China | Ageing

The kin and I

The state is unprepared for rising numbers of old people living alone

|XI’AN

LIU CAIPING is a former maths teacher, now 71, who has lived alone in the western city of Xi’an since her husband died last year. The radio is her steadfast companion. Her eyesight is failing and she rarely goes out. Like many city residents, her former neighbours have scattered, and her two daughters are far away. When she can no longer cope on her own she will go to a nursing home, she says. That option remains extremely rare for old Chinese. And that highlights the problem: China is struggling to cope with a rapidly ageing society and a rising number of elderly people living by themselves.

For most of the past two millennia the family has been central to how Chinese have seen themselves—and the state has been seen as a family writ large. Filial piety was somewhere near the heart of a Confucian order regulating society, and the family was an extended, stable unit of several generations under one roof. A very common saying encapsulated it all: yang er fang lao—“raise children for your old age”.

Today multi-generation families are still the norm. Almost three-fifths of people over 65 live with their children, a higher proportion than in most rich countries. Yet things are changing fast. Increasingly, parents are living apart from their children—and when one spouse dies, as with Ms Liu, the other often lives alone. A fifth of all single-person households in China are made up of over-65-year-olds. In contrast to younger Chinese living alone, few elderly do so by choice. Many are poorly educated. Women predominate, because they tend to outlive their husbands.

China is unprepared for the consequences of solo dwelling among the elderly. Government policy enshrines the idea that families should live together and provide for the old and others unable to look after themselves. Despite efforts to extend pensions and other social protection, provisions fall far short because the state assumes offspring will help the old and sick. The welfare system is ill-equipped to help the elderly living alone.

State financial support has improved in the past decade, but many millions of elderly Chinese still have no pension or retirement income. Health insurance is increasingly widespread, but usually covers only the basics. Rural areas lag far behind cities in the provision of pensions and health care for the old.

By 2025 nearly one in four Chinese will be over 60. China’s one-child policy has made a mockery of yang er fang lao—fewer among the younger generation are around for the old to move in with, a trend reinforced by starting families later. By 2050 there are likely to be just 2.5 working-age adults for every person over 65, down from eight today. Chinese born in the boondocks who migrate to far-off cities in search of work cannot easily take older family members with them even if they want to.

Despite the challenges, many in China still regard responsibility towards their family as a defining feature of their culture. Not much difference with other countries there. But the expectation of filial piety means that those who are not recipients of it often feel ashamed or isolated, says Jean Wei-Jun Yeung of the National University of Singapore. Many are reluctant to seek the help of neighbours when they need it, for instance. A study of old people in Shanghai by Yu Chen of Fudan University found that 84% rarely or never attended social activities.

The government acknowledges the problem. When it relaxed the one-child policy somewhat in 2013, one reason it cited was a growing number of elderly singletons. Some enterprising local governments have introduced schemes aimed at the lonely old. Young trainee doctors in Hangzhou in eastern China can have free board with old people living alone in return for companionship and basic medical care. Several cities encourage “time banks”, a model borrowed from America and Japan, where over-60s help those, say, over 80, building up credits to call in years later. Yet a control-freak state remains nervous about initiatives it does not closely oversee.

With a weak social-safety net, little support is in place for when families fail to help those living alone. A study in 2013 by Na Yu of the Beijing Institute of Technology found almost no neighbourhood communities in the capital offering the full range of basic services elderly people needed. Elsewhere, cities offer social activities but little personal care. Because of a lack of doctors in the community, old people with chronic conditions tend to linger in hospital. Social workers are in short supply, underpaid and overworked and have minimal training. Residential care is growing but still scant. China has 5.8m beds (enough for nearly 3% of over-60s), but there are often long waiting lists.

This is the background to a rise in the suicide rate among China’s elderly, even as that for other age groups is falling. In 2009-11 people over 65 accounted for just under half of all suicides, and more in rural areas: living alone in old age can be harsh anywhere, but in China it may be particularly isolating, given that so many young Chinese have left their villages, and parents, in search of work. The government has tried to enforce filial piety, passing a law in 2013 that threatens fines or jail if people fail to visit parents and feed their “spiritual needs”. It is a futile response. In a rapidly changing China, much greater state provision is needed.

This article appeared in the China section of the print edition under the headline "The kin and I"

The Great Fall of China

From the August 27th 2015 edition

Discover stories from this section and more in the list of contents

Explore the edition

Discover more

Who is up and who is down on China’s economic team

Xi Jinping is in charge. The rest need sorting

A gruesome murder sparks a debate about juvenile justice in China

A system that had become more merciful is being tested


Chinese nationalists have issues with “3 Body Problem”

The show is a hit in the West. But its history lesson is not for everyone