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Worry about eldercare in China

well. Japan and South Korea, two leading industrialized countries coupled with rapid population aging, have witnessed
a significant expansion of both public and market provisions of eldercare since the 1990s. Care burdens traditionally
assumed by women in these societies are gradually shifted to the market and community (Peng, 2012). There has been
discussion in China about the distinction between family care – the traditional practice where eldercare is entirely given
by family members – and at-home care – where older adults use financial resources to acquire daily care and services from
the community or neighborhood. The latter is considered a social eldercare model (Chen, 2002). Eldercare, which has
been mainly limited to the family as the sole care provider, is gradually giving way in China to a shared responsibility of
the family, state, and market. Boundaries are crossed between informal and formal, public and private sectors (Zhang and
Yeung, 2012). As a result, more community services emerge in both urban and rural neighborhoods, such as household
work, health care at home, companionship, and meal services. Although the development of these services is still at
its early stage, the results show that the services that meet older adults’ needs do reduce their worry about eldercare
(Zhang, 2002). In the future, not only are more services in demand but also will be the kinds of services that suit local
circumstances and satisfy the real needs of the elderly residents (Zhang, 2002).
The support of the first hypothesis seems to suggest that the constraints faced by older adults, such as smaller family
size and less chance of living with adult children, can be compensated by their improving resources at disposal and greater
presence of community services resulted from the ongoing socio-economic development. Some believe that in the process
of modernization, the social model will ultimately replace the family eldercare model and become the dominant form of
care (Chen, 2002). Our analysis, however, points to a different direction. Family ties between generations still matter to
older adults. The finding that while fewer older adults were living with their adult children, the percentage of older adults
not worrying about their children’s filiality went up instead of going down during the same decade suggests that family
bond remains strong China. The higher percentage of older adults living alone cannot be simply interpreted as evidence
of the erosion of traditional values. Independent living of older adults is transitory in nature, which is one phase of the
eldercare process. It has been found that Chinese older adults would like to live independently in their family as long as
their health permits (Gu, Dupre, and Liu, 2007). Coresidence is still the ideal living arrangement when older adults’ health
deteriorates and need for daily assistance arises. This has been found in Taiwan, the Philippines, Thailand, and Singapore
as well (Asis, Domingo, Knodel et al., 1996). Moreover, as discussed earlier, the prominent role of coresidence in Asian
societies may not only lie in its practical function of providing eldercare but also in its compliance with traditional
practice, which is viewed as an expression of filial piety.
This study has its limitations. First, since the survey from the two-time points does not follow the same cohort, it
prevents a life course analysis of changes with age, such as the living arrangements and worry about eldercare, which
would be more revealing about the dynamics of their relationship. Second, this study also has measurement shortcomings.
The measurement of unmet need may not be accurate because the need for some older adults may not be met even if
the community services are available. Other aspects, such as the quality of services, maybe at work as well. In addition,
some of the variables on income and medical care coverage are still crude measures. For example, while the percentage
of receiving health-care coverage increased from 63.3% in 2000 to 95.7% in 2010, the change in the percentage of not
worrying about medical care was much less impressive: Only from 46.8% to 49.9%. This may reflect the disparity in
benefit coverage among older adults between regions and urban/rural areas. There is also a wide variation in the cost of
living. We attempted to address this by including subjective measures on worry about income or medical care in the paper.
Third, since the development of community services for older adults is only at its early stage in China, the availability and
usage of some types of services are still uncommon. Their full impacts remain to be seen. As reported earlier, we did find
a distinction between the availability and unmet needs of certain services. It would be interesting to do a more in-depth
analysis on this subject, which is beyond the scope of this paper.
Despite these shortcomings, the findings of this study clearly show that the family is still the ideal institution for eldercare
in China, even as it has undergone profound socio-economic transformations. As the state increases investment in welfare
programs to improve older adults’ financial and medical care coverage and to provide more community services, what
shall not be overlooked is polices that strengthen family ties between generations. It is unrealistic and counterproductive
to expect to replace family eldercare with formal services. The value of filial piety and the responsibilities it entails should
be upheld and encouraged (Chow, 2004). Measures should be taken to enable and facilitate increasingly shrinking and
dispersed families to engage in eldercare in varying forms and shapes (Chan, 2005). Formal services should serve to
crowd in, rather than crowd out, traditional family support (World Bank, 1994).
Acknowledgments
The authors would like to thank the two reviewers for their helpful comments.

10 International Journal of Population Studies | 2019, Volume 5, Issue 2