Aging Society & Health

PRC has been building a reference model in Yichang City, Hubei Province, where about a quarter of the 4 million residents are already over 60 — well above the national average. Since 2014, ADB has supported the city through technical assistance and two loans, including a $150 million project to build a three-tiered elderly care system spanning home-based, community-based, and residential care [1]. Rather than building high-end retirement villages, the program shifted toward serving low- and middle-income elderly, integrating health care and elderly care through a new city-wide ICT platform and a dedicated geriatric care hospital [2]. In June 2022, Yichang was named one of the PRC’s first “National Key Contact Cities” for its response to aging, positioning it as a demonstration model for other cities and provinces to replicate [3].

Evidence

What made this work?

• A three-tiered system only works if community-based services are built first — Yichang prioritized local centers before scaling residential capacity.
• Integrating elderly care with the health system requires a shared data platform, not just co-located facilities.
• Shifting from high-end retirement housing to serving low- and middle-income elderly is a deliberate policy choice, not a default outcome — it has to be designed in from the start.

Where else could this apply?

• Hubei Yichang Comprehensive Elderly Care Demonstration Project

  ADB project page · Loan 3767-PRC
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• Upgrading Elderly Care in Yichang City, PRC

  ADB results story
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• Elderly Care System Development in Yichang, PRC

  East Asia Working Paper No. 67
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Adaptation guidance for other cities

• Establish community-based care infrastructure before scaling residential facilities — coverage matters more than capacity at the start.
• Build a shared ICT platform linking health and elderly care early, rather than retrofitting integration later.
• Decide explicitly which income groups the system is designed to serve — this shapes financing, location, and partnership models from day one.

Yichang demonstrated how to build a three-tiered elderly care system spanning home, community, and residential care. Guangxi Zhuang Autonomous Region tackled a different part of the same problem: once that structure exists, how do you actually connect it to the health care system? In 2019, ADB approved a $100 million loan to integrate elderly care and health care across Nanning and Hezhou municipalities, introducing public-private partnership standards to the sector for the first time in the region [1]. The project funds a hospital discharge management system so elderly patients move into community or residential care directly, rather than falling into the gap between hospital and home, and it establishes a standardized care-needs-assessment framework — addressing a region where more than 85% of elderly residents live with at least one chronic condition and roughly 60% live with multiple conditions [2].

Evidence

What made this work?

• Coordinating hospital discharge with community and residential care requires a shared handoff system, not just shared funding.
• Bringing in a private-sector operator for one facility tests whether PPP standards can work in a sector PRC had previously run entirely as public.
• A standardized needs-assessment framework has to come before service matching — you can’t route people to the right tier of care without first measuring what they actually need.

Where else could this apply?

• Demonstration of Guangxi Elderly Care and Health Care Integration and PPP Project

  ADB project page · Loan 3819-PRC
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• Hebei Elderly Care Development Project

  ADB project page · Loan 3536-PRC
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• Xiangyang Elderly Care Demonstration Project

  ADB project page
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Adaptation guidance for other countries

• Build the discharge-to-care handoff mechanism before expanding facility count — coordination, not capacity, is usually the binding constraint.
• Pilot a single PPP-operated facility before mandating private-sector involvement system-wide.
• Establish a standardized needs-assessment tool early, so capacity expansion is guided by measured demand rather than guesswork.