Do Preferences for Old-Age Care Among Older Adults in Contemporary China Deviate from Traditional Familial Care?

Background and Purpose: In Chinese tradition, the responsibility for old-age care belongs to adult children. However, due to falling fertility, decline of intergenerational coresidence, and erosion of Confucian ideology, the traditional family model is becoming increasingly difficult to sustain in contemporary Chinese society. As classic modernization theory postulates, when a society becomes modernized with urbanization and industrialization, traditional family value declines, and children’s obligations to older parents weaken. With modernization, it is reasonable to hypothesize that parents would adjust their expectations of traditional familial care in old age. This study aims to provide timely information of Chinese older people’s preferences for care provision. 

Methods: We analyzed data collected from a random sample of adults aged 55 and older living in Shanghai in 2018. Respondents were sampled through a stratified multistage probability sampling design. A total of 1,200 were sampled and 882 completed the survey, yielding an overall response rate of 73.50%. Preferences for care provision were coded into a 4-category variable: (1) family care provided by adult children, (2) family care provided by spouse, (3) community care, and (4) residential care. Multinomial probit models were employed for the study. Three sets of explanatory variables were examined: (1) socioeconomic resources measured by education, income and former employment sector, (2) perception of children’s filial piety measured by overall rate of children’s filial piety, and children’s frequent visits, and (3) practicality factors including numbers of children, whether providing grandchild care or housework assistance to adult children, and whether living in a relatively aging-friendly community. Demographic characteristics and health conditions were also included as control variables.   

Results: Results show that family care provided by spouse was the most preferred care provision for older people, while residential care was the least preferred one. Higher individual socioeconomic status facilitated deviations from the traditional family care provided by adult children. Older people who experienced more filial piety from their children were more likely to prefer the traditional family care provided by adult children. Practical factors also mattered. Those providing care for grandchildren were more likely to prefer care by adult children. Living in a relatively aging-friendly community enabled older adults to choose non-traditional care provision.

Conclusions and Implications: The study suggests that modernization does not necessarily result in less traditional familial care preferences. While developing an aging-friendly environment in communities might encourage Chinese older people to choose community care as an alternative and thus may ease the heavy family burden of increasing demands for old-age care.