Discussion keeps the world turning.
This is Roundtable.
Hello, welcome to Roundtable where we serve up piping hot debates on the issues that sizzle in China and beyond.
I'm Niu Henlin.
As China enters the phase of depopulation aging, the question of how to care for an expanding elderly population has become more urgent and more complex.
Traditional family support is weakening, while institutional care alone cannot meet growing demand.
In response, communities across the country are experimenting with new methods of mutual care or mutual aid, searching for solutions that are sustainable, humane and rooted in everyday life.
Today Roundtable invites you to have a look at the latest trends in the world of elder care in China.
For this episode, I'm joined by Fei Fei and Steve Hatherly.
Now grab your virtual compass and follow us to the heart of the discussion.
Across continents, societies are grappling with the same question.
How do we care for a rapidly aging population when professional care is costly and human connection is increasingly fragmented?
From neighborhood programs in Europe to community pilots in China, time banking has re-emerged as a practical response.
Instead of replacing formal care systems, it reframes care as something communities can help generate themselves.
But how much long term elder care can it help to cover?
And can a system built on trust really scale up?
And can it pull in younger people to keep it alive?
That are the questions we want to discuss today.
But for those who are not familiar with the concept of, you know, time banking.
What exactly is it?
Yeah, this isn't new per se.
This goes back to the 1970s.
That's when it originated.
And now, though, it's practiced in over 60 countries around the world as of the end of 2024.
In brief, I guess we could say a time bank does with time what other banks do with money.
It stores it and it trades it.
Interests?
No interest.
It doesn't accrue over time.
But here's how it works.
So one hour of help equals one time credit, regardless of what the task or its market value.
No task is considered more valuable than any other task.
It's a mechanism designed to treat everyone's time as equally valuable.
It's a really cool concept.
So What happens is you would volunteer one hour of time.
You'd go onto a platform or an app.
You'd find someone who needed some help with something and that something could be doing their grocery shopping.
So you'd take their list, and you'd go to the shop, get their stuff, and bring it back to them.
That would be one example.
Spending time with an elderly person, playing cards together, watching a movie together.
That might be one or two hours.
It can really be anything.
People post what they want, what they need, on the platform.
You reply say yep, I'll do that for you.
You do it for an hour.
You therefore get one hour of time credit and now that's yours, and then you can post when you need your help and someone can volunteer to help you.
So it's a very, I think, a big system that requires basically deposits and withdrawal from that bank, as we discussed.
So that's why I think the system is being brought up lately by a lot of people who say that this can be an innovative solution to many of our social problems, for example, the aging population.
And it is, for example, in China, I think we have faced challenges.
For example, we have over 45 million older adults in China living with disabilities and cognitive impairments.
But when it comes to certified caregivers for these people, there are only 500,000.
So there's a big gap over here, and maybe time banking can be a solution.
That's the idea behind it.
And the aging population here in China, Fei-Fei, it's not just a Chinese issue.
It's a worldwide issue.
By 2050, these are UN projections.
They show that one in six people around the world will be over 65.
I found that interesting. to be a shocking statistic.
And that's up from 1 in 11 from just six years ago.
And because of that rapid aging population worldwide, it means there's a growing number of older people that need help.
Alongside.
If you compare it, then that by logic it means there's a shrinking number of younger people that are available to provide that help.
And the reason time banking is such a novel idea a novel concept is because it doesn't require cash.
It doesn't require any money, such as other forms of care do.
In the U.S., the cost of professional long-term care is extremely high.
For instance, the estimated annual cost of a nursing home is about 100000 US dollars, and even in-home assistance is roughly 60000 dollars.
So that is a price tag that most families in the United States cannot afford.
It's a lot more affordable here in China from what I understand, but still it would be expensive for some families.
For example, in Beijing, a senior care facility costs on average about 6600 yuan a month, which is about 11000 US dollars annually.
But we also, as we're facing a growing aging population, most of the time is that it's very difficult to get a space, first of all in these facilities.
And even though it sounds affordable internationally, it doesn't mean everybody in China can afford that.
So that's another issue.
And the third one is not everybody is very open to going to a nursing home.
Yeah, right.
Not everyone wants to.
And that is why in China, 90% of elder care is supposed to be, by design, happening at home.
So it's supposed to be family-supported elder care.
Of course, you can have all kinds of different services having the kind of aid from the neighborhood or from community centers to come to your home and help you with adapting your home, for example, providing medical services for the elderly as such.
But I think the time bank idea is not only there, or it's not purely designed there to solve these kind of systematical problems.
