FOR many people, the idea of getting old conjures up visions of poor health, loneliness and discomfort.

That’s a pretty depressing scenario in a country with a rapidly growing elderly population. Thirty-five years of China’s one-child policy have led to a social imbalance. People are living longer, and there are fewer working-age people to support pensions, healthcare and other programs for the elderly.

Worse, the gap between demand and supply in elderly care is expected to widen in coming decades.

Official data showed that in Shanghai alone there were about 4.14 million people 60 years and older by the end of 2014, and growth of that number has been accelerating over the past few years. At last count, there were an estimated 753,200 seniors 80 years or older.

Governments at all levels are seeking to address the problem. The retirement age is expected to be extended, and couples are now allowed to have up to two children. But all that won’t be enough. In a time when government budgets are already strained, the private sector is being tapped to participate in the business of elderly care.

The State Council, China’s cabinet, said last year that it wants between 35 and 40 bed spaces available in senior care facilities for each 1,000 seniors by 2020. The nationwide average is currently 27.5.

At a meeting last month, the council formally announced support for private funds to build elderly care communities and hospitals. The government will offer incentives in the form of lower prices on building sites, purchase of care services in the facilities and long-term insurance.

Even before the decision became formal, early-bird efforts were underway, especially from insurance companies with money to invest.

The China Insurance Regulatory Commission in 2010 removed its ban on insurers investing in real estate.

Taikang Life Insurance and Union Life Insurance were the first companies to acquire sites to build elderly care communities. In the first three quarters this year, at least 10 insurers have invested a combined 25 billion yuan in the sector.

The US model known as the “continuum care retirement community” has become a popular blueprint in China. That system provides several levels of care at one site, allowing people who can live independently at first to progress to intensive nursing care beds if their health deteriorates.

In the US, that model is typically financed by private investment, not government.

The elderly care market in China is currently estimated at 4 trillion yuan and is expected to reach 13 trillion by 2030, according to the Chinese Academy of Social Sciences.

Taikang opened its first continuum care facility in Beijing in June, and its affiliated hospital opened last month there to serve both community residents and the general public.

Community plus hospital

The insurer plans to open similar projects in Shanghai and Guangzhou next year, utilizing its “community plus hospital” model. It has plans to build four more in the cities of Suzhou, Wuhan, Sanya, and Chengdu.

The Beijing facility can house 3,000 occupants, while the one in Shanghai will accommodate 2,000.

The company also has its eyes on building an elderly care facility in Nanjing, where it spent 5 billion yuan to acquire an 80 percent stake in a public hospital.

Chen Dongsheng, chairman and CEO of Taikang Life, said the insurer has already invested more than 5 billion in these projects and is prepared to allocate more than 100 billion yuan to elderly care in the next five to eight years.

“Elderly care and medical services will be the most significant social problem as China’s society ages, and we have a population of relatively wealthy people in need of high-end products and services,” Chen said, adding that all projects are expected to break even within three years of full operation.

Taiping Life Insurance started construction of an elderly community on a 15.6-hectare site in the Pudong New Area last year. The blueprint calls for 14 buildings and 2,000 beds. It is expected to be completed in about two years.

“Insurance funds are ideal for setting up and operating elderly care businesses because we seek long-term, stable returns,” said Liu Baoping, general manager of operations management for Taiping Senior Living Investments Co. “We have large number of clients and a close relationship with them. That’s the advantage of insurers in the elderly care business.”

China Life Insurance in September started construction on an 11-hectare elderly community in Suzhou, and China Ping An Insurance said it plans to invest 17 billion yuan in a 150-hectare Zhejiang Province project that will combine elderly care, commercial facilities and tourism.

All the projects on the drawing boards will no doubt relieve some of the bottleneck in elderly care, but they are no panacea.

For one thing, most of the planned communities will come with high costs and be accessible only to wealthier Chinese.

An 80-square meter apartment in one of these communities could cost a couple 15,000 yuan a month for basic care and meals.

The insurance companies usually require prospective occupants to pay an upfront fee of between 2-3 million yuan premium for a pension program before they reach the age of 60. That reserves them a space in a community when they retire, and the pension plan helps defray the cost.

At present, people who wish to send their parents to live in such residential communities have to pay the premium.

Most of these large-scale elderly care communities are located on the outskirts of cities where suitable land is available. Seniors living in such residences get cut off from their old circle of friends and family.

Though service providers try to choose sites close to Metro stations and often provide shuttle bus services, distances traveled are still a deterrent for family and friends to visit.

Beyond that, many elderly people are loath to leave places where they grew up and lived for years, or even to go into hospital care.

Then, too, a serious shortage of professional people trained to care for the elderly looms for the developers of residential facilities for the aged. Many young people don’t want to go into the sector because of low wages and poor job esteem.

However much elderly-care communities try to emulate a homey atmosphere, there’s no escaping the old saying that “there’s no place like home.”

“It is not the most ideal choice, but it was the right one,” said Chen Hanyuan, former deputy head of China’s central television station, who now lives in Taikang’s Beijing elderly-care community with his wife.

“You don’t meet friends here,” he said. “You make acquaintances, then you forget their names the next day. It’s not like living at home, but the health care and nice meals help make up for the loss.”

Chen’s only child lives in Japan, and his wife, who is now in her 70s, could no longer take care of him alone because he suffers from Parkinson’s disease and subsequent low blood pressure.

“We really had no other place to stay because we don’t want to move to Japan,” Chen said. “We don’t understand the language and we have no friends there.”

The search for new and better ways to provide the elderly a happy and quality life in their twilight years continues.

Domestic and foreign studies suggest preventative care to improve health and extend the independence of older folks.

Immunization of older people against flu, pneumonia and shingles could reduce the number of hospital admissions and associated mortalities. Volunteer befriending programs and group activities can be very effective in reducing functional decline caused by loneliness. Assists such as door-entry intercoms, motion sensors and alarms can be installed to help old people living home and provide them a mechanism to call for help if they need it.

Seniors should also be encouraged to take advantages of new technology, such as diet and exercise apps, games and wearable devices to keep mentally stimulated and socially connected.

The Chinese government is also trying to encourage community hospitals, which many seniors don’t trust, to offer more residential care and daily medical services to the elderly.

Most of these ideas require money and more availability of doctors, nurses and professional carers. Is it enough? That’s still anybody’s guess.