Dispatch from China by our mobile Director of Communications
With a long interest in eldercare, I’ve always taken note of the older people anywhere I travel. I try to learn and observe how elders are treated in different societies, as well as find out different nuances about how families and the country’s systems manage care for elders needing assistance.
Having lived in the People’s Republic of China for almost two years, I am slowly learning more about this culture and have tried to do a lot of reading to overcome some of my ignorance, and many misconceptions. There is a lot about the “Eastern” versus “Western” perspectives that can make it a big gap to bridge. For anyone interested in this subject, I highly recommend The Geography of Thought: How Asians and Westerners Think Differently…and Why by Richard Nisbett as a good primer (based in research). Clearly, filial piety, group/relationship orientation and an intergenerational focus provide the framework for caregiving here. Traditionally, this is a culture very based in familial responsibility and generations caring for one another, living together, etc. Lessons from Confucianism, Buddhism and Taoism form much of the value system. Of course, China also has a unique historical and political history to contend with in terms of its system and norms.
Now, China (in so many ways) is struggling with a rapidly changing society and various repercussions. The top one when it comes to eldercare being that (recurrent) theme of declining birth rates/availability of younger generation to help the older. In China, this has presumably been exacerbated by the one child policy. Additionally, as the population becomes rapidly wealthier and living conditions improve, life expectancy has increased. The family structure of today is often called 4 to 1, i.e. four elders (two parents and two grandparents) for one adult child to care for. In a culture where (despite my grade school idea of “communism”) there are few safety net supports, the burden of care typically is both physical/emotional and financial. Additionally, there has been a mass migration of rural people to cities for work opportunities over the past few decades. Many times elders remain in the villages, often with the grandchildren (at least until the parents can afford to bring them or they are old enough to go to school). Now, many rural communities are home almost solely to older residents and these very young children. Benefits such as schooling and healthcare are also tied to the residency system (hukou), adding challenges for the migrant worker families.
Many societies are struggling with providing for our elders under modern conditions, and we can learn a lot from each other’s problems and solutions. China has recently seen the “import” of some western concepts of eldercare help, from a couple of international private duty home care companies starting services here to the first private assisted living facilities. A subsidiary of Emeritus opened a facility in Shanghai last year, which I hope to tour at some point. A care facility here has typically been seen as a last resort for the very poor, so this concept is a huge leap. It sounds as if the companies have done their homework on trying to make some cultural adaptations. However, I understand that the care facility is only operating at about 20% occupancy, so it is far from a wild success at this point.
Clearly more options are going to be necessary as things change. There are not going to be easy answers for China or anybody else as we all work towards meeting the challenge of caring for our elders. There has been a lot of discussion about changes to the one child policy (there have always been some exceptions to this rule for rural families, ethnic minorities and those who can pay a penalty fee) and some adaptations have been made to attempt to alleviate the pressure of the “4 to 1” structure for two only children marrying. Interestingly, some research points to the fact that, policy or not, many young professionals no longer desire to have more than one child (as we are seeing in most European countries and Japan, where the population shifts have been dramatic).
Another aspect of eldercare that has continued to crystallize for me here is the challenge of long-distance caregiving. As the entire world becomes more mobile, more of us face this issue. The expat community in Shanghai is very large, estimated at about 200,000. I probably have at least one conversation each week with someone who is concerned about an aging parent at home. One friend has a daily check-in phone call with his parents and he and his wife make several trips back each year to handle appointments, check to see how things are going and make arrangements and plans. Another friend expressed her suspicions that Mom has a chronic illness and has not yet told the family. I personally had the experience a couple years ago, while living in Spain, of getting the phone call in which my Mom told me she had two brain tumors and would be going in for surgery within the month.
Fortunately, technology has made it easier for us to keep in touch and travel quickly and we can avail ourselves of many resources to assist. In the U.S., we’re fortunate to have a very strong geriatric care management profession, which is well-equipped to support long-distance caregivers with services like geriatric assessments for a clear picture and road map. Of course, what is available in each country varies in addition to the family’s personal and economic resources. Given that, I am hopeful however, that most of us can now access better information to understand options and we can share ideas and resources worldwide to help us all better care for those we love.
These are so many different cultural perspectives on eldercare and healthcare, as well as innovative ideas in different communities. I would also love to hear from you about your experiences (feel free to leave us a note or connect on social media). I look forward to sharing more about what I learn from my travels and research!