It's more like a complementary solution to address the kind of issue i i see it from, or i.
I would like to separate it into two parts.
The first part is having more and more people joining the program and helping those in need, so that it can somehow ease the problem that we face now.
And the second phase would be after those volunteers get older, when it's their time to enjoy the service, to get their money excuse me, time out of the bank, Their credit.
Their credit out of the bank and have some company.
And I would assume at that time more people would value the human touch rather than the actual, so-called tangible help they get.
Because we did a survey before recording the show on roundtables, all kinds of social platforms, about this episode we're about to do.
And we asked them what is your ideal form of elder care for your future?
Take a guess which one got to the highest.
Well, let's say, what about you, both of you?
What would you think would be the relatively more ideal way of receiving eldercare in our golden, well silver, hair age?
Well, i would definitely want to be surrounded by people i know, like my neighbors, my friends, my family, and in an environment that i'm familiar with, like my home.
So, family-based or within the community yes, I'm thinking swimming pool, large screen TV.
Is this what you're asking me or am I supposed to say something about family?
No, that's good, because the highest number or the highest choice we've got from our social media platforms is Surprisingly, to be honest, for me personally, surprisingly is that most people would like to be surrounded or to be supported by high tech gadgets.
They want exoskeletons so that they can still move around, maybe even travel.
They want the kind of monitors that are powered by AI.
They are kind of monitored, but not by another human being, but by the system and by data.
And they want their homes to be adapted with high technology.
So I think for this generation, for those who are hardcore fans of Roundtable and search for the kind of votings we put up there, they are not there yet.
They haven't been so keen to human touch.
And they're still thinking about the basic needs in the sense that they're supported.
I understand.
But you're asking a group of people about the future.
Yes.
20, 30 years.
So it's difficult.
You don't know until you get there.
But even if you want to be surrounded by family, even if you do need that human touch, you still need the humans to provide.
Exactly.
And I think that is what time banking is trying to solve or trying to provide.
And this concept, like Steve said, it is novel.
It's quite a cool idea.
Yet it has been there for a while.
And internationally.
We've already seen some examples of how it's practiced and how it's benefiting maybe the community, or how are people receiving it.
Well, the one that's maybe the most famous, if I can say famous, in the United States is called Our Exchange Portland H-O-U-R.
Our
It's in Portland, Oregon in the United States, and it's one of the longest running time banks in America.
And it's a system where neighbors have traded their services using time credits for hours, about almost thirty years.
It opened in nineteen ninety seven and it's among hundreds of time banks operating in that particular country.
Uh, i checked in canada as well.
We have, we have time bank, but we also have something called and i did not know about this Parent Time Bank.
And apparently that's really popular with single parents who are working and need help with this, that or the other in their lives.
And they go to that time bank to...
To help each other out, yeah, in the community there.
That's Canada.
There are other international examples.
There's one called Time Republic.
It was first launched in Switzerland in 2012.
That is a little bit different, though.
So this functions as a time bank.
They call it a time bank for the Internet era, and they have over 100,000 users worldwide.
But what they do there is they use their, their assistants online, so like doing video calls for I don't know things like professional fashion advice is one example oh, I need that, and that might be in exchange for an online meditation course for one hour or a lesson for one hour, and they use a credit known as time coin in that particular example, where 15 minutes of service, not one hour, 15 minutes of service equals one credit, and again, It's regardless of the job.
Very interesting.
How about the situation in China?
Well, here in China actually, the concept surprisingly appeared firstly in China in 1998 in Shanghai, with the establishment of the first labor bank.
But that, and I think till now, what's Chinese time banks a little different than their international peers is that it's more sort of trialed in communities for the aging population, especially in the model of lower age elders helping higher age elders.
Ah.
It's like the elderly in their 60s helping those in their 80s or 90s.
So, for example, I oversaw an example in Hengshui, Hebei province.
They have a community called Yangshu, where volunteers in their 60s help those who are much older than them to run errands, to do their haircuts, to pick up their medicines or parcels.
And so they have about 70 such elder volunteers in that community and they get credit points in this volunteer work which then can later be redeemed things like soaps or services of other volunteers.
They can also save up these points so that they can use such services when they reach their 80s or when they need such services in the future.
In that sense, it'd be an investment.
Yeah, sort of.
Yeah, and then you can redeem it later on in your life.
I'm curious.
I think it depends on the time bank and where it is in the world.
But for some...
So, for example, if I wanted time for my parents, I could volunteer an hour for somebody else doing something.
