The Future of China’s Elderly Care is Young

Siyi Chu (褚司怡)

Can young professionals change geriatric care in China, or will it change them first?

If it were up to Tang Yongqi, rollercoasters of the future would be fitted with straps for wheelchairs. “ Amusement parks seem to be for young people only, but if we design them to better suit the elderly, maybe they would feel less awkward going there,” the 25-year-old designer tells TWOC, “and then maybe we can all have fun together.”

Tang works at So Young, a Chengdu-based startup trying to revolutionize the care of seniors in China. The roller coaster is part of her new conceptual project: a series of illustrations that express how young people imagine the future of geriatric care, or gerontology. “But maybe we can actually build it,” says Zhou Hang, So Young’s 31-year-old co-founder, “when we have the money.”

Currently, So Young operates a government-built senior home in collaboration with a local medical team in the city of Ya’an, about 130 kilometers west of Chengdu, while also putting out social media content and holding exhibitions on new ideas in elderly care. For the home’s 60 or-so residents, daily life may not include hair-raising (or denture-shaking) amusement park rides yet, but it still seems unorthodox to the general public. Traditionally, senior homes in China conjure up an image of subdued tranquility, where lackluster routines fill up residents’ days as they wait for the next visit from their children.

But a video introducing So Young on media platform Yitiao last November shows youngsters in their 20s, including Tang, dancing, laughing, swapping clothes, and putting on glamorous fashion photo shoots with their silver-haired clients. Zhou explains to TWOC that they only hold these activities once in a while in this otherwise conventional facility. But the video still captured more than 100,000 views, with many young netizens commenting they want to “reserve a spot” for when they retire.

Young folks bringing new ideas to gerontology gives the public hope, especially given the reality of China’s aging society and the field’s desperation for young talent. Many young people like Zhou and Tang enter the profession, willfully or serendipitously, with aspirations to innovate, contribute to society, or find better attitudes toward life. But the field is full of challenges, some even touching on heavy topics—like equality, life and death, and dignity—which sometimes catch the young workers unprepared.

According to a National Health Commission report, by the end of 2021, China’s population of over 65-year-olds surpassed 200 million, meaning that for every 100 working age adults there were 20.8 seniors to take care of. That year, the worldwide ratio was only 15 to 100 on average, according to the World Bank.

The same report mentions there are only about 322,000 registered geriatric care workers in the country, far too few to serve the 8.14 million spots in residential facilities nationwide. Gerontology-related majors have mushroomed, offered in over 200 colleges and universities as of 2021—a sign that preparation for elder care professionals in the country is on the “fast track,” as China Society News, an affiliate of the Ministry of Civil Affairs, interpreted in an article last year. In Beijing and in eastern China’s Zhejiang province, college graduates can receive government subsidies for becoming geriatric caregivers.

Zhou tells TWOC she was “accidentally led down this path” when, in 2016, her best friend (and now the company’s co-founder) Dai Jialin dragged her along to check out senior centers for Dai’s grandfather, who was suffering the aftermath of a stroke. “When the caregivers helped the elders roll over, they handled them like objects,” Zhou remembers the grim scenes. The pair decided to create their own center, one where they could see themselves living in their old age.

But skeptics of this venture are as vocal as proponents. Prior to starting their business, Dai was studying material sciences in Melbourne, and Zhou had just gotten her masters degree in Museum Studies from New York University—neither had a clue about gerontology. “Our activities might not be a 100 percent fit to the elders’ preference,” Zhou admits, as some netizens question whether it’s actually appropriate to make the residents’ lives “so exciting everyday.”

“But they can at least try them,” Zhou counters. If the residents only have access to stereotypical senior fun, like mahjong or routine exercises, she says, then they wouldn’t be able to figure out their own interests, let alone have a voice. At So Young, one woman in her 80s still likes to dribble basketball, another grandma loves showing off new outfits, and a grandpa manipulates his electric wheelchair like a race car.

“Elderly-friendly” has become a popular catchphrase in recent years, with multiple national policies calling for technological, architectural, and service designs suitable for the aging population—for example, enlarged captcha on websites, and handles in public bathrooms stalls. “But if you over-emphasize ‘elderly,’ you might limit them and hurt their self-esteem,” cautions Liu Yi, a former social worker who now runs several rural facilities under her brand Tongyue Elderly Care in Chongqing in southwestern China, and occasionally gives lectures to college students studying elder care.

“Sometimes the media look at senior citizens with sympathy, as a homogenous vulnerable group reliant on care and protection,” says Zhou. “I think it’s a bit condescending.”

Elder care centers have a relatively short history in China. Traditionally, multiple generations of a family lived under the same roof , and children were expected to care for parents in their old age.

During the socialist era in the 1950s, the number of senior homes nationwide grew from 923 to 150,000, mostly in rural areas as basic social welfare safety nets. They most often housed disabled senior citizens or those without a family to care for them. In the late ’90s national policies began to sound the alarm about population aging, and care centers finally turned to a market with more diverse demands.

But even nowadays, many people “look down upon senior homes because their impressions are still coming from old rural senior homes where the environment was sad and services subpar,” explains Liu. “White walls, black roofs, a lifeless scene of twilight years.”

“Some young people even think old folks are just taking up our societal resources,” Zhou adds, “but in fact, we are learning so much from these elders.”

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