Time is running out. In April, Li Fang will leave Shanghai to reunite with her family abroad. Her only concern is her mother, who lives in a nursing facility and suffers from Alzheimer's disease. "If I leave, who will visit her?" Weeks ago, Li Fang stumbled upon a post on social media offering "substitute visit" services. She decided to give it a try and arranged for the poster—a young man—to meet her mother. Unexpectedly, they hit it off so well that the visit exceeded the scheduled time. "For the coming days, I’ll entrust you to visit her weekly on my behalf," Li Fang agreed with the young man.
Meanwhile, the young man, who began frequently visiting the nursing facility, noticed that not only his client but other residents were also warm and eager to chat. As a "temporary child," he sensed the elderly’s deep longing for companionship. This observation aligns with the findings of Shen Qi, a professor and doctoral supervisor at Fudan University’s Institute of Aging Studies and director of the AI for Good and Digital Elderly Care Research Center. Over the past five years, her research across hundreds of nursing facilities nationwide revealed that loneliness is widespread among the elderly, regardless of their physical condition. Similar situations are also common among older adults living alone in communities.
To explore how to balance daily care with emotional support for the elderly amid deepening urban aging, discussions were held with seniors, "temporary children," elderly care professionals, community social workers, and scholars.
The emergence of "temporary children" brings both hope and concerns. When other residents at her mother’s nursing home remarked, "Your daughter visits you so often, how lucky you are," Li Fang felt a pang of sadness. The 55-year-old Shanghai resident lost her father, and her mother lives in a Nanjing nursing home costing 10,000 yuan monthly. Before seeking "substitute visit" services, Li Fang traveled between the two cities weekly. While the physical strain was manageable, the emotional exhaustion was overwhelming. Her mother, who has Alzheimer’s, remembers her youth but no longer recognizes her daughter. Each visit required Li Fang to reintroduce herself, often triggering painful memories and leaving both in tears or silence. With her upcoming move abroad, Li Fang discovered a post by Xiao Qiu on the Xiaohongshu platform: "Substitute visits to offer companionship and ease family regrets." She thought, "Perhaps my role can be filled by someone else."
Xiao Qiu, a 1999-born Nanjing native with a master’s degree from a top-tier university, has a stable job and offers "substitute visit" services on weekends for 100 yuan per hour. He describes it as "a side job with social research elements." Having a grandmother with Alzheimer’s, he understands Li Fang’s struggle. His first meeting with Li Fang’s mother went surprisingly smoothly; she immediately accepted him as her "granddaughter’s friend." Sharing an interest in traditional opera, he engaged her in conversations about Kunqu, her past as a doctor, and even modern youth perspectives on relationships. Their lively exchange lasted an hour and a half, reassuring Li Fang. She considered it a form of quality companionship.
Xiao Qiu notes that besides Li Fang, he has received requests, such as accompanying an elderly woman for a haircut, from children in their fifties or sixties. "These ‘pre-seniors’ are active online and value emotional support over mere errands," he says. Similar posts offering "substitute visit" services are found on various social platforms, attracting young people, including students, though many in Shanghai report no actual bookings yet.
However, "substitute visits" operate in a gray area with risks. Shen Qi highlights ethical and qualification concerns, as there are no uniform standards or training in elderly psychology or dementia care, potentially causing emotional harm. Privacy and liability issues also arise from handling sensitive family information without clear guidelines. Additionally, emotional dependency may lead to distress if services end abruptly. Xiao Qiu acknowledges these risks, sharing his credentials with clients and preferring visits in nursing homes for safety in public settings.
Frequent visits made Xiao Qiu a familiar face at the facility, where other residents expressed admiration and envy. He wondered if seniors compared visit frequencies. Zhang Yamin, head of Shanghai Oustion Gucun International Nursing Center, notes variations: some seniors, like those with children abroad, adapt to solitude, while others expect daily visits from retired children, even tracking their punctuality. Shen Qi explains that moving to semi-closed environments like nursing homes often severs social ties, making visits a vital link to the outside world. While some independent seniors prioritize visit quality over frequency, those reliant on family bonds may feel abandoned if visits decrease.
To combat loneliness, nursing facilities in Shanghai encourage seniors to join club activities. Zhang Weiming, a resident at Taikang Community Shenyuan, befriended Tan Shuhui, a "00s" graduate in social work from East China University of Science and Technology, now a social worker there. Zhang appreciates sharing personal matters with younger staff without burdening his children. He seeks tech help from young care managers and enjoys exchanging life stories with Tan, finding solace in offering advice to the youth. Facilities like Oustion and Taikang have hired many post-95s and "00s" graduates in elderly care and social work, with some becoming beloved "grandchildren figures." Shen Qi observes that younger teams in mid-to-high-end facilities provide intergenerational emotional support, a unique advantage over traditional middle-aged caregivers.
In Shanghai’s "9073" elderly care framework, 90% of seniors age at home. However, those who are older, live alone, or have lost children need more support. Ai Huaguo, an elderly resident in Baoshan’s Gongkang Liucun, often visits neighboring Qicun to see "Xiao Cheng"—Cheng Xinghai, a "90s" community worker. Their first meeting was awkward, but Cheng’s persistence won Ai’s trust. Learning of Ai’s lupus and isolation, Cheng started daily morning greetings via WeChat for over 700 days. With 105 solo seniors among 1,647 households in Qicun, Cheng uses WeChat groups for check-ins but faces challenges with limited staff.
To improve home-based care, Shanghai launched a "property + elderly care" pilot, encouraging物业 firms to expand services like meal delivery, cleaning, and medical aid. Shen Qi views this as a crucial supplement, leveraging物业's proximity and responsiveness. However, mental health needs, especially for vulnerable seniors, often outweigh practical services. She advocates training物业 staff in basic elderly psychology and creating pathways to professional social workers, transforming物业 into frontline emotional support stations. Yet,基层 workers note that many物业 firms in older neighborhoods struggle financially, with fees under 1 yuan, focusing on core services first.
In the digital age, AI companions offer potential. Observations show many seniors adeptly use smartphones, payments, and live streams. Fudan’s research indicates older adults are more open to technology than stereotypes suggest. At a Shanghai rehab aids exhibit, the Ren couple traveled from Minhang to explore smart products. They inquired about "Youni," a 11-cm-tall chat robot understanding Mandarin and Shanghainese, costing 80 yuan monthly to rent (with subsidies reducing it to 40 yuan for qualified seniors). Priced under 1,000 yuan, it sold two units recently. Designed for emotional value, "Youni" engages in conversations, asks follow-up questions, and recalls past chats to comfort users. After 50 hours of talk, it generates a life memoir, though no user has reached that duration yet. Feedback urges integrating more services, like an information hub. Liu Qingtong, a rental service provider, notes seniors desire multifunctional robots.
Shen Qi emphasizes that amid caregiver shortages, robots are valuable supplements. For wider adoption, they need age-friendly design, emotionally intelligent AI trained on elderly dialogues, and full support services to address usage barriers. Crucially, integration with existing care systems is vital for real-time health monitoring and resource coordination, creating a "companion + monitoring + care" loop. Ultimately, genuine "heartfelt" care for the elderly cannot rely solely on machines but must enhance human-centric networks with smart technology.
(Note: Li Fang and Zhang Weiming are pseudonyms at interviewees' request.)