And then instead of me keeping that credit, I can transfer that credit to my parents.
I wonder if that's how it works, too.
I'm not really sure if that's how it works, because right now I think these time banks in China is running on pretty small scale.
You can see the example that I gave in Hengshui.
They only have like 70 such volunteers.
Even though it's not a very big community, is only a very short a small portion of people out there.
And I think one of the reason is because, as Steve mentioned, how do we ensure the transparency of getting these credits?
Who are there to guarantee that the points you get are really the time that you served.
But that is kind of a hurdle we have to jump if you want to scale it up because, if you think about it, many people would like to do volunteer work if they know that their parents from far away a different province is also taken care of, and that is why we see that Qingdao, for instance, is planning to achieve this city-wide and eventually with neighboring cities as Weifan and Yantai all of them are in the same province to maximize the scope of service curriculum, making sure that if you do your service in this one city, your parents can enjoy it from another city.
And if it can be a national level system definitely, I think the more people would like to take part in.
And I think I've seen the kind of videos on China's social media web apps and also platforms.
Many people would do a nice deed and saying Something like I have signed up the agreement of helping other people's parents.
And I want to do that because I want my parents to be taken care of as well.
The so-called agreement does not really exist.
It's a concept that are very welcome among the younger generation here in the country.
Whenever you hear something like this, you tend to help the elder generation understand that you meet in subway stations, in train stations and anywhere, to be honest, so that this kind of good mojo can spread around the country.
Yeah, and some people will do this out of the kindness of their hearts.
And that's great, because some people really like to volunteer and give back to the community.
But not everyone likes to do that.
But I think this system still works in other ways.
For example, we talked about the cost of health care and the time that it takes, and some people are very busy with their jobs.
They simply don't have the time, or perhaps they simply don't have the money, and if you are in a situation in a low-income family, then this is just such a great alternative to get extra help.
And it doesn't have to be for deeply personal things like adjusting seniors in their beds or things like that.
It can be something really, really simple like going to pick up something from the shop.
And when it comes to trust on that level Well, you could use things like blockchain technology to ensure that your time is properly capped and stored, as opposed to writing it down on a piece of paper in somebody's office somewhere.
So that would address that problem.
But then in terms of safety and vetting, like who are these people who are volunteering their time, and things like that.
I think when you have simple transactions, then it makes it a little bit more perhaps palatable for people to entice people to want to use these services, even if you don't, even if you don't necessarily know the person.
I mean, think about it.
If you order takeout delivery food, you don't know who your delivery driver is.
And that's okay.
And that's okay, right.
You're not inviting the delivery driver into your home to unpack your groceries into your fridge.
And you're not inviting exactly inviting them into your life, which is why, in recent years, we are seeing a re-emergence of this time banking system.
And are we looking at a possible future with this really being a, at least after several years?
Is it possible to have it as a national scale system?
I want to go back to the example from the United States, that Our Exchange Portland Institute.
So membership-wise, by the end of 2021, they were down to around 400 members.
And then in 2022, a year later, 20 new members made it into the Time Bank.
Then another 309 members, those were both old and new applicants, they were introduced into the system again. in 2023 and around 800 deactivated accounts were suddenly turned back on people who stopped using the service all of a sudden started using it again you add up those numbers that's well over a thousand people there um that's that's a significant amount for for one particular community um the numbers too in terms of age i think are significant there in 2024
They discovered that the main members were aged 40 to 49.
They were the biggest group from all different age groups.
They represented 26%.
Younger members 18 to 29 and older members 80 to 89.
They were a very small percentage.
But 40 to 49 that tells – if they're the largest percentage of the group, then that tells me that those are people who have kids the sandwich generation.
They probably have kids, and they have their parents that they need to take care of.
So this type of service would be a tremendous – asset to their lives.
That reminds me that here in China we have a very new concept as well called shared grammar.
Oh, yes.
It's got a great name too.
It's now also linked to the time banking system as well.
For example, in Taizhou, Zhejiang province, There is a community that adopts this time banking system with shared grandma, meaning that the elderly in their 60s, especially who used to work as teachers, they can help young working couples to pick up their children.
And they can also offer services like reading to these children, taking group activities like drawing.
So it's like a nanny service?
Yeah, kind of just to take care of these children in the one or two hours when their parents don't have the time or can't make it on time to pick up them.
And so by these services, these shared grandma quote unquote can save up their credit points for later other services as well.
So you can see that I think, when it comes to time banking, we may need to, you know, look at a bigger concept of not just being solving ageing population but making that link between generations.
