At six o'clock each morning, Wei Qiang helps his 80-year-old mother sit up in bed. His mother, once known for her sharp memory, now stares blankly as Wei adjusts her pillow, wipes her mouth, and whispers reminders to eat slowly and swallow. This routine of feeding, bathing and turning her at night to prevent bed sores repeats every day without a nurse on duty or a shift change.

"Alzheimer's disease has transformed our home into a full-time care unit, one run almost entirely by ourselves," Wei said.

Wei's struggle is the face of mounting national pressure. According to the China Alzheimer's Disease Report 2024, which was organized by Renji Hospital of Shanghai Jiaotong University School of Medicine and participated in by a number of medical institutions in China, the current number of patients living with Alzheimer's and other dementias in China is nearly 17 million.

As the country ages rapidly, formal care options remain limited, uneven, or culturally stigmatized. In practice, families — most often consisting of adult children or elderly spouses — have become the front-line providers of long-term dementia care, shouldering medical decisions, emotional labor and moral responsibility largely on their own.

In China, Alzheimer's care is "less a medical service than a family obligation shaped by filial ethics, constrained by scarce institutional support and intensified by the pressure to do everything possible", Wei said.

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.

A different path

At Beijing's Kang Yuxuan Care Center, an 85-year-old woman named Guan sits in her wheelchair, gently tapping a percussion instrument during a group music session. Two years ago, Guan was bedridden, frequently hospitalized, and considered a candidate for tube feeding.

Her family, exhausted by repeated ICU admissions, wanted to stop aggressive treatment but feared what that decision might mean."We thought refusing procedures meant we didn't love her enough,"Guan's daughter said.

The shift came not through advanced technology, but through deliberate restraint. Under the guidance of Jin Enjing, a geriatrician with training in Japan, Sweden and the United States, Guan's care plan focused on restoring fragments of daily life, which included eating from ceramic plates, folding origami, receiving hand massages and listening to familiar songs.

"Our goal here was never to extend life at any cost," Jin said. "It was to return dignity to living."

Jin's philosophy challenges a dominant model of elder care in China, where safety protocols and medical control often override autonomy. At the Kang Yuxuan center, residents cook with adaptive utensils, sit by large windows for spatial orientation, and participate in music and touch-based therapies.

"A space isn't a proper home for Alzheimer patients without the clatter of dishes," Jin said. "We cannot promise to eliminate all risk, but we can try our best to create safe autonomy for them."

Over six months, Guan regained the ability to eat soft foods. Her daughter recently asked about her getting dentures. "This was a request that would have seemed impossible before," Jin said.

Teaching families to let go

Not all families accept this approach easily. When Jin's team first suggested avoiding a feeding tube for Guan, her daughter hesitated. In China, medical restraint is often misread as neglect.

"Families equate medical aggression with devotion," Jin said. "We have to teach them that not doing certain things can also be an act of love."

This reframing from intervention to presence, from prolonging life to preserving meaning, runs against powerful social currents. Nursing homes remain stigmatized as places for "unfilial" families. Professional caregivers are undervalued and undertrained. Meanwhile, demographic change has shrunk family size, leaving fewer hands to share the load.

Yet even as institutional care expands, families remain the last safety net. They absorb the emotional shock of diagnosis, manage daily routines, negotiate with doctors, and live with the consequences of every decision.

Late at night, Wei sits beside his mother's bed, listening for changes in her breathing. There is no sense of resolution, only endurance. "My mother's memory will not return, and I always know that the disease will progress," he said.

But in the quiet repetition of care, the spoon lifted, the hand held, Wei said that he has found what devotion means.

"For a long time, I thought love meant fighting the disease," he said."Now I think it means staying with her, even when there's nothing left to fix."