# 17. Having elderly family members at home Having elderly relatives living with you often means that the main problems aren’t a lack of money, but failing to discuss matters clearly and sign the necessary documents in advance. The final section looks at pressure ulcers in bedridden patients; it calculates costs based on mortality rates and isn’t meant to be compared with the other items in this chapter. ### 1. While the elderly are still lucid, designate a future guardian in writing - Cost: It costs only a few hundred yuan to have a notarized document drawn up at a notary office. A single conversation with the elderly person is enough to settle the matter. The real difficulty lies in bringing it up — you must directly discuss the day when they will no longer be able to make decisions for themselves. - In plain terms: While an elderly person still has a clear mind, it’s worth spending a few hundred yuan to have a written document notarized, naming who will serve as their guardian. Without such a document, once they lose decision-making capacity, a court must decide who gets to sign on their behalf and manage their finances. If family members disagree, the process can drag on even longer. - Benefit: Under civil law, adults who are mentally sound and capable of independent decisions (legally termed “adults with full civil capacity”) may proactively arrange for a future guardian through mutual agreement. This person can be a close relative or any willing individual or organization. Such an arrangement must be formalized in writing. When the person later loses all or part of their decision-making ability, the designated individual assumes responsibility. Absent this document, guardianship must be assigned by a court. - Evidence grade: A - Sources:全国人大 (2020). 民法典（第三十三条）. - Notes: This arrangement is known as “voluntary guardianship,” meaning the guardian is chosen by the individual themselves, taking precedence over the standard legal order of guardianship. It is especially important for elderly people living alone, whose children reside far away, or those from complex family backgrounds. It is recommended to have the document notarized at a notary office. ### 2. Make a will — remember that later ones override earlier ones, and notarized wills no longer take priority - Cost: Writing a will by hand costs nothing. Having it notarized at a notary office costs several hundred to over a thousand yuan. The hard part is bringing it up: you must discuss end‑of‑life matters with your family. - In plain terms: The law recognizes six types of wills, but a single mistake in the format can render the entire document invalid — this is the most common pitfall. A handwritten will must be written entirely by the testator, signed, and dated. If multiple wills exist and they conflict, the last one signed prevails. Since 2021, a notarized will no longer automatically takes precedence over others. - Benefit: The Civil Code acknowledges six legal forms of wills: handwritten, dictated to a scribe, printed, recorded on audio or video, oral, and notarized. Each type has specific formal requirements that must be met. When several wills exist, the most recent one governs. Starting in 2021, notarized wills no longer automatically rank above others. - Evidence grade: A - Sources:全国人大 (2020). 民法典（第一千一百三十四条至第一千一百四十二条）. - Notes: A handwritten will must be written entirely by the testator, signed, and dated. For printed wills, at least two witnesses are required; both the testator and witnesses must sign every page and include the date. Relatives of the testator, potential heirs, or anyone named to receive assets cannot serve as witnesses. Any failure to meet these formal rules renders the will invalid — this is the most frequent cause of problems. ### 3. Keep the elderly person’s money in a separate account and set a rule requiring two people to approve any large withdrawals - Cost: This costs nothing. You only need to discuss it once with family members and agree on a spending limit. The real challenge is how to bring it up without making the senior feel you’re trying to restrict them. - In plain terms: Scammers targeting seniors for health products, collectibles, or financial schemes all follow the same pattern: they spend months building rapport, then strike all at once. By establishing a rule that any withdrawal above a certain amount must be approved by another person, you effectively delay the spending decision until the initial impulse