderly are more severe, and there are large gaps in terms of economic income level and affordability of elderly care service costs.

　　In this context, how can elderly care cover the vast rural areas with greater area, more warmth, and better quality and efficiency?

　　In recent years, China has accelerated efforts to make up for the shortcomings in rural elderly care services, and the service capacity and development level have been significantly improved. Data from the Ministry of Civil Affairs shows that as of June 2024, there were 16,000 rural nursing homes with 1,681,000 beds; and approximately 145,000 rural mutual aid elderly care service facilities.

　　Looking to the future, solidly promoting the construction of China's rural elderly care service system and realizing the transformation from existence to excellence depends on the continuous expansion of the coverage of the three-level elderly care service network in counties, townships and villages, the double improvement of the quantity and quality of rural elderly care service supply, the further improvement of the efficiency of service resource utilization, and the optimized allocation of service support and guarantee funds.

　　"This place is very good, the environment is clean and the food is delicious." Li Dequan, a 61-year-old impoverished elderly man in Dapo Elderly Care Service Center, Xishui County, Zunyi City, Guizhou Province, said with emotion after moving into his "new home" for a year.

　　About 70 elderly people from rural areas in several surrounding towns and villages receive centralized care in the center. It has more than 100 beds and is equipped with 10 functional spaces such as a medical room and an entertainment room. It also has vegetable gardens, workshops and other venues, and often organizes activities such as坝坝舞 and paper cutting to enrich the lives of the elderly.

　　In recent years, China has accelerated the improvement of a three-level elderly care service network covering urban and rural areas. In 2024, the central government arranged 296 million yuan to support 59 regions in carrying out innovative pilot projects for the county elderly care service system, so as to promote the overall improvement of rural elderly care services.

　　In terms of expanding the functions of county-level special hardship support service institutions, various regions have increased their efforts to support institutions in setting up special care areas for the disabled or those with cognitive impairment as needed, and to strengthen the construction of nursing beds.

　　Hubei is promoting the construction of county-level public elderly care institutions in accordance with the planning layout of one special hardship support institution per county. At present, 116 county-level special hardship support institutions have been built in 103 counties (cities and districts) in the province. Shaoyang County, Shaoyang City, Hunan Province, where the proportion of rural disabled and semi-disabled elderly people exceeds 20%, has built a county-level disability and dementia care center to respond to the centralized support needs of rural special hardship people, especially the disabled special hardship elderly.

　　In terms of promoting the construction of regional elderly care service centers in townships (streets), many places are accelerating the transformation of qualified township (street) special hardship support service facilities (nursing homes) and other elderly care institutions into regional elderly care service centers with functions such as coordination and guidance, full-day care, day care, home visits, and service referral.

　　"As a key node connecting counties and villages, the township level plays a connecting role in the elderly care service network." Zhao Jun, director of the Xishui County Civil Affairs Bureau, introduced that the county has integrated 21 township (street) nursing homes into 7 regional elderly care service centers since 2022, with a bed utilization rate of 74%.

　　In addition, various regions have incorporated the construction of village-level neighborhood mutual assistance points, rural happiness homes and other mutual assistance elderly care service facilities into village planning, and strived to open up the "last mile" for providing elderly care services to the rural elderly.

　　Taking Guizhou as an example, the local government provides operating rewards and subsidies of no less than 10,000 yuan to qualified exemplary rural happiness homes, and plans to build 100 rural mutual aid elderly care demonstration points with complete facilities and standardized management by 2025.

　　"To ensure that outstanding service needs such as disability care, medical and health care integration, meal assistance, visits and care, and learning and entertainment are effectively met, counties, townships and villages need to work together, perform their respective duties, develop in a balanced manner, and connect smoothly, so that rural elderly care services are truly accessible and tangible." said Fang Yu, deputy director of the Institute of Aging Strategy and Policy of the China National Research Center on Aging.

　　Recently, Wu Cunde, who is in his eighties, moved back to the village. He used to live in a nursing home in Huinong District, Shizuishan City, Ningxia Hui Autonomous Region. "It costs more than 1,000 yuan a month for food and accommodation." The old man felt it was not cost-effective, so he moved back to the Weizha Village Mutual Aid Happiness Home in Weizha Town, the district.

　　Here, the elderly only need to pay for heating and water and electricity, which costs about 2,000 yuan a year. "I have poor digestion and only eat two meals a day. Breakfast is at 9 am and costs only 2 yuan; lunch is at 2 pm and costs 4 yuan. It costs less than 200 yuan a month." Wu Cunde said.

　　In recent years, various regions have explored and established sustainable development models based on local conditions, such as government support and guidance, village collective organization and construction, voluntary mutual assistance among the elderly, and broad social support, focusing on building facilities and promoting services around the needs of the elderly, and striving to solve the problem of rural elderly care without leaving the village or township.

