China reached a pivotal moment this year, announcing on Tuesday that its population had, for the first time since the 1960s, shrunk.

It’s not just fewer people that China has to contend with. The country’s planners have another mammoth challenge ahead: a rapidly aging population.

The World Health Organization expects China to have more than 400 million people over the age of 60 by 2040, up from 254 million in 2019. That’s nearly a third of its total population, compared to the US Census Bureau’s estimate of 22.9% of Americans being aged 60 and over in 2019.

“China became an aging society in 1999. It will become an aged society by 2026, and a super-aged society by 2047,” Sabrina Luk, an assistant professor of public policy and global affairs at the Nanyang Technological University of Singapore, told Insider.

For the most part, Chinese elderly are expected to remain in their family homes and be cared for by their children or grandchildren.

There’s a stigma in China against placing aging parents or older family members in nursing homes, said Luk, who’s written two studies on China’s aging population. Filial piety is a strongly held value in China, and many older adults prefer to grow old in their own homes, she added.

It’s when these seniors need help with chronic illnesses, disabilities, or dementia that care becomes complicated, and they may have to be admitted to nursing homes, Luk said.

Beijing has been watching this issue since at least 2006, she added. It’s been trialing a national insurance scheme for aged care across 15 cities such as Shanghai, Guangzhou, and Chengdu since 2016.

Each city decides independently who gets the insurance and what benefits they’re covered for, Luk said.

In most of these cities, the money comes from an already existing insurance pool that all urban working residents must pay for, so a Chinese person doesn’t necessarily need to pay a premium to get long-term care.

However, there still aren’t enough facilities covered by this plan, and care standards are inconsistent among those currently available, said Luk.

“Some seniors have to endure lengthy waits to be admitted to nursing homes due to inadequate beds that are covered,” she said. “Those who stay in nursing homes may not be able to get timely and responsive care due to staffing shortages.”

There isn’t even standardized training or a qualification system for elder care workers in China yet, Luk added.

Access to good senior care is likely to vary greatly across the country, with large gaps between the wealthiest and poorest provinces, David Goodman, the director of the China Studies Center in the University of Sydney, told Insider.

“Bear in mind that anything, anything welfare-related isn’t done by the central government,” said Goodman. “It’s left to the local governments, the provincial and subprovincial governments, the prefectures. They are responsible for the hospitals and the schools.”

Ultimately, China’s finding itself facing a challenge that it’s been late to react to, said Gu Qingyang, an associate professor of public policy at the National University of Singapore and the editor of the Journal of Infrastructure, Policy and Development.

“They were late by about 10 years compared to developed countries like Japan. It was only six, seven years ago that China removed its one-child policy,” he told Insider. “If they had done that five years earlier, China would be in a much better situation.”

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