BEIJING - On Feb. 3 while in Beijing, Yan Zi received a call from her 65-year-old mother saying she’d been in the hospital for two days with high blood pressure.

This wasn’t the first time Yan Zi had received a belated call like this from her mother, who lives alone in Xilinhot City, in the Chinese autonomous region of Inner Mongolia. A few weeks earlier she had slipped and fallen, leaving her bedridden for days. Yan Zi didn’t know about it until relatives called her three days after the accident. “Even if I had called you, there’d be nothing you could do,” her mother said.

Those words made Yan Zi sad for several days, but it was true. It takes six to seven hours to drive from Beijing to Xilinhot. The evening after they were informed of their mother’s fall, Yan Zi and her sister went to Xilinhot. But because of work, they only stayed for one day before having to return to Beijing.

Yan Zi hired a carer to look after her mother and also promised she and her sister would bring their families to visit during Spring Festival. However, her mother thinks it might be best to move back to Beijing with her daughters.

With the increasing mobility of China’s workers and the overall aging of the population, situations like Yan Zi’s are becoming common.

Staying Behind

A survey of eight cities showed that from 2000 to 2010, the proportion of elderly living in an “empty nest” (a home where an elderly person lives alone or with another elderly person) in urban areas went from 42 to 54%. The proportion of their rural counterparts living in empty nests went from 37.9 to 45.6%.

Yan Qingchun, deputy director of the China National Committee on Ageing, says that in developed countries like the UK and the U.S. more than 80% of elderly people live in an empty nest. So the proportion in China will certainly continue to increase. He says that this is bringing pressure to families and also spurring the development of retirement homes that can offer long-term professional care.

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In Songpan, Sichuan - Photo: memn

Yan is concerned that the issue of caring for elderly people who’ve lost the ability to look after themselves has been neglected for too long. According to one estimate, the proportion of elderly in urban and rural areas who have lost the ability to care for themselves was 6.4% in 2010 – representing about 10.8 million people. It is expected that this number will reach 12.4 million by 2015.

This situation often leads to tragedy. In 2005, Wang Rulin, a former government vice minister, was found dead in the bathroom at her home. Police said she had been dead for several days, and had had an accident that caused excessive bleeding.

Tragedies like this can be even worse when elderly people are looking after their grandchildren, whose parents have gone to work in the city.

Xiao Kaiquan from Loudi City in the south-central Hunan Province was working in the provincial capital of Changsha in 2011. In September of that year, he quickly returned home after nobody answered his calls for several days. When he arrived, he was confronted with his worst nightmare. His 20-month-old daughter was lying unconscious in the arms of her grandmother’s decaying corpse. The grandmother had died one week earlier and the child barely survived.

Elderly people living in urban empty nests can have it just as bad. Since Yan Zi’s mother has long suffered from heart disease, high blood pressure and diabetes, she needs to inject herself with insulin every day. She has managed by herself for the past few years, but her recent fall and hospitalization have made her reevaluate the risks of living alone.

Full House or Empty Nest?

As early as 1999, China started to become an aging society. In that year, the population of people aged 60 and above accounted for 10% of the total population. By the end of 2011, it had reached 13.7%.

The generation born in the 1980s after the introduction of the one-child policy is now getting married and having children, while their parents grow old. The problem of how these aging parents will live out their retirement with only one child to support them is becoming a major concern.

Lin Qiang, born in 1982, is originally from Hunan Province and began working in the south Guangdong province after graduating from university. Lin lives with his wife, his three-year-old son and his wife’s parents in a two-bedroom apartment.

His own parents are also close to 60-years-old, retired and living alone back in Hunan. Lin says that he’s struggling to manage all his responsibilities. Should the limited resources be focused on his own son or on both sets of parents? Ignoring the parents would bring major shame, given the country’s filial tradition. But in China, simply sending parents off to a retirement home can also be considered morally questionable.

Yan says the utilization rate of retirement homes in rural areas is currently only 78%, leaving 475,000 empty beds. Furthermore, only about 11,000 out of the 30,000 rural retirement homes are officially registered and legal.

On the other hand, Yan explains, elderly people are becoming less willing to live with their children unless they’re needed to look after grandchildren. Yan Zi, for instance, has a sister who can share the pressure of caring for their mother. But after living with them in Beijing for six months, the mother went back to Xilinhot because she couldn’t adapt to the loneliness and boredom of city life.

“After her fall, she wanted to come live in Beijing again,” Yan Zi says. “But she’s not willing to live with us, so we would have to rent or buy another apartment for her.”

However, that would significantly increase their financial burden. Even if they live close to their mother in Beijing, they’d still need to hire a carer to look after her. Yan Zi worries that it won’t be easy to find someone who can do housework and has medical knowledge.

Currently there are only about 300,000 caregivers for elderly people across the country – of which less than 100,000 have professional qualifications. But the market demand for caregivers is more than 10 million. “The government needs to take responsibility for reducing the burden on children providing for the elderly,” Yan says. “But it should also allow private capital to enter the industry.”

What worries him more is that the total population of migrant workers working in urban areas was 250 million in 2011 – of which over 90% were employed temporarily. The restrictions of the hukou household registrationsystem, the lack of employment standardization in companies and unstable work relations have caused a large number of migrant workers to hover between urban and rural systems. Less than one-sixth of the total migrant population has joined the basic pension insurance scheme. So where will their pensions come from in the future?

Cementing Parental Care into Law

To address both the issue of elderly people staying behind in rural areas and living alone in urban “empty nests,” some experts have suggested passing a law requiring their children to visit them at home frequently.

In June 2012, the The Law of Protection of the Rights and Interests of the Elderly was proposed to the Standing Committee of the National People's Congress for the first time. The provision that drew the most attention said: “Family members should care for the spiritual needs of the elderly and must not ignore or neglect them. The supporters who live separately from the elderly should frequently visit or send a greeting.”

In December 2012, the law was passed. It takes effect on July 1, 2013.

According to Yan, visiting the elderly has been cemented into the law in the hopes of re-establishing traditional virtues for society. Under the protection of law, honoring and providing for elderly people can become a social and moral norm. The law can also lead to other social changes, says Yan.

For instance, businesses may need to make changes like extending paid leave for workers to visit their parents in order to accommodate the new law.

Dang Junwu, vice director of China Research Center on Aging, says that 33 million elderly people across the country need help caring for themselves, which affects one-fourth to one-third of China’s families. “Dementia and losing the ability for self-care are the most difficult problems associated with the aging population,” Dang says.

Yan says that the government must continually improve the social pension system while also supporting policies to improve the development of the retirement industry.

He believes the concept of “home-based care for the aged” will be promoted in China in the future. Developed countries have formulated several measures to support home care for the elderly involving tax breaks, subsidies and flexible employment policies. In the future, it’s expected that over 95% of China’s elderly will want to live out their retirement at home, but policy in this area is almost non-existent at present.

This article was translated by Zhu Na