17 Elderly at home

The Civil Code (民法典) says an adult who is clear-headed and can decide for themselves (in law, an adult with full capacity for civil conduct (具有完全民事行为能力的成年人)) may agree in advance who will be their guardian. That person can be a close relative, or another willing individual or organization. The agreement must name the guardian in writing (以书面形式确定自己的监护人). When they later cannot decide, or can decide only in part (lose or partly lose capacity for civil conduct (丧失或者部分丧失民事行为能力)), the person named in the document takes charge. Without that document, Article 28 of the Civil Code sets the guardian in this order: spouse; parents and children; other close relatives; then another willing individual or organization with the consent of the residents' committee, the villagers' committee, or the civil affairs bureau. Article 31 says that if people dispute who the guardian should be, the residents' committee, the villagers' committee, or the civil affairs bureau designates one. Anyone who disagrees may ask a court to designate the guardian, and they may also apply to a court directly.

The Civil Code (民法典) recognizes 6 forms of will: written by the person, written by someone else at their request, printed, audio or video, oral, and notarized. Each has its own formal requirements (形式要件). For the kind written by the person, Article 1134 of the Civil Code requires that it be "written by the testator in their own hand, signed, and dated with the year, month, and day." If several wills are made and they conflict, the last one controls. From 2021, a notarized will no longer automatically ranks ahead.

In 2022 the Supreme People's Procuratorate (最高检) released typical elder-fraud cases. It said these crimes first use small favors and a show of family concern to win trust, then false claims and promises of high returns to take large sums. In one case, a company selling fake collectibles sent staff to clean for elders and sit and talk with them, and even took them as "godparents." When they sold the goods they sealed them in a black bag and told the elder not to open it, so the elder's family would not find out. The company took in more than 1,920,000 yuan. The boss was sentenced to 7 years and 6 months for fund-raising fraud. In 2023 the Beijing Local Financial Regulatory Bureau (北京市地方金融管理局) warned elders not to believe a scammer who says "do not tell anyone." When you are unsure, talk with family, children, and neighbors and friends you trust, and ask the family before you invest. The U.S. Federal Trade Commission totaled the reported losses of people aged 60 and over. In 2020 the total was about 600000000 US dollars. In 2024 it had risen to about 2400000000 US dollars. The rise was mainly cases in which a single loss exceeded 100000 US dollars. Agreeing in advance that "spending above a set amount has to be mentioned to a specific person first" lets the family know before the money goes out, and pushes that decision back.

Pitches and fraud both lean on live pressure. The U.S. Federal Trade Commission anti-scam guide says scammers want action before you can think. On phone calls they tell you not to hang up so you cannot verify. The guide says tell someone—a friend, family member, or neighbor—before you act; saying it aloud may expose the scam. The former China Banking and Insurance Regulatory Commission (银保监会) risk notice in 2021 also told elders to consult family before buying wealth products. One experiment enrolled 116 people aged 65–85 and 115 aged 30–40. Researchers used a win/loss game to stir some people’s emotions, then showed exaggerated ads. Those whose emotions were stirred wanted to buy more. Regardless of arousal, elders wanted to buy more than younger adults. Authors advise waiting until emotions settle before spending. Another experiment enrolled people previously cheated by mail fraud, mostly older. Without prior warning, nearly half agreed outright to a simulated telemarketing scam call. With a reminder call two to four weeks ahead, clearly fewer agreed outright. Agreeing on “I need to go home and talk with my family” gives the elder an exit without deciding on the spot.