fades. - Benefit: Most scams aimed at older adults rely on building trust over weeks or months before making a large financial demand. Setting a rule that requires a second person’s approval for any sizable expenditure helps delay that decision, reducing the chance of impulsive, costly mistakes. - Evidence grade: C - Sources:作者经验，无直接文献；防骗通则见第 8 节和第 13 节 - Notes: Frame this not as “protecting them from fraud” but as “keeping household finances organized.” That approach is far easier for seniors to accept. Also, avoid moving all of their money into a child’s account — doing so can lead to entirely different kinds of disputes. ### 4. A ready-made phrase for seniors to deflect unwanted offers - Cost: No cost at all. It only takes a few minutes to discuss this with the senior once. - In plain terms: Sales pitches and scams rely on creating immediate pressure, making it hard for people to say no on the spot. By agreeing beforehand on the phrase “I need to go home and discuss this with my family,” the senior has an easy way out whenever needed. This works far better than trying to reason with them later. - Benefit: Both sales tactics and scams depend on on‑the‑spot pressure. Having a pre‑arranged line such as “I need to go home and discuss this with my family” gives seniors a graceful exit, making it far more effective than any post‑event explanation. - Evidence grade: C - Sources:作者经验，无直接文献 - Notes: Use this together with tip #3 (keeping the senior’s money in a separate account). You can also carry out home modifications to prevent falls, as described in Section 1. This phrase isn’t meant to protect the senior from themselves; it simply provides a way to decline politely without feeling awkward. When surrounded by salespeople, the hardest part isn’t judging whether they’re trustworthy — it’s finding the courage to say no in front of everyone. Agreeing on this line beforehand removes that burden entirely. ### 5. Avoid any “investment-based senior care” schemes that require upfront payments: card enrollment, prepaid care fees, buying senior housing units, travel-based care programs, and sales of senior products all fall under the same category of illegal fundraising - Cost: No cost at all. Simply read the following list of common tactics to seniors; it takes just a few minutes. In the future, use this list to reject any such offers outright: don’t attend informational sessions, don’t visit facilities, and don’t leave contact details. The real challenge arises when seniors have already attended several sessions and formed relationships with promoters — in those cases, convincing them to back off becomes much harder. - In plain terms: Any senior care program that demands an initial payment while promising financial returns is essentially a scam. These schemes include selling membership cards, collecting prepaid care fees, selling senior housing units, offering travel-based care packages, and promoting various senior products. Under current regulations, recovered funds are extremely rare; victims usually bear the full financial loss. Official reports document cases where fraudsters raised 136,000,000 yuan by marketing “pre-booked senior housing units,” defrauding over 2,100 people. Another case saw fraudsters collect 620,000 yuan through similar tactics, affecting more than 2,100 people. The only effective preventive step is stopping the initial payment. - Benefit: The Civil Affairs Bureau has identified five primary patterns used by fraudsters; recognizing these patterns is far more reliable than trusting individual promoters. First, fake senior care organizations: these entities lack any physical presence and merely rent temporary venues while falsely claiming partnerships with legitimate care providers. Second, “senior care services” marketed via premium cards, membership passes, or prepaid plans that promise far more services than their actual capacity can deliver. Third, “investment in senior care projects” — including fictitious senior housing developments, long-term bed leases, and so-called “time bank” mutual care systems — often advertised with promises of principal return, rental guarantees, or buyback agreements. Fourth, sales of “senior products” involving product buybacks, consignment sales, loyalty discounts, complimentary health screenings, gift giveaways, conference promotions, wellness seminars, and expert medical consultations. Fifth, “travel-based senior care” packages featuring discounted or free trips, stored-value