And what's a funny benefit or side effect is that we see that back in 2019, 10 of new graduates who participated in Time Bank volunteer services in China went on to pursue a career in the elder care sector.
They feel the rewards doing these kind of volunteer work and they decided to make it a career which gives us something that is in your everyday life.
Perhaps you do not have an elder person in your home to take care of.
Yet after participating in these kind of activities, most people would have the rewarding feeling.
And that right there is something that shows us, if we manage to scale it up probably, it will definitely be popular.
And if it's popular, you'll solve a talent gap problem.
You'll solve a worker shortage problem.
We talked about engineers on Roundtable recently and how professionals from outside the universities were coming into the universities to assist with the programs and the curriculum design, thereby making engineering students feel comfortable that they can follow a career path outside.
Beyond their their university studies in the same field.
I see the same thing happening here.
If young people who getting involved at this from a young age in terms of their studies, if they see where their career path can go and and it's clear to them, then it would encourage more students to follow that kind of path.
Yes, and just last month we see that China has issued a well, it's more of a development of an elderly care service standard system.
Compared with the 2017 edition, the updated guidelines introduce adjustments and expansions in the overall framework, classification methods, coverage of service targets and standard coding.
The new regulations also take into full account different service settings, including home-based, community-based and institution care, as well as further standardized services closely related to older adults daily lives, and that includes not only personal care but also emotional support as well, and emotional support, i think, is going to be even more taken care of by the time banking system if they scale up.
And that also shows well.
I think it goes without saying that all countries around the world are facing these problems and are finding different ways to solve it.
Time banking is one.
But the ones that we mentioned that are really popular among the younger generation, picturing when they get older would be technical support different types of technical or development or innovation.
And here, of course, in China, we've seen a lot of adaptation happening in one's home so that it can be better served or meet the needs of the elder generation.
Yeah exactly, and when we are talking about building a more age-friendly living environment and i think it's not only about technology but also about these um this, you know, invisible care that you can give to the elderly is because for us who are not in our 80s or 90s, there are just something in life you won't notice.
For example, there is a depression in the floor.
That's not a problem for us, but maybe for someone in their 90s that's a big problem, that's a big risk for them.
And i think by having community, you know, mutual help with low age elderly, helping higher age elderly.
They are really in their shoes to be able to know, you know what's going on in this room, What's really are needed, truly needed, by these elderly people.
And that's why I think in the documents they mentioned about community level and emotional support.
These are all just communities can get.
I think I see your point there.
So young enough to be able to help, but yet old enough to be able to understand the needs of the elderly people.
Yes, and I see this really cute example in Shanghai.
There is an age-friendly renovation solution demonstration car.
It's a mobile exhibition vehicle and it showcases the products like liftable cabinet baskets, water leak alarms and foldable bathroom handrails.
And by driving these cars into many communities with elder generation, those living in their original homes, loving it and do not realize that it can be better.
After giving a tour in this you know car, they would know what kind of services can actually make their life easier.
So yeah, on top of having the younger, older people helping the older, older people, we can do these as well.
Everybody helping everybody, everybody.
Yes, exactly.
And besides that, in China, we already mentioned that you can spend your older years at home in communities based or community centered homes.
But also a lot of people would choose to travel to different places.
I think those are also relatively more applied to the younger, elder generation.
And it's becoming an industry.
And I think it suits Steve quite well when you are at that age.
I hope I make it that far.
Would you be able to enjoy big swimming pool, nice, huge TV for sports games?
You can also enjoy the nature in these places providing these services.
Well, you know, right now is the season, isn't it?
The elderly in the northeastern part of China.
Travel to Hainan, enjoy the tropical weather, enjoy their swimming pools.
And they're called, I think, migratory elderly in the country, that they travel to warmer places in the winters and then back to the colder places.
We have that concept in North America, too.
In Canada, they're called snowbirds.
And that can be really something that I think I would look forward to in my retirement someday in the future.
Yeah.
Yes.
And on Roundtable.
We've also discussed that a lot of elderly homes are cooperating with kindergartens so that some kind of social activities of the kindergarten kids would happen in the elderly home as well.
They take care of each other.
The elderly would pass down the wisdom.
The young kids would run around and make money.
The outer home that used to be tranquilized and beautiful and peaceful outer home, so noisy and lively and kids running around and laughing and screaming.
And that would be a good idea.
So we're not lack of trying.
It's that we need a little more persistence, a little more innovation to make sure that the very successful examples can be scaled up, can happen all around in the country.