The Ministry of Civil Affairs (民政部) lists five forms. Recognizing the label is more reliable than recognizing the person. The first is borrowing the name of an elder-care service agency: there is no real operation, they rent a site for a short time, and they claim a cooperation agreement with an elder-care home so they can trade on its name. The second is in the name of providing "elder-care services": they sell a "VIP card," a "membership card," or a "prepaid card," and have people prepay "elder-care service fees." The service they promise clearly exceeds the beds they can supply. The third is in the name of investing in an "elder-care project." Common labels are buying a stake in a wellness and elder-care base, and selling a fictional elder apartment. There is also long-term rental of elder-care beds, and "time bank" mutual-aid elder care. The cover is sales that promise to return the principal, leaseback after the sale, and an agreed repurchase. The fourth is in the name of selling "elder products": repurchase of goods, consignment sale, consumption rebates, free checkups, gifts, conference marketing, wellness lectures, and expert free clinics. The fifth is in the name of enjoying "travel elder care": cheap or free travel, stored-value rebates, and points-based elder care. The money cannot be got back. The regulation says so. Article 25 of the Regulations on Prevention and Disposal of Illegal Fund-raising (防范和处置非法集资条例) says, "Losses suffered from taking part in illegal fund-raising shall be borne by the participants themselves." Lost money can only be borne by the person who put it in. In officially reported cases, Dai and others illegally raised 136,000,000 yuan in the name of pre-booking beds in an elder apartment, with more than 2100 victims. Dai was sentenced to 15 years for fund-raising fraud and fined 400,000 yuan. Cao, in the name of investing in the elder-care industry, committed fund-raising fraud of 13,207,000,000 yuan, involving more than 110,000 people. Cao was sentenced to life imprisonment, deprivation of political rights for life, and confiscation of all personal property. Conference sales of health products were prosecuted as fraud. Ni used free banquets, gifts, and a car to pick people up and drop them off, and pulled elders in to hear lectures. The lecturers used "a fake persona, fake cases, and an inflated price cut" to invent cancer-prevention and cancer-fighting effects. Elders were induced to buy "dihydroquercetin" (二氢槲皮素) at tens of times the cost price. Sales were more than 620,000 yuan. Ni was sentenced to 10 years and 3 months and fined 120,000 yuan (nationwide; the regulations took effect on 2021-05-01).

The former CBIRC Consumer Protection Bureau (银保监会消保局) separated real from fake. The real product is “housing reverse mortgage insurance for older persons.” Elders with full legal title mortgage the home to the insurer; they keep living in it, using it, and collecting rent. Sale or disposal needs the mortgagee (insurer) to agree. They receive pension payments under the contract until death. The business remains pilot-scale with few participants. Fraudsters’ “housing-for-pension” is “completely unrelated” to the state pilot and is “using national policy as cover to promote illegal fund-raising.” The method is tricking elders into a mortgage, then using the borrowed money to buy recommended products—“often a Ponzi scheme of paying old debts with new money.” The notice quotes consequences: “Some participants did not even know their property was mortgaged; they ultimately lost the house and still owed the loan.” It also gives yield lines: “If a wealth product promises returns above 6%, question it; above 8% is very dangerous; at 10% or more, prepare to lose all principal; ‘guaranteed principal with high yield’ is financial fraud.” The same notice requires careful contract signing and not signing blank contracts (nationwide, June 2021).

Long-term care service fees that meet the rules have no deductible (起付线). A deductible is a sum you pay yourself before reimbursement starts. Here you do not pay that sum first. People enrolled under the employee policy are reimbursed by the fund at about 70%. People enrolled under the policy for urban and rural residents who are not employed are reimbursed at about 50%. The most that can be paid in a year (the annual payment cap (年度最高支付限额)) is no more than 50% of the previous year's per-capita disposable income of urban and rural residents in the local pooling area. The people who can receive benefits are those who are enrolled and paying as required, whose disability has generally lasted 6 months or more, and who pass an assessment after they apply. At the start, severe disability is covered first. The document sets no age floor. A person 18 or younger who is not working is enrolled with their parents and, if eligible, receives benefits at the urban and rural resident rate. The fund mainly pays care institutions and care workers. In principle it does not pay cash directly to the disabled person. Institutional bed fees, meal fees, and other charges that are not care are not paid by the fund.

