Covering 180 million people, how does long-term care insurance solve the problem of -one person becomes disabled and the whole family becomes unbalanced-

October marks the 15th National Senior Citizens Month in China. As of the end of last year, there were approximately 297 million seniors aged 60 and above in the country, with around 45 million experiencing disabilities or dementia.

To alleviate the burden on families caring for disabled elderly individuals, China has launched long-term care insurance pilot programs since 2016, currently implemented in 49 cities. Over 2.35 million individuals have benefited, with total fund expenditures exceeding 72 billion yuan.

The long-term care insurance has covered 180 million people nationwide, with more than 2.35 million receiving benefits. Who qualifies for this insurance, and what services does it provide for seniors? Let’s take a closer look at pilot areas such as Beijing, Sichuan, and Jiangxi.

Referred to as the “sixth social insurance,” long-term care insurance is designed to provide care services or financial support for disabled individuals. In Beijing’s Shijingshan District, participants who experience severe disabilities due to old age, illness, or disability for over six months can apply for long-term care insurance. For instance, 90-year-old Huo Shuying, who suffers from a brain infarction, coronary heart disease, and Alzheimer’s, has been bedridden for the past three years.

Zhao Zhilin, an evaluator of disability levels in Shijingshan District, stated, “After our assessment, the elderly individual qualifies for the severe disability status under long-term care insurance.”

Elderly individuals like Huo, who are severely disabled and remain at home, can access 12 hours of professional home care services monthly in addition to a monthly care subsidy of 1,044 yuan.

In Chengdu, one of the first cities to pilot long-term care insurance, funding comes from employer contributions, personal payments, and government subsidies. Urban workers make transfers from their health insurance premiums without any additional costs, while rural residents pay a personal fee of 25 yuan annually, with the government providing a 30 yuan subsidy.

Currently, over 18 million people are enrolled in Chengdu’s long-term care insurance. Wang Wei, a resident of Wenjiang District, received a severe disability rating after a brain infarction left him bedridden. He gets a monthly subsidy of 542 yuan and two visits from caregivers.

To enhance service efficiency and quality, Shangrao City in Jiangxi has established a smart regulatory platform, enabling nursing institutions to create care plans in advance and schedule home visits.

According to statistics from the National Healthcare Security Administration, by 2023, 180 million people participated in long-term care insurance across 49 pilot cities, with 1.34 million enjoying benefits and fund expenditures totaling 11.856 billion yuan, significantly reducing the caregiving pressure and economic burden on families with disabled elderly members.

Warm Support for Disabled Seniors – The Role of Caregivers

Statistics indicate that about 40% of seniors over 80 are disabled or semi-disabled, requiring varying degrees of medical care and long-term support. For them, caregivers are a crucial source of comfort.

At 1:30 PM, caregiver Han Zaijie arrives at a residential community in Beijing’s Shijingshan, equipped with professional nursing tools to serve 85-year-old Zhang Huifeng, who has been bedridden for three years due to a brain infarction and fractures. Han will provide bathing and rehabilitation massage services during this visit.

Zhang’s husband, Wang Yuezong, who is also 85, had to take on the role of caregiver since their son passed away a decade ago and their daughter-in-law is unable to help due to illness. Fortunately, Zhang was able to apply for long-term care insurance in April this year, and a nursing agency hired Han for weekly three-hour visits.

52-year-old Han, who hails from a rural area in Northeast China, has worked as a caregiver in Beijing for four years. She emphasizes that caring for bedbound seniors involves not just basic hygiene but also back tapping and massage for rehabilitation.

As the expansion of long-term care insurance is imminent, a notable gap in caregivers remains. Research shows that roughly 45 million seniors in China are disabled or have dementia, yet only about 500,000 licensed caregivers are available. Based on a national standard ratio of one caregiver for every four seniors, there is a potential demand for over 10 million caregivers.

In recent years, various regions have implemented measures to grow the caregiver workforce. Early this year, the Ministry of Civil Affairs, the National Health Commission, and ten other departments released guidelines to strengthen the caregiving talent pool, aiming to expand recruitment channels and improve caregiver qualifications.

To attract talent to the caregiving sector, Baoding City in Sichuan has begun offering free “order-based” vocational training for caregivers based on employment needs. In Shangrao, nearly 60,000 disabled individuals receive long-term care insurance benefits, with about 80% living in rural towns. To address the shortage of caregivers, the city has set up care service points in the countryside, offering concentrated training to engage willing local residents and younger seniors in caregiving roles.

Cao Hong, head of Shangrao’s Long-Term Care Insurance Office, stated, “This not only resolves the labor costs for institutions but also meets the care needs of more disabled individuals, simultaneously providing jobs for 5,624 rural workers and creating 1,065 caregiving positions.”

To increase the attractiveness of caregiving careers, local governments have started implementing policies for entry subsidies, professional title evaluations, and other incentives. Recently, Ningxia announced a 2024 professional title evaluation that includes a new long-term care specialization, and Jiangsu has allowed caregivers to vie for senior professional titles.

In Shanghai, caregivers with a secondary vocational or higher education receive a one-time subsidy of 30,000 yuan or 40,000 yuan respectively, while Hangzhou offers monthly allowances ranging from 300 to 1,200 yuan based on skill level.

With the expansion of long-term care insurance on the horizon, there are still gaps to address. Since launching its pilot program in 2016, the long-term care insurance system has evolved over eight years, and with the aging population increasingly pressing, expanding coverage has become urgent. The recent Third Plenary Session of the 20th National Congress called for accelerating the establishment of a long-term care insurance system, while this year’s Government Work Report reiterated its commitment, removing the term “pilot.”

Since the beginning of this year, the National Healthcare Security Administration has rolled out numerous regulations to strengthen the grading and evaluation of disability levels and operational procedures, laying the groundwork for nationwide implementation. However, challenges remain as experts highlight the need to build a third-party disability assessment system for precise determination of benefits eligibility.

Liu Yuanli, a counselor to the State Council and a professor at Peking Union Medical College, commented, “The assessment system should evaluate the level of disability and family ability to pay—higher disability levels warrant greater coverage, while lower household income should receive higher support.”

Despite nearly 90% of seniors preferring to age at home, there is still a pressing need to increase the number and service quality of community elder care service institutions.