By Jeremy Craig
For millennia, Confucian ethics in China placed filial piety — respect for one’s elders — as a matter of cultural duty and obligation, including a duty to care for one’s family in old age.
Traditionally, the obligation fell to elders’ children, who would customarily take care for their loved ones at home. But in the face of having the world’s largest population, China’s one-child policy was implemented to reduce rapid population growth.
Now, there are fewer children to care for their elders. And with more children working full-time in an urbanizing country, the time crunch leads to a disruption in the ability to care for aging parents.
Georgia State University’s Jenny Zhan, associate professor of sociology, is investigating how the one-child policy and the relatively new, more widespread practice of institutionalized care is changing social policy and culture in a nation that has experienced rapid economic, cultural and societal change over the past few decades.
“Because of major demographic changes, as the population grows older and there are fewer children to care for older adults, the question is whether these changes will lead to changes in culture,” Zhan said. “Will there be a major shift in cultural expectations — that adult children are not expected to provide care?”
With the support of a Fulbright grant this summer, Zhan is working with Nanjing University and Nankai University in China, and Brown University in the United States, on continuing research about senior care institutions in the city of Nanjing, located 150 miles west of Shanghai.
Understanding Confucian ethics is an important part of understanding the traditions of elder care in China. In Confucian ethics, which are central to Chinese philosophy, the country is viewed like a family.
“If you can be a good head of a household, you can be a good emperor,” Zhan said. “To be a good emperor, you need to be a good father. To be a good father, you must raise your children to respect certain virtues, including respect for your parents. If you have a major disruption in your culture, all of a sudden, people are at a loss.”
In the wake of China’s rapid economic development and urbanization, families are much smaller, and the sole adult child works full time and does not live within the same household. Furthermore, many adults have gone abroad, leaving their parents at home.
“In a culture as old as China, a rapid cultural change could mean many different things,” Zhan explained. “A rapid cultural change could mean that at a microlevel, there could be a major disruption in the family and in family tradition in terms of what is done on a daily basis.”
In the next few decades, as in many other nations around the world, the baby boom generation in China will grow into retirement age, creating a wave of older adults — perhaps as many as 350 million, based on projections — who may need to change their living situation either by moving in with their adult children, or by entering a long-term care facility.
These facilities range in the level of care and independence, from assisted living facilities to more traditional nursing homes.
These facilities have been commonplace in the United States, but in China, they were not as widespread until the 1990s, Zhan said. In the city of Nanjing, where Zhan will perform research this summer, prior to 1990 the number of elder care facilities could be counted on one hand. Now, there are more than 200.
The nature of once-rare elder care facilities is also changing. Those facilities which existed more than 20 years ago were only run by the government, but most facilities are now private, earning income through the charging of fees and government subsidies of 200 yuan (U.S. $30) per bed.
Zhan is working to characterize the different levels of care at the facilities, which have not been chronicled by the government, as well as demographic information about those persons living in them.
Another topic of interest for further research is whether there is a stigma in placing older adults into facilities in a country where institutionalized care was not the norm.
“There has always been an assumption that there is a stigma, but there's no experimental research on this issue,” Zhan said. “If there is a social stigma, will it delay or prohibit people's willingness to go into an institution, even if there is a major demographic change? It is a major challenge.”