Journal of Cross-Cultural Gerontology

, Volume 31, Issue 3, pp 255–275

“I Am the Only Child of my Parents:” Perspectives on Future Elder Care for Parents among Chinese only-Children Living overseas

ORIGINAL ARTICLE

Abstract

The 1979 One­Child Policy in China created a generation of only children, leading to increased elder care dilemmas for this generation and its aging parents, particularly for young adults studying or working abroad. The current study used in-depth, semi­structured interviews with Chinese young adults who were currently studying or working in Montreal, Canada (N = 20), whose parents still lived in China. The interviews focused on the following topics: elder care patterns of respondents’ grandparents; family values and expectations; perceptions of professional long-term care institutions (in China and Canada); and future plans for taking care of aging parents. Respondents described their grandparents’ care as following traditional elder care patterns with multiple familial caregivers, which they appreciated as a positive model that defined their own obligations towards parents. Respondents reported being very close to their parents. Some planned to settle down in Canada and bring their parents, others planned to go back to China. Citing the tradition of filial piety, they expected to take care of their parents in the future, but they also considered the dilemmas involved in caring for aging parents without siblings to share the task, potentially requiring them to find compromises between their personal lives and caring for older parents. Those who planned to settle in Canada raised additional concerns about the challenges of bringing over their parents, including acculturation and access to and communication with health and long-term care providers. The results are discussed in the context of contemporary demographic, economic, and policy concerns about aging, family care, and immigration.

Keywords

Aging China Elder care Filial piety Future plans Immigration 

Introduction

In the late 1970s, the population of China was approaching one billion with a total fertility rate of about 3 births per woman. Concerns about overpopulation led the Chinese government to implement the “Family Planning Policy,” which encouraged young people to delay marriage and childbearing and strictly limited most families to only one child, particularly in China’s most urban areas. Children from these families are now referred to as the “only-child generation.” The policy, which is currently undergoing change to relax the one-child limit, was widely criticized for being coercive. Though it slowed population growth and reduced the total fertility rate to 1.66 births per woman in 2012,1 it has led to growing concerns about population aging.

Over the past three decades, declining birth rates and increased life expectancies have resulted in rapid growth in the proportion of older people. According to United Nations estimates, the percentage of persons in China aged 60 or older is projected to increase from 12.4 % to 28.1 % between 2010 and 2040 (United Nations 2013a), with a total number of persons aged 65 or older reaching 322 million (United Nations 2005). The old age dependency ratio is projected to rise from 12 to 39 per 100 working-aged adults by 2050 (United Nations 2013b). In the near future, most Chinese families will be structured as 4–2-1, which refers to having four grandparents, two parents and one child. The eldest members of the only-child generation are currently in their mid-thirties, and most of their parents are in their sixties. Many Chinese scholars predict that this generation’s parents’ elder care will become a critical social problem in the next few decades (Du and Guo 2000; Kinsella and He 2009; Silverstein et al. 2006).

The rapidly aging population is challenging traditional Chinese patterns of family-based elder care which emphasize filial piety. As an essential element in Chinese culture, the belief in filial piety can be dated to roughly around 1000 B.C. (Holzman 1998). It requires adult children to respect parents and dutifully provide both physical and emotional care for them as they age. For parents, raising children has been regarded as a way “to ensure that they will be cared for in old age” (Chou 2009, p. 589). For thousands of years, filial piety has been considered as a core cultural value and the most critical cultural force “holding together China’s system of familial elder care” (Zhan et al. 2008, p. 545).

Since the 1980s, economic reforms led by the government have brought dramatic social transformation to Chinese society.2 On the one hand, a rural surplus of workers as well as employment opportunities in informal sectors have generated massive migration flows from rural to urban areas, and from less developed to richer regions (Bao et al. 2002; Huang 2003). On the other hand, despite growing mobility of younger adults, there has been little change in the relatively “immobile” system of old-age pensions and elder care (Huang 2003). The combined socioeconomic and demographic changes are challenging China’s tradition of filial obligation and reliance on familial elder care. As Zhan et al. (2008) have noted, adult children have become “less available for elder care because of reduced family sizes, geographic mobility, and conflicting work and family obligations” (p. 545).

