Navigating Transnational Caregiving: Exploring the Decision Making Process Among Chinese Only Children Generation

Background:

The term "Chinese Only Children" refers to individuals born under China’s one-child policy (1979–2015), which restricted most families to a single child. With fewer younger family members to rely on, only children live abroad face heightened challenges in caring for their aging parents from a distance. This phenomenon raises crucial questions about how decisions are made regarding where care should be provided—whether by bringing parents to the U.S., returning to China, or coordinating from afar. This research aims to develop a theoretical framework of the transnational caregiving decision-making process, highlighting the unique challenges and constrains faced by the one-child generation in a globalized world.

Methods:

Guided by grounded theory for data collection and analysis, we employed theoretical sampling to recruit participants through a survey distributed on social media platforms commonly used within the Chinese community. The survey included screening questions to identify only children born after 1975—the year China’s one-child policy was implemented—who had either previously provided or were planning to provide transnational caregiving to their parents while residing in the United States. A total of 26 eligible participants took part in in-depth interviews conducted between September 2024 and March 2025. These interviews explored participants’ caregiving decisions and plans, as well as the personal, familial, cultural, and structural factors shaping their choices.

Results:

From the analysis, a theoretical framework of the transnational caregiving decision-making process was developed. Key factors shaping these decisions across three major domains were identified: (1) Decisive Factors – These set the baseline for decision-making, particularly the current urgent health status of the parents, which may limit their ability to travel or relocate, especially under urgent care situation. (2) Restrictive Factors– These constrain the range of caregiving options available to the only child. They include family structure and the availability of alternative caregivers, community support networks, the child's financial resources, job flexibility, and immigration status in the U.S., as well as the parents’ own financial resources and social capital. (3) Influential Factors – These shape the caregiver’s willingness and often play an important role in the final decision. They include the only child's long-term settlement plans, the parents’ willingness to relocate, and both parties’ familiarity with healthcare and insurance systems in China and the U.S.

Conclusions/Implications:

The decision-making process for Chinese only children engaged in transnational caregiving is a deeply family-centered experience, shaped by urgent care needs, structural constraints, and personal or familial preferences. These findings reveal the pressing need for culturally responsive policies and support systems that address the complex realities of caregiving across borders. As one of the first studies to explore this issue within the context of China’s one-child generation, it makes valuable contributions to ongoing efforts to promote healthy aging, alleviate caregiver stress, and strengthen transnational family connections in an era of growing global mobility and demographic changes.