China Issues Guidelines for Three-Tier Urban-Rural Elderly Care Network
China’s Ministry of Civil Affairs has officially released the “Guidelines for the Construction and Management of the Urban-Rural Three-Tier Elderly Care Service Network,” a comprehensive policy framework designed to make elderly care more accessible, secure, and comfortable for the nation’s rapidly aging population. The guidelines, signed on May 29 and publicly unveiled at a press conference on July 8, 2026, establish a standardized structure for delivering care services across county, township, and village levels.
A Three-Tier Structure for Comprehensive Coverage
The new framework organizes elderly care services into three interconnected tiers. At the county level, comprehensive elderly care service management platforms will integrate resources including special hardship service institutions, information systems, and guidance centers. These platforms will handle service demonstration, industry guidance, emergency rescue, resource coordination, data collection, and direct elderly services, according to People’s Daily.
At the township and sub-district level, regional elderly care service centers will focus on professional care delivery and resource linkage, connecting with village and community stations. The village and community-level facilities will provide day care, home visits, referral services, recreational activities, short-term respite care, meal services, and companionship visits—bringing care directly to seniors’ doorsteps.
Responding to a Demographic Crisis
The policy arrives as China confronts one of the world’s most significant aging challenges. According to the National Bureau of Statistics, as of 2025, China had 323.38 million people aged 60 and above, accounting for 23.0% of the total population. Birth rates continue to decline, with only 7.92 million births recorded in 2025—a drop of 162,000 from the previous year, as reported by China News Service.
Sun Wencan, Deputy Director of the Department of Elderly Care Services at the Ministry of Civil Affairs, noted that by the end of 2025, China had 396,000 elderly care institutions and facilities nationwide. County-level public elderly care institutions have achieved near-universal coverage, with approximately 30% already functioning as comprehensive county-level management platforms, while over 60% of townships and sub-districts have built regional elderly care service centers.
Real-World Implementation: Case Studies from the Field
The guidelines build on successful pilot programs across multiple provinces. In Hubei’s Xingshan County, the county-level platform has registered 22,400 rural elderly residents in a smart elderly care system. Bi Daoli, Deputy Director of the Hubei Provincial Department of Civil Affairs, explained that the platform has established a “child-village-county” three-level linkage response mechanism, equipping seniors with over 3,000 sets of smart bracelets and cameras. When an elderly person makes a one-button distress call, the platform dispatches the nearest mutual aid worker, who arrives within 15 minutes.
In Beijing’s Dongcheng District, authorities have integrated 17 streets into 8 elderly care service areas. Gao Honglei, Director of the Dongcheng District Civil Affairs Bureau, emphasized that the district is not simply “physically stacking” services but striving for practical results at every level, with each area relying on a street-level center to serve as a regional hub.
Perhaps the most striking transformation has occurred in Xuzhou, Jiangsu Province. Wu Bin, Director of the Xuzhou City Civil Affairs Bureau, described how the city broke administrative division restrictions to consolidate 108 nursing homes into 41 regional elderly care service centers, each with 300-400 beds capable of serving 2-3 surrounding towns. In Xinyi City, 20 outdated nursing homes were upgraded into 7 park-style centers, with bed utilization rates soaring from under 40% to over 75%.
Key Innovations and Forward Look
The guidelines introduce several innovative approaches, including smart technology integration with AI-powered elderly profiling and remote monitoring, a “center + station” operational model, and “two-institutions-one-body” arrangements where health centers manage nursing homes for integrated medical-nursing care. The policy also encourages public-private partnerships through public construction with private operation models.
Provincial civil affairs departments are now required to incorporate the three-tier network into their “15th Five-Year Plan” (2026-2030) elderly care targets, with specific timelines and responsibility assignments. The China National Committee on Aging has republished the full text of the guidelines for nationwide dissemination.
As China’s population continues to age—with rural areas facing even more severe demographic pressures, such as Xuzhou’s rural population where 28.7% are aged 60 or above—the success of this three-tier network will depend on sustained funding, workforce training, and quality assurance across the country’s vast and diverse regions. The guidelines represent a significant step toward a more structured, technology-enabled, and equitable elderly care system for China’s seniors.