These elder care concerns are likely to be even more pronounced among the growing number of Chinese young adults who have chosen to study abroad or immigrate to developed countries such as the United States, Canada, and Australia. As their parents’ only potential caregivers, these members of the only-child generation will likely need to seek help from other sources including formal caregiving institutions, but limited availability of long-term care institutions and deep-rooted traditions stressing filial piety are likely to result in elder care dilemmas for these only children. Little is known about this group, however, and how they perceive and plan for their current and future elder care responsibilities.

The current study used in-depth interviews with Chinese young adults currently studying or working in Canada to investigate their family elder care experiences, values, and concerns as members of the only-child generation. This research explored their plans and concerns regarding their parents’ care and the challenges they expected to encounter in the future. These interviews provide insights into the implications of social and demographic change, including smaller families, population aging, and migration, for this unique, transnational population.

China’s Elder Care in a Transforming Socioeconomic Situation

Close intergenerational relationships are highly valued in Chinese culture, and filial piety is one of the most important virtues. In many dynasties in Ancient China, filial behaviors were rewarded by local and even central governments, and unfilial conduct was considered to be a crime and was punished (Holzman 1998). This virtue has been explicitly taught to children by parents and teachers (Chappell and Funk 2011); from an early age, children have internalized the value that respecting and caring for aging parents is an indispensable obligation for adult children. Within this context, adult children are expected to manifest the utmost reverence towards their parents, give their parents the utmost pleasure, and display the utmost solemnity when sacrificing to their parents (Legge 2004).

Although traditional family values are not as solid as they had been in the past, the belief in filial piety has remained strong in Chinese people’s lives, especially among the elders. Accordingly, filial piety continues to be an influential factor with regard to adult children’s caregiving patterns (Wang et al. 2010). In Western countries, although family remains the major source of elder care, maintaining an independent life and separate residence, or “intimacy at a distance” (Rosenmayr 1977) is preferred by parents and adult children. In Chinese culture, on the other hand, parents’ and adult children’s lives are more closely intertwined. Family is not only a major source of elder care, but is also perceived as the most ideal location to spend one’s aging years (Zhai and Qiu 2007). Elderly persons also feel more dignified, individualized, autonomous and flexible under family care (Fan 2010). Therefore, when parents get old and sick, adult children are expected to do their utmost to take care of their parents by themselves. Importantly, this cultural expectation is reflected in the relative scarcity of formal supports, including long-term care services, thus providing few alternatives or supplementary support options for elders and their families.

For generations before the implementation of family planning policies, the overwhelming majority of Chinese couples had more than one child. Therefore, when parents needed care, siblings could share both financial and caregiving tasks while organizing the care of aging parents (Zhan 2002). The only-child generation will face the obligation of parent care without siblings.

Traditional household arrangements also favored intergenerational coresidence or living in close proximity, which facilitated familial caregiving, but recent economic and demographic changes have challenged this pattern. Rapid economic change and intensifying competition in the workplace have placed more pressure on today’s Chinese young adults to succeed in education and work compared to previous generations. The conflict between work and family roles has become a major concern in their lives and has contributed to eroding traditional family arrangements (Cheung et al. 2006). Expanding opportunities have accelerated both internal and international migration for young Chinese adults: many adult children no longer live with or near their parents due to job mobility. For instance, according to the National Bureau of Statistics of China (2014), in 2013, the total number of internal migrant workers who were employed outside of their place of origin was 268.94 million, and these numbers are likely to continue increasing. The provincial units with the highest rates of in-migration are Shanghai, Beijing, Guangdong province, and Zhengjiang province (Shen 2013). This trend is shaking the stability of traditional family structures and weakening the economic and psychological support of adult children to their aging parents (Ling and Poweli 2001).

Many gerontologists and policy makers suggest that this increasingly serious situation calls for an increase in formal systems of elder care, but the strength of filial piety creates significant challenges (Chang and Schneider 2010). In today’s Chinese society, a great majority of older people maintain high filial expectations and consider nursing home care as the very last choice. The notion of institutionalized elder care runs counter to Chinese traditional culture and values, which makes it difficult for older adults to accept long-term care institutions as a source of care in old age (Smith and Hung 2012). There are also several laws that stipulate that adult children have the responsibility to provide financial and physical support for their aging parents.3 Prior to the 1990s, only childless elders were cared for by long-term elder care institutions, and almost all of the institutions were run by the government (Zhan et al. 2008). As Chen (1996) noted, Chinese institutional elder care served elders with no children, no income, and no relatives. After the welfare reform in the mid-1990s, elder care institutions have become more privatized and have become an emerging industry. Long-term care facilities have gradually become more available as an alternative to familial elder care, though most facilities continue to serve mainly childless and disabled elders (Guan et al. 2007). Today, living in an elder care institution is stigmatized and associated with being impoverished or having “unfilial” adult children who have not taken responsibility for their aging parents. Adult children who seek out nursing home care for their aging parents encounter considerable moral pressures from others, such as friends, coworkers, and relatives (Chang and Schneider 2010).