　　Increase the number of village-level elderly care service points to better play the role of village-level mutual aid elderly care service facilities as the front line.

　　For example, Xingguo County, Ganzhou City, Jiangxi Province, selects natural villages with a relatively high concentration of elderly people, and transforms and upgrades idle school buildings of primary and secondary schools to establish more than 200 " Happy Age Mutual Aid Society ", providing meal assistance services and regularly organizing health lectures, chess competitions, birthday parties for the elderly and other activities.

　　Rely on the advantages of "neighbors" and "acquaintances" to supplement the lack of family elderly care caused by the miniaturization of family size, the decentralization of residence, and the weakening of support functions.

　　For example, since 2022, Zhushan County, Shiyan City, Hubei Province, has piloted the "neighborhood mutual assistance" care model in several villages in Baofeng Town. Delivering a hot meal a day, purchasing daily necessities and medicines once a week, and cleaning once a month... In the eyes of Cao Fenglan, a villager in Longjing Village, such things "don't require much work, just like visiting neighbors." She helps 6 people in her village, mostly elderly people living alone, people receiving minimum living allowances, and people with severe disabilities.

　　Promote the combination of elderly care and elderly contribution, encourage grassroots elderly associations to participate in service management, and widely carry out various mutual assistance activities.

　　For example, in Lianghekou Village, Baiguo Township, Enshi City, Enshi Tujia and Miao Autonomous Prefecture, Hubei Province, Zhang Bidou, a local retired cadre, initiated the establishment of the Lianghekou Elderly Association, organizing retired teachers, doctors, technicians, and village cadres to leverage their remaining value and help elderly people in rural areas with difficulties. Tong Jishen, who is nearly 70 years old, helps seven elderly people without cattle plow their fields free of charge; 84-year-old Zhou Yuanxi provides free haircuts to elderly, weak, sick, and disabled villagers; and 82-year-old Zeng Yongzhi provides free technical guidance to 74-year-old Xia Chaoguo, helping him increase his income through breeding...

　　"Guiding diverse forces to actively participate and continuously promoting mutual-aid elderly care from providing relief services to moderately inclusive services, and from home care to spiritual comfort services, according to local conditions, is a realistic and feasible choice for the development of elderly care services in rural China," said Liu Nina, associate professor at the School of Humanities and Social Sciences, North China Electric Power University.

　　It must be recognized that while various regions continue to optimize the supply structure and model of rural elderly care services, the problem of misallocation of rural elderly care resources is also relatively prominent, mainly manifested in the high vacancy rate of public elderly care institutions and the construction of mutual-aid elderly care institutions being divorced from reality.

　　—The situation of insufficient effective demand for institutional elderly care is relatively common in some areas.

　　In January 2025, a reporter from 'Outlook' News Weekly conducted a survey in a northwest county with a total elderly population of 55,000 over the age of 60 and found that the three county-level elderly care institutions had a total of 1,260 beds, including 762 nursing beds, but less than 200 service recipients were admitted, and the bed occupancy rate was less than 16%.

　　In a central county with a population of over 70,000 aged 60 and above, only 1,420 people are supported in institutions, accounting for about 2%. A survey conducted by the local Civil Affairs Bureau in a village showed that among the 359 elderly people over 60 in the village, only 5 intended to move into a nursing home.

　　—Individual regions have included village-level mutual-aid elderly care institutions in the assessment indicators for rural revitalization and increased construction, resulting in wasted resources.

　　A grassroots cadre in a central and western province told reporters that the higher-level departments once required full coverage of mutual-aid elderly care facilities in more than 500 villages (communities) in the county. Each new construction requires 150,000 yuan, and the annual operating subsidy requires 10,000 to 30,000 yuan. If all are built and put into operation, the related investment will be close to 10 million yuan. Later, the provincial level stopped the relevant assessment requirements because the grassroots finances could not afford it.

　　In practice, due to insufficient effective demand, some rural mutual-aid elderly care facilities cannot withstand operating pressure and are eventually left idle and abandoned. Many interviewees believe that there are many left-behind elderly people in rural areas, but they are scattered. The actual elderly care needs should be investigated on a village-by-village basis, and supply should be determined based on needs and local conditions to improve the efficiency of service resource utilization.

　　Shang Lizhong, the administrator of the Weizha Village Mutual-Aid Happiness Home, said that the occupancy rate of his Happiness Home is close to 90% because of its precise positioning—covering the elderly population who are relatively healthy but have needs such as heating and cooking, and do not belong to the 'Five Guarantees' households. 'The labor cost of care is low, and with government subsidies plus the elderly's payments, we can achieve a balance of payments or even a slight surplus,' said Shang Lizhong.