rewards, and points-based care programs. Legal statutes explicitly state that all financial losses resulting from participation in illegal fundraising must be borne by the victims themselves. Official statistics illustrate the scale of this problem: Dai and accomplices stole 136,000,000 yuan through similar schemes, affecting over 2,100 victims; Dai received a 15-year prison term plus a 400,000 yuan fine. Cao orchestrated a fraud totaling 13,207,000,000 yuan, impacting more than 110,000 people; he was sentenced to life imprisonment with permanent political rights revocation and full asset confiscation. Some health product promoters also employ fraud tactics: Ni lured seniors through free meals, gifts, and private transportation to attend lectures where “experts” fabricated anti-cancer benefits using false testimonials and inflated pricing; seniors ended up paying dozens of times the actual cost for a compound called dihydroquercetin. Ni received a 10-year-and-3-month sentence plus a 120,000 yuan fine. (National regulations effective May 1, 2021.) - Evidence grade: A - Sources:民政部 (2023). 关于养老服务领域非法集资的风险提示. （中国政府网发布）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示. ；国务院 (2021). 防范和处置非法集资条例（国务院令第 737 号，第二、二十五、三十条）. ；最高人民检察院 (2022). 检察机关打击整治养老诈骗犯罪典型案例. ；最高人民法院 (2025). 依法惩治涉民生领域诈骗犯罪典型案例（案例五 倪某荣诈骗案）. - Notes: Determining whether a program is legitimate should never rely on superficial impressions like “this organization looks reputable”; instead, focus on two clear indicators: does it demand an upfront payment, and does it promise financial returns? Legitimate senior care providers offer services rather than investment opportunities; any mention of returns, profits, or principal guarantees immediately disqualifies them. While it is difficult to prevent seniors from attending informational sessions, travel excursions, or medical screenings, the critical moment for intervention is when a payment is requested; this aligns perfectly with the dual-confirmation rule outlined in section 3. Once payment has already occurred, immediately contact police at 110 or the anti-fraud hotline 96110 to request a payment freeze, and simultaneously report the incident to local authorities responsible for handling illegal fundraising cases. Separate from these schemes, “housing reverse mortgage insurance” represents a distinct financial mechanism; refer to section 6 for further details. ### 6. Apart from the housing reverse mortgage insurance offered by insurers, you should avoid all other “housing-for-pension” schemes — never mortgage your home to buy financial products - Cost: There’s no cost involved. Keep your property deed in your own hands and don’t hand it over to anyone promoting “housing-for-pension” schemes. Before signing any mortgage, guarantee, or loan agreements, show them to your children first. The difficulty lies in the fact that promoters often come repeatedly and appear very enthusiastic, leaving seniors feeling awkward about refusing them. - In plain terms: The only legitimate “housing-for-pension” option is the housing reverse mortgage insurance provided by insurers, which is currently still in the pilot phase and used by very few people. Door‑to‑door sales pitches have nothing to do with this official program. Scammers trick seniors into mortgaging their homes so they can use the borrowed money to buy financial products recommended by the fraudsters — essentially a “pay‑old‑debts‑with‑new‑money” Ponzi scheme. Regulators report cases where seniors were unaware their homes had been mortgaged; as a result they ended up losing their property while still owing a loan. - Benefit: The China Banking and Insurance Regulatory Commission’s Consumer Protection Bureau clearly distinguishes between the genuine and the fraudulent schemes. The legitimate program is called “Housing Reverse Mortgage Insurance for Seniors.” Eligible seniors who fully own their homes may mortgage them to an insurer while continuing to live there, rent it out, or otherwise use it. Any sale or disposal of the property requires consent from the mortgagee — the insurer. Seniors then receive a pension according to agreed terms until their death. This service remains a pilot project with limited participants. Illegal operators label their schemes “housing‑for‑pension,” but they bear no relation to the official program; they merely exploit national policy to promote illegal fundraising. Their modus operandi is to persuade seniors to mortgage their homes and