With an increasing number of elders moving into nursing homes, the shift from family to nursing home care calls for an exploration of caregiving decision-making in urban China. This study examines how a rapidly growing aging population, the one-child policy, and economic reform in urban China pose unprecedented challenges to the country’s ingrained tradition of family caregiving. It presents interviews of matched elders and their children from a government-sponsored nursing home in Shanghai and analyzes the decision-making process of institutionalization. This book offers fresh insight into the evolving culture and arrangements of caregiving in contemporary Chinese society, illuminating the diverse needs for long-term care of Chinese elders–the world’s largest aging population–in the coming decades.

China, which is fast on its way to becoming the most powerful economic force in the world, has four unique characteristics that distinguish it from other countries in Asia: (1) The proportion of aging population is growing faster than that of Japan (the country previously recognized as having the fastest rate) and much faster than nations in western Europe. (2) An early arrival of an aging population before modernization has fully taken place, with social policy implications. It is certain that China will face a severely aged population before it has sufficient time and resources to establish an adequate social security and service system for older people. (3) There will be fluctuations in the total dependency ratio. The Chinese government estimates are that the country will reach a higher dependent burden earlier in the twenty-first century than was previously forecast. (4) The government’s fertility policy (single child per family) and its implementation has a strong influence on the aging process. Fewer children are being born, but with more elderly people a conflict arises between the objectives to limit population increase and yet maintain a balanced age structure (Peng and Guo 2001). The intersection of these fourfold factors means that the increased aging population is giving rise to serious concerns among Chinese social policy makers. There is a chronic lack of good resource materials that attempt to make sense of social policy in its relationship to examining the problems and possibilities of human aging grounded in an analysis of economic of social policy in China and impact on rural and urban spaces. Such analysis of China will be covered by conceptual, theoretical, and empirical approaches. The book will also discuss substantive topics of housing, community care, family care, pensions, and mental health. The book brings together a truly world class array of researchers to provide discussions of critical implications of aging social policy and the economic impact in China.

This thesis uses an anthropological approach to examine the current social status of the young elderly in contemporary urban China and explores the problems these people are facing. A review of literature sets up complementary theoretical frameworks for the understanding of the interaction between changing social environment and transitional life experiences of the young elderly. Discussion of historical circumstances provides the background for transitions with reference to family structure, intergenerational relationships and family life in contemporary China. Discussion includes the role and effect of related state policies since the Communist Party came to power in 1949. Data were collected from eight case studies through personal interviews with Chinese students and their elderly parents in the United States. Other data came from several informants interviewed by the author in China. Analysis focuses on the changing financial, emotional and physical status of the elderly within the social, economic and political context of urban China. Results of the study show that the social status of the elderly has changed in the direction of favoring younger generations. Elderly people in contemporary urban China are experiencing extreme challenges and various kinds of insecurities related to role transition. The state has played a critical role in leading to this situation.

The contributors to this book present case studies of elder care in China and India, and draw comparisons between the two – illuminating some of the key issues facing the two largest Asian countries as they develop rapidly. Caring for the elderly is a major challenge for all countries, and one which is of acute concern for rapidly developing economies. Development tends to run counter to long-established cultural norms of family-based caring and filial piety, even as it also tends to lead to longer life expectancy. Taking a range of methodological and conceptual approaches to understanding these challenges, the contributors present a multifaceted understanding of elder care issues in both India and China. They focus in particular on caregiving within families and at care homes – and the impacts these have on quality of life and the experience of caregiving for both caregivers and the aged themselves. An invaluable collection for scholars and students of gerontology and aging in Asia, that will also be of great interest to scholars with a broader interest in global trends in caregiving.

Informed by the social-ecological framework, this book focuses on the development of Home and Community Based Services (HCBS) in urban China. Bringing a timely discussion around HCBS development in Shanghai, it presents an interplay of formal caregiving relationships, evolving caregiving culture, and the trajectory of long-term care in China. Drawing on surveys, in-depth interviews, and government archives, this book explores the emergence of one of the most developed HCBS programs in Shanghai, its development over the past decade, its administration and services, resource allocation, staff members’ work experiences, older adults’ service experiences, as well as service evaluation and improvements. Offering fresh insight into new forms of caregiving in community settings, and shaping a new discourse on caregiving policy, this book is a key read for both students and practitioners in the fields of long-term care, gerontology, geriatrics, health care, and health policy.

China is aging at an unprecedented rate. Improvements in life expectancy and the consequences of the decades-old family planning policy have led to a rapid increase in the elderly population. According to the United Nations World Population Prospects, the proportion of older people age 65 and over will increase by about one-fourth by 2030, and the elderly will account for about one quarter of the total population by 2050. Population aging will not only pose challenges for elder care but also have an impact on the economy and all aspects of society (World Bank, 2016a). The government is aware of the need to develop an efficient and sustainable approach to aged care. To this end, the General Office of the State Council issued the 12th Five-Year Plan for the Development of Aged Care Services in China and the Development Plan for a System of Social Services for the Aged (2011-2015). It is now in the process of formulating the 13th Five-Year National Plan on Aging, which will further elaborate and finalize the reform roadmap for 2016 to 2020. The Plan is expected to be finalized and launched by June 2016. The National Development and Reform Commission (NDRC) helped draft these plans and is now leading the development of policy measures for the provision of social services for the elderly. This volume has been prepared to support the translation of the broad ideas on aged care provision expressed in the 12th and 13th Five-Year Plans and other government plans into reality and to help the government tackle the challenges described above. It strives to identify a policy framework that fits the Chinese context and can be put in place gradually. Specifically, it aims to provide an up-to-date understanding of the evolving aged care landscape in China; review international experiences in long-term care provision, financing, and quality assurance and assess their relevance to China’s current situation; discuss implications of current developments and trends for the future of aged care in China; and propose policy options based on available evidence and best practices.