　　Experts suggest adapting to the general trend of the rural population continuing to move to towns and further strengthening the construction of county-level elderly care institutions. 'With enhancing the service capacity of disability care as a prerequisite, it is better to guide the centralized support of rural people in special difficulties, especially the disabled elderly in special difficulties,' said Liu Nina.

　　At the same time, efforts should be made to reform the operation mechanism of township special hardship support service facilities (nursing homes) and regional elderly care service centers, and encourage them to provide services to the elderly in the community to enhance development vitality.

　　In Yuanzhou District, Yichun City, Jiangxi Province, Liu Huixiu, 79, suffers from Alzheimer's disease and often walks 60,000 to 70,000 steps to neighboring towns. Her family was afraid that the elderly would get lost but it was difficult to take care of her at all times, and they wanted to send the elderly to a nursing home but were worried that the institution would not take good care of her. It was not until April of this year that they saw the daily life of the elderly in Nanmiao Township Nursing Home on social media that they felt relieved to entrust the elderly to the institution.

　　It is understood that the local area promotes the direct management of township nursing homes by the county-level civil affairs department, formulates performance reform methods for nursing homes, links the performance of staff with nursing level, service quality, and the quality of the elderly's spiritual life, effectively improves management standards and service guarantees, and opens up the remaining beds to the elderly in the community. It is understood that compared with 2023, the total number of elderly people received by township nursing homes in Yuanzhou District has nearly doubled.

　　"In previous years, there were more newly built elderly care institutions, and the construction subsidy was more than 2 million yuan per year, but the occupancy rate of elderly care institutions was only 30%. In view of this situation, we have slowed down the construction pace, and the relevant subsidies in 2024 have been reduced to more than 300,000 yuan." During the interview, a civil affairs cadre in a northern city suggested that the flexibility and pertinence of the allocation and use of financial funds should be improved in response to changes in the times.

　　Ministry of Finance data shows that 2019 — From 2024, the national finance spent more than 560 billion yuan on elderly care services and elderly welfare, with an average annual increase of 11%.

　　Looking to the future, while further increasing financial investment in elderly care services based on the level of economic development and the degree of population aging, we should also continue to optimize the allocation of financial funds in the field of elderly care services, so that the elderly in rural areas have a stronger sense of gain, happiness, and security.

　　In the past, government financial subsidies for elderly care services mostly adopted the method of 'subsidizing the supply side', that is, subsidizing construction costs according to the number of beds and subsidizing operating costs according to the actual number of occupants. The heads of many county and township elderly care institutions believe that at present, the hardware construction of county and township-level elderly care institutions has been basically in place, and it is recommended that financial funds further tilt towards operation services to improve the level of institutional care services.

　　In addition, according to the existing policies, one-time bed construction subsidies are only applicable to qualified private elderly care institutions, and there is a lack of systematic institutional design for financial support for village-level mutual-aid elderly care service facilities.

　　"The rigid demand of most non-disabled elderly people is to meet the needs of meal assistance, life care, and cultural entertainment in the village or neighboring villages." Xia Zhuzhi, associate professor at the School of Sociology, Wuhan University, believes that the investment of financial funds should be tilted towards further improving rural infrastructure and strengthening public services to increase the attractiveness of elderly care in rural areas.

　　Experts further suggest strengthening the support and guarantee of rural elderly care services by improving the funding and treatment adjustment mechanism of urban and rural residents' basic pension insurance, ensuring the operating expenses of rural special hardship support service facilities (nursing homes), and the funds required for the rescue and support of people in special hardship.

　　Currently, according to different levels of care, the monthly fees of county and township-level elderly care institutions are generally between 1000 — 3000 yuan. In contrast, most rural elderly people's pensions are less than 200 yuan per month. If their children cannot provide financial support, it is difficult for the elderly to afford the cost of living in institutions on their own.

　　"There are about 30,000 disabled and demented elderly people in the county. A survey shows that about 40% of the disabled and demented elderly people cannot live in elderly care institutions due to economic reasons," said Wei Xiancheng, deputy director of the Longhui County Civil Affairs Bureau in Hunan.

　　Starting in July 2025, Zhejiang, Shandong, Chongqing, and four other regions will pilot a project to issue elderly care service consumption subsidies to moderately or severely disabled elderly individuals. Based on the pilot project, the Ministry of Civil Affairs and the Ministry of Finance will organize and implement the project nationwide before the end of 2025.

　　Industry insiders interviewed expect the policy to be implemented thoroughly to effectively reduce the financial burden of care for disabled elderly individuals, better meet the essential needs for care services for disabled elderly individuals in urban and rural areas, and enable more rural elderly individuals to have fewer worries about elderly care and enjoy their later years peacefully. (Source: Outlook Weekly)

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