Certainty Matters: Applying Prospect Theory to Analyses Relocation Decision-Making Among Childless Older Adults in Rural China

Background and Purpose: Approximately 20% of childless older adults in rural China choose to move into residential care facilities (RCFs), however, their experience of decision-making has never been explored. Previous research regarded childlessness as a category of vulnerability or simply related childlessness with institutionalization, which rendered the voice of childless older adults unheard.

This research applied prospect theory to explore how relocation was perceived, evaluated, and why moving to RCFs were preferred. Additionally, this research would provide suggestions to policy makers to better understand childless older adults, as they constitute the majority of residents at RCFs in rural China.

Method: 27 qualitative in-depth interviews were conducted with childless rural residents in Yunnan Province, one of China’s most economically disadvantaged provinces. A constructivist grounded theory approach was adopted; participants were asked to describe (a) the reason of relocation (b) the general life condition after relocation and (c) the future expectation. The sample contains 11 male, 9 female and 7 other informants (e.g. village administer, staffs at RCFs), and all participants aged from 60 to 83 years old. All interview data were taped, transcribed, compared, and repeatedly analyzed in Chinese, an in vivo coding strategy was used to capture local language and meanings.

Results: Childless older adults had been informed by antipoverty work team or village administrator about the residential choices: to remain at their own home or to relocate to RCFs, once their childlessness status was identified. It usually took one or two years to evaluate, compare and finally made the relocation decisions. When evaluating the relocation decision, three subthemes emerged: 1) possible difficulties when remaining at rural community, as farming in rural place were laborious, stressful and full of uncertainty; 2) sense of security after institutionalization, as RCFs required less farming involvement; 3) selected autonomy after institutionalization, as participants endeavored to maintain their old habits to balance the RCFs regulations and their own lifestyle.

Findings suggest that participants referred to their farming capacity as reference point to consider whether the relocation were necessary. Because farming was overall laborious and demanding, relocating to RCFs represented a sense of predictability, security, and control. In essence, the relocation choice mirrored an expectation of certainty. Further, this research also revealed that residential dwellers adapted to a variety of strategies to regain their autonomy, so the unpleasant aspect of institutionalization – usually involved with strict regulations and undermined autonomy - could be smoothed.

Conclusions and Implementations: The research underscores the importance of certainty when relocating to RCFs, as childless older adults has experienced life-long vulnerability and uncertainty in rural place. When delivering services at RCFs, social workers and staff could balance the sense of certainty with RCFs regulations, fostering person-centered a care plan to enhance autonomy among childless older residents. Policy makers would also pay attention to the certainty-seeking preference among childless older adults when initiating the ageing-in-place (AIP) policy.