The dearth of satisfactory long-term care options also contributes to a reluctance to seek help from community institutions. Generally speaking, there are still too few resources allocated to elders in China (Zhai and Qiu 2007). Both quality and quantity of long-term care institutions can not satisfy the demand created by a dramatically aging population and extended life expectancies. According to China’s National Bureau of Statistics, at the end of 2005, there were 39,546 elder care institutions including 1.5 million beds in China’s mainland, which could accommodate only 1 % of China’s older people. In addition, high-quality and middle-quality institutions only represented 20 % of the total number; the vast majority (80 %) of institutions were regarded as poor-quality nursing homes.4 There are also great disparities between urban and rural areas (Chou 2009). Most elder care institutions in small cities and rural areas are minimally equipped and offer low levels of services. Seniors living in larger cities have somewhat better options, but not all large city residents are financially able to access long-term care institutions (Zhang and Goza 2006). The number of public elder care institutions is far from sufficient, and private ones are unaffordable for most families. Lacking a well-developed national social security system, the high costs of healthcare prevent people from seeking help from existing long-term care institutions (Gu et al. 2009).

Challenges and Dilemmas for Transnational Families

International migration has also created challenges for Chinese families as increasing numbers of young people migrate to study or work in industrialized countries such as the United States, Canada, United Kingdom, and Australia. According to statistics of the Ministry of Education of China, the number of Chinese students who study overseas has increased dramatically. In 2013, there were 413,900 persons who migrated to study overseas (China Education Online 2014). Some of these Chinese students eventually settle down in these countries. For instance, since the mid-1990s, China has continually topped the list of source countries of Canadian immigration, and the large majority of these new immigrants come with a university degree, as “skilled immigrants” (Li 2010). A large proportion of these new immigrants first came to Canada as international students. As the only caregivers of their parents and with few alternative sources of elder care, however, many of these adult children prefer not to be separated from their aging parents and face the dilemma of either returning to China to provide care or bringing their parents abroad.

International migration and transnational family relations place a strain on the traditional reciprocity that has been part of Chinese family care patterns, in which “parents care for their children, and in return, children ‘repay’ this care by looking after their parents in the latters’ old age” (S. Huang et al. 2012, p. 131). In transnational families, parent care is complicated by a variety of factors, including the carer’s capacity and availability, the aging parent’s needs, availability of services, and immigration policies. Baldassar and Merla (2014) proposed the concept of “care circulation,” which refers to the “reciprocal, multidirectional and asymmetrical exchange of care that fluctuates over the life course, with transnational family networks subject to the political, economic, cultural and social contexts of both sending and receiving societies” (p. 22). According to Baldassar et al. (2007), transnational families encounter challenges at the macro, meso, and micro levels. At the macro level, family care is constrained by communication technologies, visa and immigration policies, social security systems, and international relations; at the local and community levels, family care is influenced by the availability and accessibility of care institutions and services and social networks. At the micro level, the quality of family care is linked to personal resources, including time, financial resources, language skills, caregiver’s and recipient’s physical conditions, etc.

Relocating to a foreign country at an older age potentially increases the level of dependency, requiring adult children to provide higher levels of support and assistance in their aging parents’ daily lives. For these care providers, negotiating between traditional filial expectations and their own professional and family lives becomes a major challenge (Lan 2002). Furthermore, international migration has extensive impacts for both adult children and their elderly parents (Zhou 2013). Aging parents who settle down abroad with their adult children face the sudden and drastic change in culture, environment and language (Chiang-Hanisko 2010; Kramer et al. 2002). Research on elderly immigrants in the United States has shown that the great differences between East Asian and Western cultures make it hard for East Asian immigrants to adjust and fit in, “even if they have lived in the United States for a long time or even if they were born in the United States” (Kamo and Zhou 1994). Having spent most of their lives in China, older immigrants to industrialized Western countries experience cultural conflict and language barriers: the stress of immigration and acculturation increases the risks of depression among older Chinese immigrants (Mui 1996). Due to these challenges, many regard living with their adult children as especially necessary for older Chinese immigrants, and feelings of dependency may increase with declining health and physical ability (Chiang-Hanisko 2010). For parents of the only-child generation, the small family size and adult children’s work stresses have strained the ability to provide family support and maintain intergenerational and parent care relationships (Mui 1996). Concerns about accessing a host country’s healthcare system (Chappell and Funk 2011; Rawl 1992) and fears of dying in a foreign land (Kwak and Salmon 2007) are also major concerns for Chinese aging parents and their only children living overseas.

