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Sun R and Wang H

1.4. Worry about Eldercare and Hypotheses

1.4.1. The impact of economic resources and community services

As reviewed earlier, the traditional practice of having adult children taking care of older adults has been under pressure
from drastic demographic changes in the past decades in China. As both the number of children and the proportion of
older adults coresidence with adult children are declining, it is becoming more infeasible to totally rely on families to
provide eldercare. In light of these challenges, the state has increased investment in welfare programs to provide older
adults with more resources in income and health-care coverage, which have started to show effect. For example, health
insurance programs in urban and rural areas, mainly UEBMI, URBMI, and NCMS, have been found to be effective in
booting health-care utilization, although rural area coverage is less generous (Zhang, Nikoloski, and Mossialos, 2017).
With expanding public pension and other welfare programs, older adults, especially those in urban areas, have more
disposable income and become less dependent on others financially. Even for those living in rural areas covered by NRSP,
which offers lower benefits than in urban areas, the benefit level has doubled between 2009 and 2013. The NRSP coverage
is expanding rapidly with increasing government subsidies. Several studies have shown that pension from NRSP to rural
residents has improved their sense of personal security, self-esteem, and ability to support themselves. Meanwhile, it
reduced their worries about later life (Liu et al., 2015). The expanding health-care coverage makes medical treatment
more affordable and accessible. Furthermore, the increasing availability of community services provides older adults
with alternative options in seeking care. More older adults turn to affordable and responsive community services for help
instead of relying on children (Leung, 2010). Such a trend has been observed in some other Asian societies. In Japan,
which shares Eastern Asian traditional culture, there has been a shift from family care to socialization of care. Eldercare
responsibilities have gradually been transferred from the family to the state (Hayashi, 2011). It has been reported that
as pension programs were implemented in Taiwan, there was a substantial decline in older adults relying on private
monetary transfers (Chan et al., 2003). A study in Thailand found that the financially better-off older adults were more
likely to pay non-relatives for caregiving than those less wealthy (Knodel and Chayovan, 2012). By the same token, older
adults with less power and fewer resources in Hong Kong showed a stronger expectation to be taken care of by their
children because of limited choice (Ng, Phillips, and Lee, 2002). Similarly, in Spain, characterized by a high proportion of
multigenerational households in Europe, it is the disadvantaged older adults with lower educational or financial status who
are more inclined to coreside with relatives (Fernandez-Carro, 2016). Knodel (2012) predicted that with the expansion
of state welfare allowance programs, such as pensions and social security type of benefits, there would be a reduction in
reliance on children for eldercare, and an increase in the use of formal services to substitute for it.
It seems that expanding welfare programs and community services provide older adults with an alternative and viable
option of receiving care. Therefore, we hypothesize that older adults’ socio-economic resources, mainly their income and
health-care coverage, and the availability of community services will make them less worry about eldercare (Hypothesis 1).
1.4.2. Does the family still matter?
As older adults have more resources at their disposal and have more access to community services, an interesting and
important question emerges: Is the family still relevant, or at least becoming less important? The picture is not as clear as
evaluating the impact of the resource factors discussed above.
On the one hand, Cowgill and Holmes (1972) claimed that, in the process of modernization, one traditional function
of the family of supporting its older members might fade away as a social welfare state gradually took its place. Older
adults’ increasing resources from outside the family, largely due to the establishment of public welfare programs, may
make them less dependent on the family networks for support, such as seeking medical treatment and eldercare. Typical
aspects of family structure, such as number of children and whether living with adult children, may become less critical.
A comparative study of four Asian societies found that family size was not particularly important in determining the care
older adults received when there was a remarkable decline in fertility. What mattered was children’s character rather than
the number (Asis et al., 1995). Living separately from children may not necessarily imply older adults being abandoned
or an erosion of traditional family values. The practice of multi-generational coresidence might be partly attributed to
housing shortage in the past (Zavoretti, 2006). Living in separate residence has been reported to be preferred by some
aging parents and their children in China. Although living apart, parents and married children maintain frequent contact
and offer support to each other (Whyte, 2003). As Taiwan experienced industrialization and growth in income before
the end of the last century, many older adults expressed interest in independent living that provides privacy and freedom
(Lee, Lin, and Chang, 1995). A similar trend was observed among Chinese older adults in Singapore (Mehta, Osman,

International Journal of Population Studies | 2019, Volume 5, Issue 2 3