China and its elderly care system

As is well known by now, China is a rapidly ageing society, and the proportion of its population aged over 65 will double between 2010 and 2030.[1]

By 2050, this cohort of the population will amount to one quarter of the total. Peter Bootsma of the Embassy of the Kingdom of the Netherlands explains how, in view of these developments, the Chinese Government has been rapidly developing policies and projects for an elderly care system that can address the needs of the population.

Until recently, China had no elderly care system to speak of and no long-term care insurance. Three ministries in particular—the National Development and Reform Commission, the Ministry for Civil Affairs and the National Health Commission—have now been made responsible for developing and implementing elderly care policy and projects. These ministries have been studying and analysing elderly care systems in countries such as Japan, the Netherlands, Russia, and Canada.

As a result, the elderly care system in China is now developing rapidly. However, given the size of the challenge at hand and the lack of available resources, there’s great demand for international assistance, both from the Chinese government side and from private companies looking to build up its cooperation. Let me list below of a few of the most obvious opportunities for investment.

Education of elderly care nurses and nursing assistants

In general, existing education programmes for nurses are aimed at helping them gain employment in hospitals and clinics rather than elderly care homes. Dealing with the increasing numbers of sick seniors requires specific nursing skills and knowledge – which requires specialised education. Therefore, there’s a growing need for training programmes for specialised elderly care staff, such as nursing assistants and care workers.

(Franchised) nursing homes

Most elderly care facilities have been developed for the high-end market. On average, such facilities are doing well capacity-wise, sometimes resulting in waiting lists for those with excellent reputations. The Chinese Government has made clear that it welcomes international corporations to develop nursing homes, also through franchise arrangements. Some international corporations are already active in the Chinese market, although no brand has taken the lead (yet). In addition, consulting services for nursing home operations are in demand. Worth noting though in general is that Chinese clients prefer service providers to participate (financially) in their operations in order to facilitate longer term cooperation.


As is obvious from the listing above, there is a great demand for new facilities to be built, and consequently there’s also a need for architectural services. Firms specialising in the design of elderly care homes and, in particular, facilities for the elderly suffering from dementia, will find a willing market for their services. In addition to new facilities being built, private companies and regional authorities are also aiming to redesign and reconstruct existing facilities.

Home care services

The Chinese Government elderly care policy is governed by a 90/7/3 formula, meaning it aims for 90 per cent of seniors to remain at home, 7 per cent to stay at intermediate facilities and 3 per cent at nursing homes. Bearing in mind the Chinese tradition for people to stay at home as long as possible, there is substantial potential for providing home care services in various forms. Those services could be on a one-on-one basis, but also for instance through neighbourhood day-care centres, where the elderly can stay during the daytime and return to their home or that of their children at night. For children, this might be a way of fulfilling their ‘filial piety’ by allowing them to bring their parent(s) to and from the centres.


One area where there is major demand is rehabilitation services. This is a generic name for services which might range from physiotherapy to very specialised treatment of paralysis.

Assistive devices, IT products and innovative technology

As there is a shortage of nursing staff and care workers to provide elderly care services, the involvement of devices, e-health and innovative technology may help fill the gap. As such, the interest in such technology is also increasing.

Existing government elderly care projects

The Chinese Government, through the National Development and Reform Commission (NDRC), is implementing a project aimed at establishing and, where already existing, improving elderly care services. This project is called the City-Enterprise Joint (Public Private Partnership) Elderly Care Special Action(城企联动普惠养老专项行动) and is implemented in many cities across China. The NDRC has indicated that it would welcome participation by international corporations in this project.


China is rapidly developing its elderly care services. Due to demographic developments and the government opening more areas to the private sector, including international enterprises, there is great potential for cooperation and assistance by foreign firms. However, as China is quickly learning, adapting and developing, the window of opportunity might only be open for the coming three to five years. Some fields of services in China have already surpassed those in many other countries. One of the reasons being that there are few legacy systems in China to feel threatened with being made redundant by the new applications, and moving to hinder the implementation of new models, services and systems in order to maintain the status quo.

Peter Bootsma is counselor for Health, Welfare and Sports at the Embassy of the Kingdom of the Netherlands in Beijing. He’s been active in the field of healthcare for many years, holding director-level positions at the Dutch Ministry of Health, Welfare and Sports and exploring areas for cooperation for the Dutch healthcare industry abroad in the United States and China. Connect with him at

[1] Glinskaya, Elena, and Feng, Zhanlian, Options for Aged Care in China, World Bank, 2018, viewed 12th September 2019, <>