After being diagnosed with Alzheimer’s disease, 76-year-old Han Dingrong deteriorated quickly. She lost control of her bladder and bowels, threw her own feces out the window, and even hit her two daughters when they would bathe her, leaving bruises. The family went through four caregivers, each pushed to the breaking point, and each leaving Han’s home in the southwestern megacity of Chongqing, never to be heard from again.

Desperate, Tang Tao, one of Han’s daughters, scoured the internet for help. On lifestyle app Xiaohongshu, also known as RedNote, she stumbled on a user with the handle “Elderly Care Manager Jiu Jiu,” who offered to assist families in “finding the right care solution.” Tang reached out for help. Tang paid a 99-yuan ($14) consultation fee and, that evening, received a detailed plan from Jiu Jiu recommending five nursing homes.

After visiting Jiu Jiu’s recommended nursing homes in February 2025, they chose one for their mother to move into. At the end of their one-week trial, the sisters felt it was the right place for her. The family now pays a monthly fee of 4,800 yuan for her care, after subsidies.

Tang says that there was no such thing as an elderly care manager before — finding a nursing home meant asking people you knew, and information was limited. “Now, this service exists,” she says. “It’s like a real estate agent for care. They understand your needs and give you options.”

In recent years, Chinese social media platforms have witnessed a surge in accounts like Jiu Jiu’s, dedicated to providing nursing home recommendations and senior care advice. Their work primarily involves visiting and filming nursing homes to assess living conditions, meals, and fees.

The rise of senior care managers comes as China faces an aging population. By the end of 2025, there were over 323 million people aged 60 and over in the country, roughly a fifth of the total population. In Shanghai, this figure was 37.6% — the highest in the country.

Despite China having 40,000 registered nursing homes by the end of 2024, only roughly half of the more than 5 million beds were occupied. One reason was the diversity of the elderly care market, with families finding it overwhelming to navigate options, assess service quality, and determine pricing. Against this backdrop, senior care managers have emerged as intermediaries, helping families find suitable care while connecting nursing homes with potential residents.

Standing with the family

Tang and her sister initially had strong reservations about nursing homes. “It felt like only people without children, or those who had no other choice, would send their parents to one,” she says. Relatives also objected, making the sisters feel morally corrupt for considering nursing homes as an option. 

But Jiu Jiu encouraged them to see for themselves.

And they did, visiting the recommended nursing homes and ultimately choosing one that specialized in dementia care. “There was no bad smell, it was clean, and every resident had a smile on their face,” Tang says. 

She also felt that the home treated dementia patients with respect and understanding. “They didn’t make a big deal out of their behavior,” she says. “The residents were treated with dignity.”

Her mother has continued to decline at the home, as is expected with dementia, but the center sends daily photos and updates about her to the family. “Every day, she seems happy,” says Tang. “We feel at ease knowing she can live out her days there.”

Jiu Jiu, whose real name is He Renmei, has 18,000 followers on Douyin, the Chinese version of TikTok. Based in Chongqing, she receives roughly 500 inquiries a month. She collaborates with 200 nursing homes in Chongqing, and has filmed visits to 135.

He recalls that senior care managers began to emerge around 2022. It was then that she posted her first facility tour video. 

Delivered in the local Chongqing dialect, He’s videos guide viewers through lobbies, rooms, and bathrooms, highlighting features like grab bars and non-slip flooring. She discusses meals and nutrition, whether medical services are available on site or nearby, and whether the facility is suitable for independent seniors or those with physical disabilities or dementia. She covers rehabilitation equipment and outdoor spaces, as well as daily activities and caregiver interactions. She also breaks down pricing.

He’s career path was indirect. She moved from art and design to storyboard directing at an ad agency, then spent eight years in children’s education before working as a nursing home marketing director. After seeing seniors disabled by falls and home accidents, she opened a store in 2021 that catered to senior tastes and needs, before pivoting to her current role as a senior care manager. She has also obtained governmental certifications as a senior elderly assessor and social worker. 

“This wasn’t a sudden idea. It came from years of observation and experience,” He says. “I saw that families often faced information gaps, struggled to make decisions, and felt a lot of pressure when choosing care services.”

As a senior care manager, she works with a wide network that includes nursing homes and services such as medical escorts, assisted bathing, home modifications, and in-home care, tailoring solutions to each family’s needs.

“I stand with the family. My goal is to solve their problems,” she says.

Most of He’s current clients are strangers who found her online. Many are at a breaking point. “There’s a saying in the industry: one disabled family member makes for one unbalanced family,” she says. She evaluates each case remotely, from assessing seniors’ conditions and care needs to family circumstances, and recommends either institutional or home-based care, helping to connect them with resources.

He believes her value to families lies in three key areas: streamlining the search for care options, enhancing understanding of services and costs, and alleviating emotional strain. “During moments of desperation, families fear making costly mistakes,” she says. “I provide them with guidance and tangible solutions.” 

She also aims to enhance outreach and promote transparency within the industry. Many nursing homes struggle with visibility, and He offers an affordable way for them to connect with prospective residents.

Kangyi Yiyuan, founded in 2019, is one of Chongqing’s largest nursing homes, with over 400 beds, roughly 85% of which are occupied. Zhou Xuemei, Kangyi’s director, says that since their cooperation with He began in November 2022, she has referred more than 180 potential residents; over 50 ultimately moved in. Kangyi pays He a commission of 20% of the resident’s first month’s fee after completion.

Beyond middlemen

In Changsha, capital of the central Hunan province, 37-year-old Yang Yang and her colleague also work as senior care managers, partnering with over 120 nursing homes in the region.

Yang has observed that adult children seeking care options for their parents often face a double burden of being unable to juggle both work and caregiving, but fear making the wrong choice for their parents. 

“It’s not always about money. Even families with limited means often end up paying for care because otherwise they can’t hold their lives together,” Yang explains.

The term “care managers” has recently been romanticized online, according to Yang, with some promoting it as a way to earn a high income quickly. “That attracts a lot of people who think it’s an easy path,” she says. But in reality, few achieve those results. “This industry requires steady, long-term effort,” she says. “There’s no shortcut.”

With an aging population, rising disability risks, and a significant percentage of only children who must shoulder parental care burdens alone, He believes the demand for care managers will continue to grow in China. She has chosen to broaden her approach, launching a national training program for care managers and working toward a cross-city network.

But, He says, if the profession is to become more widespread, senior care managers must stay focused on the family’s needs. “We have to avoid just becoming middlemen selling information.”

She also acknowledges the limits of her role. “A nursing home’s true strength is in the quality of its care, not marketing,” she says. “I can’t change that. What I can do is help families make better, more informed decisions.”

What drives her most is the feeling of being needed and the sense of purpose the work brings. “Many families thank me afterward, saying I helped them get back on track and ensured their loved ones are well cared for,” she says. “That kind of feedback keeps me going.”

Contributions: He Qitong; editor: Marianne Gunnarsson.

(Header image: Visuals from Flashvector and Macrovector/VCG, reedited by Sixth Tone)