The Chinese tradition of living together with their children in the older persons’ later years is challenged by some factors, including the reform of economic system, the way of supporting the elderly, especially the adoption of family planning system. The decline of fertility from five to six children per woman in the past to the currently one to two children, brings heavier burden to the children who will support their parents in the future. According to statistics, 70% of the elderly population live with their families in 1990, but now in some cities, 40% to 50% of families are empty nest families, and this percentage even reaches 70% in some cities.

According to the basic situation of China, it is impossible for the government, or institutions to solve ageing problem individually. The government, the society, individuals, and families should work together, to develop homecare service.
International and domestic practices have told us that running the business by the government proves to be a failure because of the high cost and low efficiency. And limited resources can not be used to those in need. In big cities like Beijing and Shanghai, a bed in an institution costs 300 thousand Yuan, with an extra 20 to 30 thousand Yuan per year, and further more, there is rarely any land for institutions.
Instead, the government encourages ageing in place, which means that the government pays a subsidy of 2 to 3 thousand Yuan for each elderly person each year. It lowers the cost, is more efficient and saves resources.

Ageing in place means living together with family, neighbors and relations. Older persons can enjoy home care services in a familiar environment, which to the largest extent can meet their psychological needs. According to the survey and prediction, 85% of the elderly wish to stay at home, most of whom are healthy and can take care of themselves. Only 6-8% of them prefer to stay in institutions, most of whom are old old persons or are in need of care and assistance.

From 2006, China National Commission on Ageing started to encourage local authorities to conduct home care services programs nationwide after 6-year’s pilot programs proved to be a success in eastern China’s developed areas.

Major home care services provided

Service type Service providers Service detail

1. The guidance of the government. Local authorities have included ageing in place into their plan of socio-economic plan. And the main measures are:

a. Making plans. Ageing in place is a complicated project, so governments at all levels make long-term plans, set pilot programs, then implement the plans, and at last establish regulations about it. It takes time and efforts, so governments at all levels should make mid-term or long-term plans on it, and include it in to their socio-economic plans.

b. Support from government. Home care service is a new industry in China, and most service providers are societies or small enterprises, so the government should provide them with preferential tax policies, financial support and other supportive means. In the meantime, the government also pays the bills for low-income older persons.

c. Resource integration. The government takes administrative measures to integrate resources in the community, to avoid the waste of resources.

d. Supervision and inspection. In order to guarantee the quality of the service, the government supervises and inspects the service market, service quality and the products, especially those paid by the government.

2. The involvement of society. Government’s efforts and guidance are the main power for developing home care services, but the government can not complete it without the involvement of social forces.

a. Encouraging the involvement of enterprises. The introduction of market mechanism can soundly allocate resources of home care services, so that the industry could develop in a sustainable and healthy way with low cost.

b. Making full use of NGOs. NGOs are very important in helping the government and market in many aspects. The Chinese government attaches much importance in making full use of NGOs, we buy services from them, we provide them with working places, and we reduce or exempt their taxes.

c. Making full use of volunteers. Ageing in place needs volunteers, who could be young older persons and neighbors, and this is very important.

d. The role of family. Despite the role of government and society, the role of family is also indispensable and even more important, especially in living service and spiritual comfort.

3. Professionalism. Which means:

a. Home care service includes not only housekeeping services, but also some professional services, for example, medical service, health care service, and legal service. In order to guarantee the quality of the services, the service providers are strictly chosen.

b. The service personnel, including volunteers, must be trained in professional knowledge and skills. Trained personnel will have a certificate if they pass the exam. And at the same time, the service providers also recruit graduates from universities who major in rehabilitation, health care, nursing, nutrition, psychology and so on. Community volunteers are also required to be trained in nursing and health care for the elderly. It has not been long since China started the ageing in place program. There are experience and also problems. The main problems are:

a. some local governments do not put enough investment into the project and take enough efforts to develop it;

b. some relevant NGOs are not capable enough to run the business;

c. there is not enough resources of home care services and efficient integration of resources in communities;

d. The service providers are not well-qualified and well-paid, which is not good for the professionalization of home care services.