For about 2,700 yuan ($398) a month, Zheng Qiuping washes clothes, feeds the aged who can no longer eat on their own and takes night shifts at a rural home for the elderly in central China.

Most of the caregivers there are themselves in their 50s or 60s. Zheng’s work points to a broader challenge as China’s population ages: providing care in rural areas, where caregivers can be hard to recruit and the dispersed population makes home-based services more costly to deliver.

By the end of 2025, China had 320 million people aged 60 or above, accounting for 23 per cent of the population. In recent years, the country has expanded its rural eldercare network. As of June 2024, there were about 16,000 rural homes for the elderly with 1.68 million beds, along with roughly 145,000 mutual-aid eldercare facilities.

The physical network is taking shape, yet the harder task is keeping it staffed, financially sustainable and in regular use. In Xinjin District of Chengdu, southwest China’s Sichuan Province, 67-year-old Chen Qi has lived at the Huaqiao central home for the elderly for six years.

“Necessities of life are all taken care of, so I don’t have much to worry about,” Chen said. “I like drinking tea and playing chess with friends.”

Over the past three years, Xinjin has allocated 66.94 million yuan in public funding for eldercare services, developing a three-tier network across the district, township and village levels. One district-level facility mainly serves elderly people in extreme difficulty and those with disabilities. At the township and sub-district level, five eldercare service centres provide professional care and home visits, while 83 village and community sites offer day care, home visits, information and referrals.

The network now reaches more than 10,000 elderly residents, according to local authorities. Yet building facilities is only part of the equation. In neighbouring Chongqing Municipality, a private eldercare company has taken over the operation of 11 publicly built homes in Banan District since 2023. It has invested nearly 20 million yuan in renovations and can serve 1,125 people.

Managing several facilities together helps lower fixed costs for procurement, staffing and operations. The homes also admit fee-paying residents alongside those covered by government safety-net programs, while offering additional services such as home bathing assistance and rehabilitation. The 11 facilities are now roughly breaking even. Banan has begun extending the public-built, privately operated model to all 25 of its government-run eldercare homes, said Zhu Zongbo, deputy head of the district civil affairs bureau.

These experiments reflect a broader search for a sustainable way to run rural eldercare facilities. Keeping operating costs manageable is one part of that effort. Local operators said spending on accessibility upgrades, fire safety, food safety and healthcare has increased in recent years, adding to the cost of running eldercare facilities. A more persistent issue is finding and retaining enough caregivers.

Care work is physically taxing and often poorly paid. Interviews in several regions found that many rural caregivers were in their 50s and 60s. For Zheng, the pay remains a concern.

“I hope the pay can go up in the future,” she said.

Training is becoming increasingly important as care needs grow more specialised. Many caregivers can handle basic tasks such as cleaning, meal delivery and assistance with daily activities, but lack the skills needed for more specialized care, from tailored nursing for elderly people with underlying conditions to psychological support and dementia care.

Some local governments are trying to improve pay, training and career prospects for caregivers. In Wanning, south China’s Hainan Province, a publicly built but privately operated eldercare home in Damao Township has more than 120 residents and 31 staff members, including over 20 professional care-givers.

Local caregivers generally undergo training at least once every two years, combining classroom instruction with simulations and hands-on practice. Monthly pay typically ranges from 3,000 to 6,000 yuan, rising above 6,000 yuan for those with medical nursing skills or higher vocational qualifications.

The city also uses government-purchased services and operating subsidies to help institutions improve caregivers’ pay, while encouraging career advancement, skills competitions and vocational skill assessments.

Even where facilities are in place, how effectively those facilities are used also matters. At some rural eldercare sites, space is shared with village public-service centres, an arrangement intended to make better use of existing facilities and save construction costs. In one district in a central Chinese city, such shared sites accounted for about 80 percent of the total.

Local civil affairs officials said administrative work often takes priority, while many of the eldercare sites have no full-time staff. As a result, some offer only limited eldercare services despite having space set aside for that purpose. The challenge extends beyond the facilities themselves. Providing home-based care can be more costly in rural areas, where older residents are more widely dispersed and transportation is less convenient.

Since January 1, older people across China who are assessed as moderately, severely or fully unable to care for themselves have been eligible for monthly electronic vouchers worth up to 800 yuan to help pay for care services.

Issued for 12 months under a nationwide program launched by the Ministry of Civil Affairs and the Ministry of Finance, the vouchers can be used to offset part of the cost of home-based, community-based and institutional care, including meal and bathing assistance, housekeeping, mobility support, rehabilitation nursing and daytime care.

Local officials say further refinement could help the programme work better in rural areas, where home-based services are more costly to deliver, and out-of-pocket payments may affect voucher use. For China’s rural eldercare system, expanding the service network has laid an important foundation.

The next task is to make that network work better by keeping facilities running, attracting and retaining qualified caregivers, and delivering services efficiently across widely dispersed communities as care needs continue to grow.

• A Tell Media / Xinhua report

Senior citizens and staff members make Zongzi together at an elderly care centre in Boxing County of Binzhou City, east China’s Shandong Province, and June 20, 2026.