19520 patients who had hip-fracture surgery (U.S. NSQIP, National Surgical Quality Improvement Program, 2016 to 2019). People who already had a pressure ulcer before surgery had a higher share of deaths within 30 days. After other factors were taken into account, the link still held (OR 1.2, a 21% increase in the odds, P=0.004). They were also more likely to have other problems: deep-vein thrombosis (OR 1.59), pneumonia (OR 1.39), and unplanned readmission (OR 1.43). The average hospital stay was also 0.4 days longer. 324 hospitalized elders (mean age 86) were followed for a median of 18 months. A pressure ulcer on its own predicted long-term death (HR 1.500, 95% CI 1.059 to 2.126, P=0.020). "On its own" means that after other factors are set aside, it still predicts. 65 randomized trials were pooled (a network meta-analysis). They compared a powered active air support surface with a standard hospital mattress (a standard hospital support surface). A powered active air support surface is the electric air-mattress type. People using one had a lower rate of pressure ulcers (RR 0.42, 95% CI 0.29 to 0.63, moderate certainty). A powered hybrid air support surface was RR 0.22 (0.07 to 0.66). A Cochrane review of 11 trials and 4462 people, updated in 2026, compared turning every 2 hours with turning every 4 hours. The difference was unclear (RR 1.05, 95% CI 0.79 to 1.39, very low certainty). Comparisons among other turning intervals were equally uncertain. In a trial of 1226 intensive-care patients, wearable sensors that reminded staff in real time and gave a visual alert made turning every 2 hours actually happen. The pressure-ulcer rate was lower than usual care (RR 0.28, 95% CI 0.10 to 0.75, moderate certainty). In a trial of 116 people, the prone group (lying face down) had a higher pressure-ulcer rate than the supine group (lying flat) (RR 4.55, 95% CI 2.31 to 8.98).

Randomized trial of 306 women aged 70+ with cataracts. Half had first-eye surgery within about 4 weeks; half waited 12 months per usual care. Over one year, early surgery cut fall counts by about 34%. Rate ratio 0.66, 95% CI 0.45 to 0.96. At least one fall: surgery group 49%, wait group 45%—no reduction. Two or more falls: surgery 18%, wait 25%. Fractures: surgery group 4 (3%), wait group 12 (8%). Cochrane included this trial: first-eye surgery in women reduced fall counts; second-eye surgery did not. Second-eye randomized trial, 239 women aged 70+: surgery group fall rate 32% lower but difference may be chance (rate ratio 0.68, 95% CI 0.39 to 1.19). U.S. Medicare 5% sample: 1,113,640 cataract patients aged 65+ (2002–2009), observational only. Surgery associated with about 16% lower one-year hip fracture odds (OR 0.84, 95% CI 0.81 to 0.87). Absolute difference 0.20 percentage points—about 2 fewer cases per 1,000 people.

U.S. emergency surveillance data, scaled up to the whole country, counted fractures in people aged 65 and over who fell while walking a dog on a leash. There were about 1671 in 2004 and about 4396 in 2017, and the rise was statistically significant. Among the people with fractures, 78.6% were women, and 28.7% were hospitalized. By single body site, the hip was the most common, at 17.3%. By broad region, the upper limb was the most common, at 52.1%. Another national emergency dataset covers 2001 to 2018. Injuries related to a dog leash were estimated at about 360000 visits (exact figure 356746). Of those, 193483 visits were injuries from being pulled by a dog, and 136767 visits were trips or entanglement in the leash. Injuries per million people rose from 25.4 to 105.5. A hand-surgery clinic saw 443 patients with hand injuries from a dog leash over 5 years. About three-quarters were injuries to the hand or fingers from the leash wrapping and the dog pulling (the abstract says 337 people, 75.9%). About a fifth needed surgery (96 people, 21.6%). The U.S. Centers for Disease Control and Prevention counted about 86629 fall-injury visits a year from 2001 to 2006 that were related to cats and dogs. Of those, 88.0% were related to dogs. Among the dog-related falls, 26% happened while walking the dog, and 21.2% were the dog pushing or pulling the person down.