then use the proceeds to purchase recommended financial products — often a classic Ponzi arrangement. The original warning states that some participants are completely unaware their homes have been mortgaged, ultimately resulting in loss of the property and outstanding debt. A useful guideline for evaluating returns is also provided: if a financial product promises a yield above 6 %, it should be viewed with suspicion; above 8 % it becomes highly risky; and anything over 10 % means you should expect to lose all principal — “high returns with guaranteed principal” is a hallmark of financial fraud. The same warning also stresses the need to be cautious when signing contracts and never to sign blank documents (National level, June 2021). - Evidence grade: B - Sources:中国银保监会消费者权益保护局 (2021). 关于警惕「投资养老」「以房养老」金融诈骗的风险提示（2021 年第三期）. （湖南省地方金融监督管理局转载）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示（第四种表现形式：以宣称「以房养老」为名非法集资）. - Notes: This grade B reflects that the statements derive from regulatory risk warnings and expert judgment rather than empirical research data. The 6 %, 8 %, and 10 % thresholds are reference points suggested by regulators for consumers, not legally mandated standards. The former CBIRC has been merged into the National Financial Regulatory Administration; the original announcement page is no longer accessible, so we cite a reposted version from a provincial financial regulator. The core issue here is not merely possible losses on financial investments, but that after mortgaging their homes seniors still carry a loan obligation — a loss far exceeding any potential principal loss. General rules concerning contract signing and blank documents are covered in Section 8, Item 17; steps to halt fraudulent transactions after being scammed are outlined in Section 8, Item 2. ### 7. For elderly individuals at home who are bedridden or severely disabled, apply to the local yibao (basic medical insurance) office for long-term care insurance; it is not limited to seniors only - Cost: You only need to visit the local yibao office once to submit an application and undergo a disability assessment. If you pass the assessment on the first try, the evaluation fee is covered by the insurance fund — no out-of-pocket expense is required. - In plain terms: Long-term care insurance helps cover the cost of hiring caregivers. Those who are severely disabled and have remained in that condition for at least six months may apply to their local yibao office. Eligible care expenses do not need to be paid upfront; roughly 70% is reimbursed for employees covered under the worker policy, while about 50% is reimbursed for residents enrolled in the urban/rural resident policy. However, costs such as room charges and meals are not covered. Though often mistaken for a senior-specific program, official documents refer to “insured persons” without any age restriction — even younger individuals with severe disabilities may apply. - Benefit: There is no deductible threshold for approved long-term care services; you do not need to pay a set amount out-of-pocket before reimbursement begins. Approximately 70% of eligible costs are reimbursed for workers, and about 50% for urban/rural residents. The maximum annual payout cannot exceed 50% of the local average per-capita disposable income for residents in that region. - Evidence grade: A - Sources:国家医保局等八部门 (2026). 关于印发《加快建立长期护理保险制度实施方案》的通知. ：保障对象为「按规定参保缴费且失能状态长期持续（一般为6个月以上），经申请通过评估认定的失能人员」，「制度起步阶段保障重度失能人员」；「待遇享受不设起付标准。符合规定的长期护理服务费用，按未就业城乡居民参保政策参保的，基金支付比例为50%左右；按单位职工参保政策参保的，基金支付比例为70%左右，退休人员享受单位职工参保待遇」；「参保人员基金年度最高支付限额不超过统筹地区上年度城乡居民人均可支配收入的50%」；「待遇享受固定等待期原则上按照6个月设置」；另见中共中央办公厅、国务院办公厅《关于加快建立长期护理保险制度的意见》. - Notes: Disability must be “long-term and continuous” — generally lasting six months or more; a few weeks of hospitalization does not qualify. A six-month waiting period applies before benefits can be claimed. Expenses unrelated to care, such as room fees or meals, are not covered by this insurance. Medical costs normally paid by yibao are also excluded. Individuals already receiving work-related injury care benefits cannot claim both simultaneously. This insurance is separate from disability-related subsidies; they follow different application procedures and provide distinct financial aid, as detailed in Section 7, Article 8. Care received at home or in community settings receives preferential reimbursement rates; institutionalization is not mandatory. Implementation varies by region, and assessment