The process of modernization in China is occurring in a context of rapid population ageing—the reverse of the sequence in the West—and presents serious challenges to the tradition of reliance on family and work unit support. This paper examines the impact of post-Mao economic reform, including the de-collectivization of agriculture, the loosening of restrictions on migration, and housing and enterprise reform, on the support systems of China's elderly. Delivering family support has become increasingly problematic, and researchers and policy-makers have begun urging the Chinese government to take practical steps to alleviate the situation. They point out that most children are doing whatever they can, but that the financial and opportunity costs of providing care exceed what is possible. They urge the government to address problems of elderly poverty by developing rural pension schemes, major illness insurance and long-term care insurance, by increasing hospital and community health services for the elderly, and by training basic-level workers in the special needs of the elderly.