Overcoming the 'paralyzed family' trap

Stopping fraud

To prevent the fraud that plagued some pilot schemes — including inflated disability ratings, fabricated service records, and identity theft — the new national program mandates surveillance technology.

Millimeter-wave radar sensors, as small as a computer mouse, use thermal sensing to detect a carer's presence and the service duration without capturing identifiable images, and preserving patient privacy. Bluetooth-enabled badges worn by carers transmit signals every 10 to 20 seconds; any departure from the patient's home triggers a back end alert.

Random "flight checks" by supervisors and quarterly satisfaction surveys further enforce the quality of care, said He Yue, Puyuan's national operations director.

Zhang, who cares for his father in Suzhou, said he welcomes the monitoring. "I am completely at ease," he said. "It doesn't feel like an invasion of privacy. It makes the service more standardized and gives me peace of mind."

Behind the technology are human carers like Xu Xinglan, 55, who has worked in long-term care for six years. She holds an elderly care certificate, a medical care certificate, and — as of May 2026 — a new "long-term carer" certification that requires passing both written and practical exams.

Xu recalled one of her most difficult patients: an elderly man with severe Alzheimer's who did not recognize his own family, screamed at them, and would hit anyone who tried to clean him. On her first visit, he was hostile and tried to strike her.

"I didn't get impatient," Xu said. "I crouched down, spoke softly, soothed him like a child. Even when he kicked or yelled, I understood — he was sick and couldn't control himself."

After months of daily visits, the man began to recognize Xu. He now greets her and sometimes says "thank you". His family, she said, marvels that he is closer to her than to his own children.