criteria differ locally. Contact 12393 or your local yibao office to confirm whether the program is active in your area and how to schedule an evaluation. Even if an initial assessment fails, reapplication is possible once disability worsens. ### 8. For families with someone bedridden at home, pressure ulcers are a top concern: use an electric alternating-pressure air mattress, turn the patient regularly, and check bony areas daily - Cost: Electric alternating-pressure air mattresses for home use start at a few hundred yuan. Turning a patient takes just a few minutes. The real challenge is doing it every two to three hours, even at night — no single caregiver can manage that alone. - In plain terms: Pressure ulcers are far more than just superficial skin injuries. Among 19,520 patients undergoing hip‑fracture surgery, those already having pressure ulcers at admission had a roughly 20% higher chance of dying within 30 days. Three evidence‑based actions help: using an electric air mattress cuts new ulcer formation by about 60% compared with ordinary hospital mattresses; consistently turning the patient reduces risk by roughly 70% versus standard care; and keeping the person from lying prone for long periods also helps. Check the sacrum, heels, hips, and shoulders each day; if any area shows persistent redness that doesn’t fade when pressed, contact a nurse or doctor right away. A total of 1,226 patients showed similar trends, and 116 patients demonstrated a clear increase in ulcer risk under prone positioning. - Benefit: Data come from 19,520 hip‑fracture patients in the U.S. NSQIP registry (2016‑2019). Those with pre‑existing pressure ulcers showed a higher 30‑day mortality rate; after adjusting for other factors, this link remained significant (OR 1.2, a 21% increase in risk, P = 0.004). They also faced higher rates of deep‑vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmissions (OR 1.43), and an average hospital stay 0.4 days longer. In a follow‑up of 324 elderly inpatients (mean age 86) over 18 months, pressure ulcers independently predicted long‑term death (HR 1.500, 95% CI 1.059‑2.126, P = 0.020). A network meta‑analysis of 65 randomized trials compared electric alternating‑pressure air mattresses with standard hospital mattresses; the former lowered ulcer incidence (RR 0.42, 95% CI 0.29‑0.63, moderate certainty). Similar benefits were seen with hybrid systems (RR 0.22, 95% CI 0.07‑0.66). A 2026 Cochrane review of 11 trials involving 4,462 patients found little difference between turning schedules of 2 hours versus 4 hours (RR 1.05, 95% CI 0.79‑1.39, very low certainty). However, using wearable sensors to enforce 2‑hour turning intervals in an ICU setting cut ulcer rates compared with usual care (RR 0.28, 95% CI 0.10‑0.75, moderate certainty). Finally, patients kept in a prone position developed ulcers far more often than those lying supine (RR 4.55, 95% CI 2.31‑8.98). - Evidence grade: B - Sources:Porter SB, Pla R, Chow JH, et al. (2022). Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients. JAAOS Global Research & Reviews, 6(11). ；Ottaviani S, Rondanina E, Longo E, 等 (2026). Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults. European Geriatric Medicine, 17(2), 665-672. ；Shi C, Dumville JC, Cullum N (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS ONE, 13(2), e0192707. ；Latimer SL, Chaboyer WP, Probst S, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. - Notes: This grade reflects three main points. First, the mortality studies showed only that patients with ulcers fared worse; they did not prove that preventing ulcers directly lowers death rates. Second, the evidence on optimal turning intervals from randomized trials is quite weak. Third, the data on air mattresses are relatively stronger, yet they compared hospital‑grade mattresses to ordinary home mattresses, so extrapolation to home use is somewhat uncertain. Daily inspection of bony areas is standard nursing practice and lacks dedicated research support. The mortality benefit is evaluated separately from cost calculations for other items in this section. Home‑based care services covered by long‑term care insurance are described in item 7. Sudden leg swelling should be treated as a possible deep‑vein thrombosis, as covered in section 13, item 11. Situations involving prolonged bed rest after falls or severe injury are discussed in section 1, item 34. ### 9. If an older person’s cataracts already affect walking safely, have an