The People’s Republic of China has the largest population of older persons of any country in the world. It is a nation that has experienced enormous economic, social, and demographic changes over the past three and a half decades. Traditionally, the family was the main social support for older persons; this changed somewhat under early socialism, but in recent years, the importance of family support has been reasserted. However, over this time, the family’s ability to support its older members has been considerably altered and arguably weakened. This article reviews four key issues (population change, the hukou system, economic reform, general features surrounding modernization) that have gradually changed families’ capacity to provide support for older members. Research foci and public policy directions are considered under which the state might take some responsibilities from the family, support capacity to care, and improve the quality and quantity of support for older citizens.