Sole Caregiving from Afar: Reconceptualizing Transnational Caregiving Among Chinese Only Children in the U.S

Background:
Global migration and China’s one-child policy have produced a unique caregiving cohort—Chinese only children living abroad—who shoulder sole responsibility for aging parents across borders. Rooted in Confucian filial piety and shaped by demographic realities, these caregivers navigate emotional, logistical, and moral challenges often invisible in mainstream caregiving models. This study explores how Chinese only children in the U.S. define and enact transnational caregiving, and how their experiences challenge conventional caregiving frameworks that rely on physical proximity and shared family responsibilities.

Methods:
This qualitative study employed Interpretative Phenomenological Analysis (IPA) to explore the lived experiences of Chinese only children who have provided or plan to provide transnational caregiving from the U.S. Participants were recruited through social network sites commonly used within the Chinese community and interviewed via Zoom or WeChat. 26 eligible participants—8 males and 18 females, aged 27 to 45 (mean age = 36.44)—took part in in-depth interviews conducted between September 2024 and March 2025. Interviews were transcribed and analyzed using IPA, with reflexive memos and audit trails to ensure analytic rigor. Group experiential themes were developed to identify shared meanings of transnational caregiving.

Results:
Seven key dimensions characterized participants' understandings of transnational caregiving: (1) Bridging Cross-National Information Gaps – Participants translated and contextualized health information between countries, navigating misinformation and geopolitical anxieties; (2) Bilateral Healthcare Planning – Participants compared eldercare systems in China and the U.S., weighing long-term options and insurance policies amid legal, financial, and regulatory complexities; (3) Transnational Care Management – Daily responsibilities included wiring funds, scheduling appointments, managing medications, communicating with healthcare providers remotely across time zones; (4) Promoting Preventive Health – Caregivers encouraged screenings and shared health education as a strategy to delay emergencies; (5) Emotional Caregiving and Informal Monitoring – Frequent calls and subtle assessments of tone and appearance helped caregivers compensate for parents’ tendency to conceal health issues; (6) Building Local Support Systems – Efforts to create a care network around their parents locally in China were central to the caregiving strategy; (7) Caregiver Self-Care as Filial Labor – Maintaining their own health was framed as a form of care for parents, who often prioritized the well-being of their adult children. Participants articulated a deep sense of non-negotiable obligation shaped by Confucian values and demographic realities. New concepts such as compensatory care—the symbolic, emotional, and logistical practices used to maintain connection and presence across distance—and filial piety anxiety—the psychological strain of falling short of culturally embedded caregiving ideals—emerged, highlighting the emotional, strategic, and symbolic labor involved in caregiving from afar.

Conclusions and Implications:
This study reconceptualizes transnational caregiving as a multidimensional and culturally anchored practice. Chinese only children serve as emotional anchors, information brokers, care navigators, and long-distance advocates—roles largely unrecognized by current caregiving frameworks. Their stories underscore the emotional and strategic labor of caring from afar and call for policies that reflect these realities. Expanding caregiving definitions to include transnational, sole-provider contexts is critical in designing responsive services, immigration pathways, and culturally competent support systems.