The Ministry of Civil Affairs (民政部) measures for the administration of elder-care institutions say that within 10 working days after a home takes an elder in, it must register with the civil affairs bureau. If the papers are complete, the bureau issues a registration receipt. The home must sign a service agreement with the elder or their agent, stating the care level, the fee schedule, refunds, and liability for breach. If they do not sign an agreement, the bureau orders correction and issues a warning; in a serious case the fine is up to 30,000 yuan. A 2024 document from 7 departments, including the Ministry of Civil Affairs, set caps on prepaid fees. Elder-care service fees may be collected at most 12 months ahead. The deposit is at most 12 times that elder's monthly bed fee. The deposit may be used only for refunds, advancing the cost of sudden medical care, offsetting unpaid fees, and compensation. Public homes, and homes that were built with public funds and are privately run, may not charge a membership fee. A home that is not yet built, or that cannot yet take elders in, may not charge a membership fee either. The deposit and membership fees must all be placed in a dedicated deposit account under third-party custody at a bank. They may not be collected into a personal account. When money is received, an invoice must be issued. A receipt may not stand in for an invoice. If the elder cancels before moving in, the home must return the prepaid money promptly. If the elder has moved in, deduct what has already been used and, in principle, refund the rest in one payment through the original channel. This document took effect on 2024-10-01. Provinces may set stricter rules. The 2025 custody guidelines require that after the home applies for a refund, the custodian bank pay it the same day, or the next day at the latest, in one payment back through the original channel.

Provinces put care leave in different local regulations. The Henan Provincial Regulations on the Protection of the Rights and Interests of the Elderly say that when an elder who holds the honorary certificate for parents of an only child (独生子女父母光荣证) is in hospital, the child's employer must give care leave. The leave is at least 20 days a year in total, and it counts as attendance. The Fujian Provincial Regulations on the Protection of the Rights and Interests of the Elderly say that when a parent of an only child is 60 or older and is in hospital with an illness, the employer must give the child time for care. That time is at most 10 days a year in total, and wages and benefits stay the same. If the employer does not pay wages and benefits for the care period, the human resources and social security department (人社) or the relevant department orders payment by a deadline. The Guangdong Provincial Regulations on Population and Family Planning cover couples with Guangdong hukou (户口 — household registration) who, in the years when the state encouraged one couple to have one child, voluntarily had only one child. When they turn 60, the employer gives the child 5 days of care leave a year. If they are ill and in hospital, the total is at most 15 days a year. If the employer does not provide the leave the regulations require, the human resources and social security department at county level or above orders correction. The liability chapter of the Henan regulations does not say what happens if the employer does not give the care leave.

The UK NICE dementia guideline (NG97) requires that, when dementia is suspected, the history be taken from the person and from family who know them. It also requires a physical exam, blood and urine tests to rule out causes that can be reversed, and a cognitive test. The guideline names four things to check first: delirium (sudden confusion that comes in spells), depression, poor vision or hearing, and medicines with a heavy anticholinergic load. If those are ruled out and dementia is still suspected, refer the person to a specialist service such as a memory clinic for a diagnosis. A 2003 meta-analysis pooled 39 studies, of which 5620 people had a confirmed dementia diagnosis. Alzheimer disease accounted for 56.3%, and vascular disease for 20.3%. Causes that might be reversed accounted for 9%. Those who truly improved were only 0.6%: partial improvement 0.29%, full improvement 0.31%. The same NICE guideline requires an early discussion with the patient and the family about arrangements made in advance. That includes authorizing someone else to manage health and money, and the person's wishes for future care. A 2024 action plan by 15 departments, including the National Health Commission (国家卫健委), calls for pushing a first cognitive screen for people aged 65 and over, and encourages hospitals to set up memory clinics.