eye doctor assess surgery; when both eyes are affected, do not delay the second eye too long - Cost: Accompany the older person to ophthalmology once; the doctor decides whether surgery is appropriate. One eye is operated at a time; many hospitals do it as day surgery and send the patient home the same day. If both eyes have cataracts, operate in two separate procedures. Out-of-pocket cost depends on which intraocular lens (artificial lens) you choose and how local yibao reimburses — ask before surgery. - In plain terms: In women aged 70 and older, having the first-eye cataract surgery sooner cut falls over the next year by about one-third, and fewer people fractured bones. The number who fell at least once did not drop. For the second eye, surgery did not show a clear difference in falls. After surgery, hip fracture over one year was about 16% lower. - Benefit: A randomized trial enrolled 306 women aged 70 or older with cataracts. Half had first-eye surgery within about four weeks; half waited 12 months per usual care. Over one year, the early-surgery group had about 34% fewer falls (fall rate ratio 0.66, 95% CI 0.45 to 0.96). At least one fall occurred in 49% of the surgery group versus 45% in the wait group — no reduction. Two or more falls: 18% versus 25%. Fractures: 4 in the surgery group (3%) versus 12 (8%). A Cochrane review included this trial and concluded first-eye surgery in women reduced fall counts; second-eye surgery did not. A randomized trial of the second eye enrolled 239 women aged 70 or older. Fall rates were 32% lower in the surgery group, but the difference could be chance (fall rate ratio 0.68, 95% CI 0.39 to 1.19). In a 5% sample of US Medicare, 1,113,640 cataract patients aged 65 or older (2002–2009) were followed observationally without randomization. After surgery, one-year hip fracture odds were about 16% lower (OR 0.84, 95% CI 0.81 to 0.87). Absolute difference 0.20 percentage points — about 2 fewer cases per 1,000. - Evidence grade: B - Sources:Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005). Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. British Journal of Ophthalmology, 89(1), 53-59. ; Foss AJ, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T (2006). Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age and Ageing, 35(1), 66-71. ; Gillespie LD, Robertson MC, Gillespie WJ, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, CD007146. ; Tseng VL, Yu F, Lum F, Coleman AL (2012). Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA, 308(5), 493-501. ; Desapriya E, Subzwari S, Scime-Beltrano G, et al. (2010). Vision improvement and reduction in falls after expedited cataract surgery: systematic review and metaanalysis. Journal of Cataract and Refractive Surgery, 36(1), 13-19. ; Meuleners LB, Lee AH, Ng JQ, Morlet N, Fraser ML (2012). First eye cataract surgery and hospitalization from injuries due to a fall: a population-based study. Journal of the American Geriatrics Society, 60(9), 1730-1733. ; Meuleners LB, Fraser ML, Ng J, Morlet N (2014). The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study. Age and Ageing, 43(3), 341-346. ; Keay L, Ho KC, Rogers K, et al. (2022). The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study. Medical Journal of Australia, 217(2), 94-99. ; 国家卫生健康委 (2022). 「十四五」全国眼健康规划（2021-2025年）. - Notes: Controversy: pooling the two randomized trials, the number who fell at least once did not fall significantly (OR 0.81, 95% CI 0.55 to 1.17). In Western Australian all-population hospital records, hospitalization for fall injury in the year after first-eye surgery rose 27%. Between the two surgeries, such hospitalizations were 2.14 times the pre-surgery rate. Before-after comparisons cannot separate surgery from aging. Another Australian follow-up found the largest drop in fall counts after the second eye. If both eyes have cataracts, do not delay the second too long. Between surgeries, take extra care on stairs and when getting up. A Cochrane-included trial that addressed vision problems in older people actually increased fall counts by about 57%. Surgery fixes vision; preventing falls still needs Section 1, item 13 (balance and leg strength). Whether bones can survive a fall: Section 1, item 39 (bone density screening) and item 40 (treat osteoporosis if found). National eye-health planning states cataract surgery is widely available at county level — not only at big-city hospitals. Main beneficiaries: your parents and grandparents.