Elderly Care in Ancient China: the Honor of Being Old

In the post-Covid era with the worst of the pandemic behind us, we all witnessed the vulnerability of the elderly among us, and in today’s podcast we’ll explore how authorities in ancient China addressed the challenges of elderly care and consider its relevance to contemporary society.

China has introduced a national standard for in-home care services aimed at the elderly population, marking a significant step towards enhancing the nation’s elderly care infrastructure and elevating the overall quality of life for its growing proportion of senior citizens.

As of the end of 2022, China’s elderly demographic, defined as those aged 60 and above, had surged to an astounding 280 million. The overwhelming preference among senior citizens for in-home care has spurred a substantial rise in the demand for elderly care services delivered in the comfort of their own residences.

Unveiled during a press conference hosted by the Ministry of Civil Affairs on October 20, the national standard draws from localized experiences and noteworthy accomplishments in the field of eldercare. It serves to clarify the fundamental prerequisites that service providers must meet and the core criteria that underpin these services.

This comprehensive standard delineates seven distinct at-home care services tailored for the elderly, encompassing fundamental care, health management, emotional support, and home environment enhancements aimed at facilitating seniors’ comfort and convenience, among other vital provisions.

Furthermore, the document outlines the essential protocols for furnishing in-home elderly care services while establishing stringent prerequisites for assessment and feedback mechanisms.

The introduction of this national standard is poised to deliver a twofold impact: first, it will garner greater trust and acceptance from the elderly population for in-home care services, thereby bolstering their confidence and inclination to engage these services. While at the same time, it will fortify the regulation and oversight of these services, as underscored by Zhen Bingliang, a senior official from the Ministry.

In the Chinese context, “having a support system in one’s old age” is a never-ending dream for the public. It means having a source of support or care in one’s later years, usually in the form of family members or some form of social safety net.

So, it won’t surprise you to learn that by the end of China’s last imperial dynasty, the Qing, an institutionalized system of respecting and taking care of the elderly had been operating in the country for more than 2,000 years . The State and society promoted the idea of respecting and looking after seniors. Elderly people enjoyed favorable treatment in tax and legal obligations. Penalties were imposed for misconduct if senior family members were not taken care of properly. There were publicly or privately funded nursing homes. Even the mental health of seniors was accounted for. Any modern-day system used to care for the elderly can also be found in ancient China.  

For example, during the Han Dynasty from the 3rd century BCE, emperors granted crutches to their subjects above 70 years old. A turtle dove perches at the top of the crutch. Ancient people believed that this bird would never choke on its food. Eight such crutches were excavated from Han graves in northwestern China’s Gansu Province in the late 1950s and early 1980s. Decrees about special treatment for the elderly above 70 were inscribed on the wooden slips that came with the crutches. One of the rules was that criminals above 70 could be immune from prosecution as long as they were not the main perpetrator. 

The question was how old was regarded as old enough to be entitled to State-guaranteed elderly care measures. There were different standards. According to Confucianism, 50 was the threshold of old age. 

But this was too young for imperial dynasties. Everyone under 60 had to pay taxes and serve as conscripted labor. It meant that only those above 60 could be regarded as elderly. And the State’s favorable policies were only accessible to those above 70, or even 80 and 90.

The average life expectancy of ancient Chinese was only 30 to 40 years old, but these figures are somewhat skewed due to high infant mortality rates. This means that the average life expectancy of those who survived infancy and grew up could be higher than the overall average of the whole population. But still the average life expectancy of ancient people is much lower than today. As an ancient Chinese saying goes, few people ever lived to 70 years old. 

But oh my, how things do change, because in 2018, the average life expectancy of Chinese was 70. The retirement age in China is 50 to 60. A person is entitled to a pension 10 to 15 years before reaching 70. But in ancient China, a man may have to work another 20 years after the average life expectancy. Even if he finally was done with his tax and conscripted labor obligations by the age of 60, he had to wait at least another 10 years to enjoy the favorable treatment the State provided for the elderly.

All this shows that State-sponsored benefits for the elderly in ancient China was not a universal national welfare program for everyone as it is today. It was more like an “honor” that the imperial governments granted to the few very individuals that reached old age. It made more sense politically for rulers in terms of helping the elderly. 

The lack of State support was the basis of the traditional idea of relying on sons for care in old age, which meant a big family was supposed to be the best choice in ancient China. A big family also fits into the picture people today have about life in ancient times. However, the consensus among researchers is that a typical family consisted of about five members since the Warring States period between the 5th and 3rd centuries – not nearly as big as people think.

