BEIJING, April 3 (Xinhua) -- In China, eldercare, which has long been a family responsibility, is shifting to a more structured network of support that involves both the state and society at large, thanks to the expansion of long-term care insurance.
This marks a further improvement of the social security network as the country strives to cope with an aging population, and ease the burden on smaller households shouldering the responsibility of eldercare, particularly those looking after seniors who have limited or no ability to care for themselves.
The Chinese government has been expanding long-term care insurance, a scheme that helps cover the cost of daily care and related medical needs for people with functional impairments due to age, illness, or disability.
In late March, authorities issued relevant guidelines outlining plans to expand the scheme nationwide by 2028, with funding to come from a combination of employers, individuals, government and social resources.
For families of the 45 million seniors affected by physical or cognitive impairments in China, the move is significant.
The initiative builds on a decade of trials. China started piloting the long-term care insurance scheme in 2016, integrating insurance, welfare and social assistance to better support people who can no longer care for themselves.
The pilot programs, enrolling around 300 million participants, have benefited 3.3 million individuals with functional impairments, with cumulative fund spending exceeding 100 billion yuan (about 14.51 billion U.S. dollars).
The trial came as a much-needed relief to the family of Liao Houzhang, an elderly man from China's southernmost province of Hainan. He was left bedridden and unable to speak after a stroke in 2020.
After joining the local pilot program in 2024 and being assessed as severely functionally impaired, Liao began receiving 20 hours of basic care services each month, with almost no out-of-pocket costs after reimbursement.
Regular visits from professional caregivers eased the strain on his wife, who had long struggled with both the physical demands of care and the uncertainty of how best to look after him.
A SECURITY CUSHION
While long-term care insurance is well established in countries such as Japan and Germany, China faces the unique challenge of extending coverage across a vast population with uneven levels of economic and social development.
China has the world's largest elderly population. By the end of 2025, more than 320 million people were aged 60 or above, accounting for 23 percent of the total population. As a result, eldercare has become an increasingly pressing national issue.
One of the most pressing challenges is caring for seniors with functional impairments, a group expected to grow to 77 million by 2030.
According to the guidelines, the insurance scheme initially targets those affected by severe functional impairments, with plans to broaden coverage as the economy grows and the system matures.
Measures have also been introduced to promote equity. Guo Yang, a senior social security department official with the Ministry of Finance, highlighted government subsidies for rural and non-working urban enrollees.
Targeted fiscal support for disadvantaged groups -- including those facing special hardships and recipients of minimum subsistence allowances -- will be provided to facilitate their participation, Guo said.
RAISING STANDARDS
The guidelines clarify that long-term care insurance funds are primarily used to cover basic services delivered by qualified institutions and caregivers.
In its 15th Five-Year Plan (2026-2030), issued in early March, China calls for integrating medical and eldercare services, establishing and refining a unified system for assessing seniors' functional abilities, and building a more skilled eldercare workforce.
In a town in southwest China's Sichuan Province -- one of the earliest long-term care insurance pilot sites -- a local health center has adopted an integrated care model that combines inpatient treatment, rehabilitation, daily assistance and hospice support for people who rely on such care. Among its beneficiaries is an octogenarian surnamed Lu, who receives both daily care and medical support, including monitoring of vital signs and rehabilitation guidance.
Nationwide, the number of designated long-term care providers has grown tenfold since the pilot began, reaching around 12,000 and significantly boosting capacity, according to the National Healthcare Security Administration (NHSA). As the scheme expands, a growing pool of professional assessors and caregivers is emerging.
In central China's Henan Province, assessor Zhang Yali recommended cognitive exercises and improved nutrition for a bedridden senior after evaluating her mobility. "Professional assessment helps seniors access better care," Zhang explained.
Meanwhile, Sun Yan, a woman in her 40s, has attended a training course for long-term care workers in east China's Shandong Province.
"I already hold a junior caregiving certificate," she said. "Through this training, I hope to upgrade my skills and care for seniors with severe functional impairments."
Today, China has more than 10,000 certified long-term care workers. The national service catalog lists 36 items, ranging from feeding, bathing and toilet assistance to health checkups and rehabilitation.
Yet challenges remain. A shortage of skilled caregivers continues to constrain the system. "Stronger policy incentives are needed to encourage insurers and care providers to invest in training, alongside improved subsidies and clear career paths for long-term care workers," said Jin Li, a finance professor at the Southern University of Science and Technology.
BEYOND PUBLIC WELFARE
Long-term care insurance has spurred new industries and business models, including the production and rental of assistive devices and functional ability assessment services, said Wang Wenjun, deputy head of the NHSA.
During the ten-year pilot phase, the scheme attracted over 60 billion yuan in social capital investment into related industries.
In Fuzhou City in east China's Fujian Province, the program has helped cultivate an eldercare industry chain worth more than 600 million yuan, creating over 1,000 jobs. In Hainan, more than 3,000 positions in care, assessment and management have been generated, along with 453 new service providers.
Li Qianqian, operations director at an elderly care service company based in east China's Zhejiang Province, said the pilot programs enabled her company to build a nationwide team of over 20,000 professionals delivering more than 20 million service visits annually.
As demographics shift, technology -- from smart care robots to home-based monitoring devices -- is playing an increasingly important role in expanding access and improving efficiency. The March guidelines signal that authorities are exploring the inclusion of smart care services and assistive devices under long-term care insurance.
NHSA data show that the pilot phase alone saw more than 100 billion yuan spent on care services. With the nationwide rollout, billions more are expected to flow into the market annually, providing greater certainty and encouraging continued investment.
"The long-term care insurance system protects the dignity of people with functional impairments, eases family burdens, and fuels economic development," Wang said. ■
