Faced With Rapidly Aging Society, China Releases Long-Term Plans on Dementia and Eldercare Services

In the past month, Chinese authorities have rolled out two framework documents setting out long-term objectives to improve dementia and eldercare services for China’s rapidly aging population. While both set out a range of laudable goals, it is unclear as to how effective they will be, particularly in responding to the pressing demographic and economic realities facing rural China.

On December 30, 2024, the Communist Party's Central Committee and State Council issued a joint "Opinion on Deepening Reform and Development of Eldercare Services." The following day, the National Health Commission and 14 other state bureaus and commissions issued a comprehensive national 2024-2030 action plan to combat dementia. Both documents set out a range of general guidelines instructing local authorities to ramp up preparations for the increasing needs an aging China will face, such as accelerating the establishment of insurance systems for long-term care and expanding care services for dementia patients.   

These moves reflect a range of mounting challenges. For example, numbers of dementia cases in China are projected to rise dramatically as the population rapidly ages over the coming decades. In 2021, China had more than 16 million people suffering from dementia (roughly 1% of the total population). Estimates suggest those numbers will rise to between 37 and 66 million by 2050 (between 3 to 5% of the total population). Naturally, China is not unique in this regard. Many other countries, including the United States, will also face an increase in dementia cases by the middle of the century. But precisely because East Asia is aging much faster than the rest of the world, the increase there will be particularly sharp. Current projections are for roughly one-tenth of Japan’s total population to have some form of cognitive decline (including both dementia as well as mild cognitive impairment) by 2040.

Both documents emphasize care models primarily focused on home-based service provision, coupled with community and institutional support. That reflects China’s current realities. As of 2021, only 3% of Chinese senior citizens resided in eldercare institutions, with roughly 90% living at home and relying on themselves or family members for care.    

However, the numbers of China’s elderly living alone (or with an aging spouse) is surging. The percentage of senior citizens falling in that category rose from under half in 2010 to around 60% in 2021. Those figures will rise yet further in the coming decades as China follows the demographic trajectory of its East Asian neighbors. Currently, the corresponding figure for South Korea is 88% (32.8% of Korean’s seniors live by themselves, 55.2% live with their spouse, while just 10.3% live with their children).

Such trends raise serious questions as to who will actually care for China’s elderly, particularly in rapidly aging rural China. The central opinion on eldercare services gestures vaguely in the direction of improving “rural mutual assistance” organizations to guide aging rural senior citizens to care for one another. It also emphasizes the need to develop "humanoid robots, brain-computer interfaces, artificial intelligence and other technological products" as part of expanding China’s eldercare services. 

But neither of those models appear likely to effectively respond to the realities of many depopulated, impoverished rural Chinese areas, which lack any access to mental health services and are experiencing a steady outflow of health professionals. They also differ dramatically from the experience of the other East Asian societies, where rapidly increasing eldercare needs have only been met by sustained inflows of foreign migrant labor. Taiwan, for example, currently has some 227,000 migrant caregivers, primarily from Southeast Asia, or roughly one percent of the island’s entire population.