The reason lies in the State policies of taxation, which could be in the form of grain, money, or conscripted labor. From the first imperial dynasty, the Qin in the 3rd century, until the late 17th century, taxes were based on households and the number of adult men under 60 years old. In addition, households were subject to different levels of taxation according to their assets. This gave the public incentives to divide their big families into smaller ones to reduce their tax burden. This created more households. Local governments had no incentive to stop this because more households created more sources of tax revenue. 

According to research by Professor Zheng Zhenman（郑振满） of Peking University, at least since the Tang Dynasty in the 7th century, the law banned families from dividing into more households while their parents or grandparents were alive or for a few years after they died. But he found that in Fujian Province in the southeast of the country, it was common that fathers, sons, and brothers began to live separately at least as early as during the Song Dynasty in the 10th century to reduce the number of people being conscripted for labor. Local governments turned a blind eye to this practice. 

In the Western Han Dynasty starting from the 3rd century BCE, filial piety was adopted as one of the standards of recommendation for candidates who wanted to be an official. But a poem by an unknown author at that time says that some nominees let their fathers live alone. This shows that while people at that time believed a dutiful son should not do this, it still did happen. 

All this shows that imperial rulers were implementing a tax policy that ran counter to the values they themselves advocated. They believed that loyal officials must all come from families upholding filial piety. The emperors themselves often liked to set a good example. Li Zhi （李治）, a Tang crown prince in the 7th century, built a Buddhist temple in the imperial capital, today’s Xi’an in Shaanxi Province, to commemorate his late mother. He named the temple Ci’en (慈恩）, which means “a loving mother’s grace.” A pagoda and other buildings were built after he assumed the throne. The temple compound was destroyed later and rebuilt in the 15th century during the Ming Dynasty. Today, it is a must-see place to visit for tourists in that area. 

Despite all this, the taxation system was destroying families. We cannot assert here that dividing up a family means the family left its elderly members completely unattended, but it is reasonable to say that this practice weakened family relationships and care for the elderly. The result could be serious sometimes. Zhou Lang （周朗）, an official in the 5th century, was worried about the distance within families due to their division. He described a situation in which family members were uninformed about or ignored dangers or hunger faced by other members. 

A unique form of elderly care in ancient China appeared in the Northern Song Dynasty between the 10th and 12th centuries. People who shared the same surname believed they were descendants of the same ancestors a thousand years earlier. They organized into patriarchal clans. They built temples to enshrine all of their ancestors through generations. But in fact, they may not have had a common ancestor. It was the identity, not the blood ties, that brought them together to form the clan, so it was actually a social network. 

This belief was encouraged by Confucian scholars in the Northern Song Dynasty. Before that, in an aristocratic family, only a man’s first son born with his wife, not a concubine, was recognized as the ancestor of his offspring from generation to generation. Other sons were worshiped only by their following four generations. Ordinary people did not record or worship their ancestors. In the meantime, a Confucian principle states that ordinary people were not required to follow protocols and ethical standards as strictly as the aristocracy.

But Confucian scholars during the Northern Song decided to change this. They hoped that everyone in society would follow Confucian-based protocols and ethical standards, and ancestor worship is highly valued in Confucianism. But how could the standards be followed by all of society if so many people did not even know their roots? This was unacceptable for those scholars. 

Under the design and promotion of those scholars, gradually people began to create their common identity as offspring of the same ancestors, set up temples to pay tribute to their common ancestors, and follow certain protocols in their daily family life. This strengthened the bond and sense of belonging among people.       

Elderly care in this new social organization then emerged. Fan Zhongyan (范仲淹）, a renowned literati and politician from the late 10th to the mid-11th century during the Northern Song Dynasty, bought land in his hometown in today’s Suzhou, Jiangsu Province. The rent from the land was used to provide for members of the Fan’s patriarchal clan, especially the old and poor that lived on the land. Other patriarchal clans followed suit. 

Fan Zhongyan’s offspring maintained and operated the estate for more than 800 years, the longest history of any non-government charity organization in China. There is a middle school on the site of the main home. The memorial temple for Fan Zhongyan originally built nearly 1,000 years ago is now a museum dedicated to Fan. 

Elderly care as a social issue is relatively new after human life expectancy became long enough to have an old age. But the recipe for a decent elderly life remains the same: support from the family, the State, and society at large.  

Well, that’s the end of our podcast. Our theme music is by the famous film score composer Roc Chen. We want to thank our writer Zhang Yue, translator Li Jia, and copy editor Kathleen Naday. And thank you for listening. We hope you enjoyed it, and if you did, please tell a friend so they, too, can understand The Context.