“If he doesn’t farm, we won’t have enough food to eat,” said Hou, 71, her hair in pigtails and her hands shaking as she spoke. “When we run out of money for our medical bills, we just stop treating ourselves.
“We can live like this, it’s okay. But please, don’t let us become really ill.”
Decades of societal turmoil — radical communism followed by rampant capitalism — have frayed the ties that once bound China’s families together extremely closely. In a country famous for its Confucian traditions of filial obedience, tens of millions of elderly Chinese are being left behind by the country’s transformation, suffering poverty, illness and depression. It has become such a serious problem that the Chinese government put into effect a law in July allowing parents to sue their children if they failed to visit and support them.
“Many rural children don’t treat their parents that well,” said Zhao Yaohui of Peking University, co-author of a recent study of the problems facing China’s oldest people. For centuries, patriarchs controlled their families’ limited resources in the countryside. But now, Zhao said, “the rural elderly don’t have that much power or property they can use to buy their children’s respect and support.”
Among China’s 185 million people older than 65, nearly one in four is living below the poverty line, more than one in three struggles with daily activities and 40 percent show significant symptoms of depression, the survey showed.
The results were worse in China’s villages than in the cities, where pensions are much higher. Indeed, in rural areas, the elderly are nearly three times as likely to be poor as the average resident.
Mao Zedong’s attempts to redraw China’s society and remove all trace of its ancient traditions weakened family ties as hundreds of millions of villagers were forced to work on collective farms from 1958 onward. Loyalty to Mao was supposed to trump family bonds, and the Cultural Revolution saw close relatives denounce and humiliate one another.
Deng Xiaoping’s economic reforms in the 1980s failed to fully repair the damage, with communal land parceled out and separate plots leased to individual farmers. While in neighboring India land is typically owned by the male head of the household, giving the patriarch influence over his extended family, in China the elderly and their children often have distinct plots of land.
China’s massive rural-to-urban migration has put additional, extreme pressure on the nation’s social fabric. Whereas about 70 percent of the rural elderly lived with their adult children in 1990, that figure had fallen to 40 percent by 2006, according to a 2012 World Bank report.
The neighboring villages of Luzhai and Gonggou, in China’s Anhui province, bear testament to these profound social changes. One-fifth of the people in villages are older than 60.
New houses, often clad in shiny ceramic tiles, have sprung up everywhere. Built by villagers who have left for migrant work in the cities, many homes lie vacant. In between them nestle tiny, tumbledown red-brick houses. “If you see a house in very bad condition, it must have old people living in it,” said local doctor Cai Rucai.
In Gonggou, 87-year-old Dou Shengli lives with his 85-year-old wife, He Xiuying, in a typically shambolic one-room house.
Although they have two sons living nearby, and three daughters, the couple gets little help with their living expenses and medical costs.
“They have their own families to look after — if they have money, they spend it on themselves and nobody takes care of us,” said He, a folded washcloth over her grizzled hair in the late summer heat. “My first son wants to build a new house, and even came to ask us for money.”
The couple survives on the government’s modest rural pension of 60 yuan (less than $10) a month. “I don’t have money to buy vegetables,” she said, “so we just grow what we can.”
The rapid aging of China’s society is one of its most profound economic challenges. By 2053, the number of senior citizens is expected to grow to 487 million, or 35 percent of the population, compared with just over 12 percent now, according to the China National Committee on Aging. There will be more retired Chinese people than the entire U.S. population by that date.
But even before then, the country faces the prospect of growing old before it grows rich. Chinese citizens who have grown up under the one-child policy could end up caring for two parents and four grandparents each as they enter late middle age, a potentially crippling economic burden.
The government has gradually rolled out a pension plan for rural senior citizens since 2009; a new national cooperative medical insurance system has also helped defray health-care costs for old people. But the benefits are spread thinly over a vast population, and the government will struggle to fund a dramatic improvement in social welfare spending if the Chinese economy continues to slow.
Mindful of that growing burden, Premier Li Keqiang vowed last month to cut red tape to encourage foreign investment in Western-style nursing care. But this is unlikely to do much to plug the gap.
In 2012, in another attempt to repair the damage of its own social engineering, the Chinese government updated a 700-year-old collection of well-known folk stories showing examples of how children — mostly sons — showed their devotion to their parents. Instead of romantic tales like “He Strangled a Tiger to Save His Father” or the more mundane “He Picked Mulberries to Serve His Mother,” the new government directives suggested that children take their parents on vacation, call them on the weekend or teach them how to use the Internet. But it is far from clear that anyone took notice.
Indeed, the government’s own rules are still regressive; strict residence registration requirements force migrant workers to leave their parents behind in the villages, because the elderly can access state medical benefits only if they stay at home.
In the end, most of the burden of caring for China’s old folk will inevitably fall on their children. Many Chinese children still care for their parents much better than many of their counterparts in the West — and not because the government tells them to. But it is equally clear that the old assumptions about loyal Chinese sons are no longer as uniformly valid as they once might have been.
In Gonggou, Cai Wushi, 94, lives alone; her children come when she needs firewood, but otherwise she sits at home, alone, all day. “My eyes don’t work well, but I can still hear,” she said, a lone tooth protruding from her mouth. “But I am not useful anymore.”
Liu Liu contributed to this report.