Care at home

The disease and management of acute episodes are usually diagnosed in hospitals, but long-term care remains fragmented. Specialized memory-care facilities are few, expensive, or concentrated in major cities such as Beijing and Shanghai. Community-based services exist on paper in many regions, but staffing shortages and limited training mean families still carry most of the burden. Statistics from the China National Committee on Aging show that China currently lacks more than 10 million grassroots caregivers nationwide, a gap projected to widen to over 30 million by 2050. The profession remains deeply unattractive, with more than a third of caregivers earning less than 4,000 yuan ($550) a month, while nearly half work between nine and 12 hours a day. Low pay, low social recognition, and intense physical demands have driven high turnover rates, leaving many families with few alternatives beyond caring for relatives themselves.

"In many households, Alzheimer's care does not begin by choice, but by default," Wei said.

Families must constantly weigh whether to hospitalize a parent for an infection, insert a feeding tube, or use restraints to prevent wandering.

"These decisions never feel medical," Wei said. "They feel moral. Like every choice proves whether you are a good son or not."

This pressure is deeply entwined with xiaodao, or filial devotion emphasizing loyalty and sacrifice. In the context of dementia, love for parents is increasingly measured by the willingness to authorize aggressive medical intervention, even when the benefits are uncertain.

Zhang Wei, whose father had advanced Alzheimer's five years ago, echoes this sentiment.

"Doing less feels like giving up," said Zhang. "And giving up feels unfilial."

As technology expands, families are confronted with invasive options like repeated intensive care unit admissions and constant monitoring, which are often presented as standard symbols of commitment. Yet, these interventions can also prolong suffering and push families into cycles of guilt.

"In the hospital, everything is about preventing risk," Zhang said. "At home, you're thinking about whether your parent still feels like themselves."

This tension defines a system that catches families between traditional expectations and a modern medical model that equates care with intervention.