Conceptual Framework

Social exchange theory is one of the most widely cited theories in studies of intergenerational relations and elder care. The founders of social exchange theory posited that social association can be considered as “an exchange of activity, tangible or intangible, and more or less rewarding or costly, between at least two persons” (Homans 1961, p. 13). Hence, exchange theorists have argued that relationships are interdependent: individuals depend on each other and at the same time take responsibility for each other (Kelley and Thibaut 1978). In traditional Chinese culture, filial piety is based on the notion of reciprocity, with child-rearing regarded as an investment that is reciprocated with parent care in old age.

The strong intergenerational relationships and expectations, however, are fundamentally influenced by macro-level structural factors, including social norms and socioeconomic arrangements. Connidis and McMullin (2002) developed the concept of structural ambivalence to describe the “structurally created contradictions” (p. 559) when interpersonal relations are constrained by social structural arrangements. Connidis (2015) has further argued that structural ambivalences lead to considerable stresses and contradictory feelings for individuals. In the context of the current study, the only-children are caught between their commitments to and emotional bonds with parents and the structural constraints imposed by the need for migration, education, and time and distance away from family. These structural ambivalences lead to adult children’s psychological ambivalence, because the contradictions and conflicts created by larger social forces “are made manifest in the social interactions of family life and must be worked out in family members’ encounters with one another” (Connidis 2010, p. 140). In-depth interviews with only-child Chinese migrants living in Canada provide insight into the ambivalence they experienced, being torn between competing demands with few resources to resolve or mitigate the tensions caused by these contradictory social constraints, cultural expectations, and personal ties.

Sample and Method

The current study sought to examine how members of the only-child generation perceive the dilemmas brought on by the conflict between traditional Chinese family values, the pursuit of opportunities overseas, and new patterns of elder care. In-depth qualitative methods, specifically semi-structured interviews, were used to explore these concerns and how they were perceived and navigated by only-children living abroad.

Respondents were recruited through a snowball sampling strategy. The first round of interviews with seven respondents was conducted in 2011 in Montreal, Canada. The second round of interviews with thirteen respondents in Montreal was conducted by telephone in 2013. Each interview lasted approximately 30 min.

All of the respondents were Chinese young adults who were studying or working in Montreal, Canada (N = 20) and whose parents were still living in China. Ten respondents expressed that they preferred to settle down in Canada, seven planned to go back to China after finishing their studies or getting some work experience, and three did not have specific plans yet. Eight had already become Canadian permanent residents or citizens, and twelve were international students. All of the respondents were born after 1980. The respondents’ ages ranged from 23 to 31 years old. One respondent’s father had passed away a year before the interview, but all others were from families in which both parents were still living and the parents had siblings. Three respondents had no living grandparents; the rest each had at least one grandparent who was still alive. Eighteen respondents came from China’s urban areas, and two came from rural areas. Their durations of stay in Canada varied from one year to 11 years.

Respondents were very cooperative and most showed great interest in the topic. The interviews were recorded and transcribed with the respondents’ consent. The questionnaire was developed to explore the following topics: how do these respondents’ parents take care of their grandparents; what are these young people’s family values; how do they see professional long-term care institutions; and how do these respondents plan to take care of their aging parents in the future.

The data were analyzed through a thematic analysis approach, with thematic codes developed through a data-driven approach (Boyatzis 1998). The interviews were transcribed in Chinese. After reading and re-reading the raw data, initial codes were generated. In the next stage, we combined statements with the same labels into overarching themes. Emerged themes and categories were analyzed and connected with existing theories and empirical studies.

Results and analysis

There were four main themes in the interviews. First, respondents discussed the elder care patterns of their grandparents, providing a cultural model of existing elder care arrangements in their families. Next, respondents described their relationships with their parents. Since all of the respondents were currently living in Canada while their parents were still in China, they also discussed the psychological experiences of being separated. In the last part, respondents discussed their own future plans with regard to their parents’ elder care as well as their perceptions and attitudes towards professional long-term elder care institutions.

