Has China Solved Its Elder-Care Crisis?

What's to come?
Nov. 5 2013 10:30 AM

Bank on It

Is this volunteer program the solution to China’s elder-care crisis?

Shanghai, mother and daughter
A mother and daughter walk together on a street in Shanghai on July 1, 2013.

Photo by Peter Parks/AFP/Getty Images

We have become so accustomed to thinking about China as an almost unstoppable economic juggernaut that we have overlooked one of the most basic ways China’s ascent could be arrested: the speed with which it will grow old. In 2012, 10 percent of China’s population was 60 or older; by 2050, the percentage will triple. In absolute numbers, that’s an increase from 128 million to 431 million. Globally, this will make China the country with the largest elderly population by far. Estimates are that by 2040 China will have more dementia patients than exist in the rest of the developed world—this in a country in which the very word in Mandarin for dementia is stigmatized. China needs solutions to its aging problem, and fast.

The majority of China’s elderly are geographically separated from their children. Families have been split apart, as young adults have moved away from their rural homes to urban areas in search of employment. In addition, while China’s one-child policy was designed to stop a particular demographic concern (overpopulation), it turned out to create another, what the Chinese call their “4:2:1” problem. The “4:2:1” refers to the painful reality across China that every one adult child today has two parents and four grandparents to care for, because filial piety remains a widespread and deeply held Confucian value. Traditionally, multiple generations would cohabitate, allowing the young to take care of the old. But the combined pressures created by the urban-rural geographic separation and the 4:2:1 problem make it nearly impossible for them to honor traditional values and family expectations.

Most Chinese expect their government to come up with a solution. After all, of what benefit is the country’s economic growth if it does not provide better health care for all and support for the elderly in particular? The choking smog that wraps its fingers around China’s cities and the contaminated food and water supplies are constant reminders of the sacrifices the average Chinese family has been asked to make at the altar of economic progress. Today, many across China are far from certain the sacrifice is going to be worth the price. This realization has driven China’s central government to make massive investments in its health care system, at the same time it is pursuing innovative ideas to deal with the country’s aging. One such innovation being tested around the country: volunteer banks.

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The idea is simple enough. As an adult worker, you agree to get a basic level of training on senior care from a government agency. In turn, you volunteer in the homes of the elderly as you are able, providing companionship and basic care services such as cleaning, shopping, cooking, counseling, and personal hygiene. The government records the number of hours you work over your lifetime, until you reach retirement age and begin to need care yourself. At that point, you are able to debit against the total number of hours you volunteered for your own care needs.

The concept appears to have been first tested by social entrepreneur Feng Kexiong in Chongqing. Feng had a little red book, but instead of Maoist poetry, his held the number of hours volunteers worked with the elderly. The idea was that the program could grow in size over time until volunteers would be able to debit from their accumulated hours when needed.

For Feng’s idea to scale, the Chinese government had to get involved. The plan required systems to give caregivers background checks, collect and investigate complaints from the elderly, and ensure no one is abused. The bank of hours itself had to go into a database of some kind, and an exchange mechanism put in place that allows for credits to be collected and debits to be deducted. However, when measured against other, much more costly programs—such as building new housing for the elderly or providing caregivers—the cost of administering and maintaining a volunteer bank is small.

Policymakers in China understand all too well that the majority of solutions they will be able to pursue are probably not going to create commercial opportunities. Yes, the pharmaceutical industry will benefit as new drugs are consumed by an increasingly older Chinese population. Equally, the wealthy and upper middle class across China will find they can access a growing set of retirement housing products that will bear striking similarity to options available in the United States and Europe. But the sheer size of China’s aging population, coupled to the fact that most of the country’s elderly are poor and live in rural areas, means it must find solutions that blend private engagement with public oversight.

Would something similar work in the United States? The demographic burdens in both countries are severe, but America is growing old well after it grew rich. The same cannot be said of China. As a consequence, China not only needs innovative solutions to its aging problem—it needs those solutions to be extremely cost-effective. And what’s more cost-effective than volunteers?

America’s accumulated wealth and cultural approach to giving back make a similar approach such as China’s volunteer banks a bit more difficult to pull off. We want to believe that the combined efforts of personal savings and government-led health care and pension programs such as Medicare and Social Security will be adequate to address our needs during retirement. Yet as every passing debt ceiling crisis illustrates, portions of America’s electorate are deeply divided over the sustainability of entitlements. It seems all but inevitable that changes to both programs will come, which in turn will force people to rethink what they need from family and community. Volunteering has deep roots in America, yet the idea that a new program coordinated by the federal government could get through Washington anytime soon seems frustratingly quaint.

That China will get old is a demographic certainty. That it will get rich is not certain at all. The country will get old years before it solves basic questions about its national health care and pension systems. Because of these concerns, China is more willing than the United States to try innovative community-centered ideas such as the volunteer bank simply because the country has no other choice. Yet, if China’s embrace of an idea such Feng’s volunteer bank proves successful, it may touch on a simple truth: Government can be a powerful force in shaping how society responds to crises like aging, even if it does nothing more than organize and oversee a community’s collective efforts. America’s spirit of volunteering is certainly strong and vibrant enough to respond to this challenge. But whether our political system is capable of similar innovative thinking seems uncertain.

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