SHANGHAI — When Qing Zhuren comes to work every day as the manager of the Shanghai Fahua Home for the Aged, he confronts a scene that he once could barely imagine.
The tiny rooms off a chilly hallway that smells of cleaning solvents are all full. Three to four residents wrapped in Hello Kitty blankets lie in touching twin beds. There's enough space in the room for only one person to enter at a time.
Decades ago, the idea that China's eldest residents would be put in the care of non-family members was laughable — impossible, Qing said. In China's tradition-ruled society, parents and grandparents have always depended on their children, grandchildren or in-laws to care for them in their old age.
However, the full rooms at the Fahua Home for the Aged here are proof of a demographic change that's quietly making itself felt throughout this country of 1.3 billion.
Largely due to government policies, birthrates have been falling for the past few decades. At the same time, the explosion of China's middle class has produced millions of upwardly mobile, two career families that are more than willing to move about the country or even abroad for their jobs.
Xu Anqi, a professor and the deputy director of the Center of Family Research at the Shanghai Academy of Social Sciences, said China's birthrate has been falling for 16 years. Though it's hard to pinpoint the cause, many point to population control policies that date back to the days when China was barely able to feed itself.
In the 1950s and 1960s, the government tried promoting contraception, and then encouraged later marriages and longer waits between children. In 1979, China grew desperate and resorted to what's known today as the One Child Policy. Under this policy, urban couples are limited to one child, while farmers and rural couples are limited to two.
The policy worked. From 1960 to 1980, China's fertility rate fell from six children per woman to two — the most rapid decline in fertility ever recorded.
It was a win for the government, but many Chinese consider it the loss of a tradition.
"Families traditionally used to having many siblings around to take care of older residents suddenly find themselves faced with a problem," Xu Anqi said. "All the pressure is on one child to take care of his parent and grandparents and spouse's parents. It's too much for just one person."
Researchers have dubbed it the "1-2-4 problem" — one child taking care of two parents and four grandparents.
The situation has become so pressing that the Chinese government is examining alternatives, including more elder care centers such as Qing's and staff.
"A nursing home is a very good option," Qing said. "The kids, when they get older, they don't have enough time. The adults . . . they don't want to be a bother. It's not a breakdown of the tradition; we still are going to take care of our families. The method, though, has changed. We are adapting."
Part of the process of adapting is ensuring that traditional values are preserved.
For example, before a person is accepted to the Fahua Home for the Aged, relatives must promise to visit and call. In the five years that Qing has worked at the home, he can't remember anyone who hasn't had visitors.
"It just doesn't happen," Qing said.
Although researchers admit that the one child policy isn't making the current situation any better, they expect the policy to remain in effect, at least for now.
Zhang Weiqing, the State Population and Family Planning Commission Minister, told the country's official English-language newspaper, the China Daily, in 2008 that the nation won't make any drastic changes to the one child policy for at least another decade. He added that the government was aware of the problem and was aiming to help the country deal with the situation.
Xu Anqi thinks that isn't enough.
"It's a serious problem that the government has to address," she said. "Our nursing homes are crowded, and our families are distraught. They have been making progress, but I fear it's not fast enough."
Researchers estimate that by 2030, the number of people age 65 and older in China will reach 167 million, roughly half of the entire U.S. population.
That scares Qing. Already overworked and overbooked, there's only so much more he says he can do.
"It's a problem that I never thought we would encounter," he said. "But I'm glad we are able to do something."
The waiting list for the Shanghai Fahua Home for the Aged is "very long," Qing said. Its proximity to downtown Shanghai is a major appeal for young adults who can visit their parents on their way home from work or during the day. The building is secluded, down a narrow street.
Qing said that before residents are admitted into the Fahua Home, they must sign a contract that ensures that a family representative will visit them. Although officials acknowledge that they can't force a visit, they use repeated phone calls and letters to make it hard to avoid doing so.
"Some family members come every day, some come in every weekend," Qing said. "It's all different. But no one goes unvisited."
Xu Jinfeng, the director of the Pudong Social Workers' Association in Shanghai, sees the challenges that families face in dealing with older family members. Because of the boom of nursing homes sprouting up all over China — there are more than 500 in Shanghai alone — the caseload for social workers in the region has doubled, making it hard to ensure that all the needs are met for the families around Shanghai.
Still, some traditions are hard to change, and nursing homes aren't for everyone.
Shanghai resident Winnie Yao said that she and her husband already have begun planning for the future of two sets of aging parents.
Her mother and father are still active. Eventually, Yao said, they won't be able to keep up, but she said there will be no nursing home in their future.
"My husband and I have already discussed this," Yao said. "We plan to do whatever we can to be able to have them live with us. I know nursing homes are okay, but I still don't feel comfortable with them. I don't want to be looked down upon."
(Lawrence, a graduate of Penn State University, reported this story from Shanghai for a class in international journalism.)
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