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Increased life expectancy in China implies that adults increasingly survive long enough to see their grandchildren reach adulthood and take on elevated importance—even as smaller family size reduces the number of children and grandchildren available. This article examined the prevalence with which older adults received support and care from grandchildren and the family conditions under which the likelihood of this assistance is enhanced. The data for our analysis derived from the 2014 wave of the Chinese Longitudinal Aging Social Survey, limited to 13.4% of respondents (n = 1,551) who reported requiring personal assistance to perform daily activities. Logistic regression revealed that grandparents were more likely to receive assistance from grandchildren when they had no son available or had daughters who did not provide assistance. Results were consistent across urban and rural regions. These findings support the compensatory or substitution role of grandchildren as sources of support and care for their grandparents within a gendered family system. Implications for policies and services serving older people in China are discussed.