Respondents’ Grandparents’ Elder Care Patterns

Among all 20 respondents, only two had grandparents living in long-term care institutions. According to our respondents, family-based elder care was still the primary choice in their extended families, which included multiple members living in close proximity. Each of our respondents reported that their grandparents had at least one adult child who served as the primary caregiver, living with or very close to them. These grandparents were frequently visited by their adult children, at least once a week:

My [paternal] grandparents don’t live in the same city with us, but my aunts and uncles live very close to them. My uncles and aunts visit them every day. During weekends and holidays, all of my uncles and aunts get together in my grandparents’ house. (Female, 25 years old)

After the death of my maternal grandpa, my parents invited my [maternal] grandma to live with them. They take good care of my grandma, and my grandma is very willing to live with my parents. My paternal grandma has dementia. She lives with my father’s elder brother since the death of my paternal grandpa. (Female, 27 years old)

Besides visiting, several respondents also informed us that their parents telephoned their grandparents frequently to check on their physical and mental condition and to “just chat with them, to make them happy.” One respondent said:

Every time when we call my grandparents, they sound very happy and never want to end the conversation. Old people often feel lonely, so my parents call them every day (Male, 28 years old).

As mentioned earlier, two respondents had grandparents living in long-term care institutions; they explained that this arrangement was needed because their parents and parents’ siblings were too busy with their work and unable to provide necessary elder care themselves. But according to these two respondents, their parents still visited their grandparents frequently in the nursing home, at least once a week. Several respondents reported that their grandparents had home care workers, but that their parents still visited their grandparents quite often to provide them with company and help with housework. Some respondents expressed that professional caregivers or home care workers could only help seniors with daily tasks, but could not satisfy seniors’ emotional needs. Their perception was that seniors often “feel lonely,” and “they always want to be with their children and grandchildren.”

Several respondents mentioned that their parents and parents’ siblings could not accept sending their grandparents to long-term elder care institutions, because taking care of aging parents was regarded as the adult children’s “obligation,” and the conditions in most long-term elder care institutions were seen as unsatisfactory. For example, two respondents specifically described their perceptions and concerns about long-term care:

My family is very traditional, I don’t think my parents would send my grandma to nursing home. We think that older people should live with their adult children. Nursing home is the last choice. My parents, uncles and aunts think that they have to make every effort to take care of my grandparents by themselves. It’s impossible for them to send my grandparents to nursing home. (Female, 31 years old)

I come from a small village. In [China’s] rural areas, only seniors without children would be sent to nursing homes by local government. People believe that adult children have to take care of their aging parents. My parents and their siblings live very close to my grandparents, so taking care of my grandparents is not a problem. (Female, 23 years old)

Generally speaking, the relationships between our respondents’ family members were described as quite close. Family-based elder care patterns were still the primary or even only choice in most respondents’ extended families. According to respondents, besides offering good physical care, their parents were also trying to give their grandparents as much emotional support as possible, which they believed only adult children could provide.

Most of these respondents’ families did not consider sending their grandparents to long-term care institutions for two reasons. First, all of their grandparents had multiple adult children who served as caregivers and could share elder care tasks. Hence, taking care of one’s aging parents was not perceived as a burden in these families. Second, most respondents’ parents still maintained a strong belief in filial piety and saw nursing home care negatively. Taking care of aging parents was considered to be the adult children’s obligation. This observation is consistent with prior studies that have emphasized family size and availability of caregivers as critical factors that influence placement in long-term care institutions (Chang and Schneider 2010; Chou 2009). The decision to send a loved one to a nursing home is especially difficult because of the belief in filial obligation (Park et al. 2004). Thus, most of the respondents expected to provide familial elder care just as their parents’ generation has done for their grandparents.

Relationships between Respondents and their Parents

Respondent were asked about their relationships with their own parents as well as their feelings about being separated from them because of living abroad. All respondents described their relationships as “very close.” While living in Canada, they maintained contact with their parents by instant messaging, telephone, video chat, and text messages. They were in contact with their parents at least once a week, and four respondents noted that they called or texted their parents every day; they also noted that their parents also called or texted them frequently. One respondent also described a childless aunt (father’s only sister who saw him as her own child) with whom he maintained daily contact as well as with his parents.

As their parents’ only children, these young people described maintaining strong emotional ties with their parents. A great majority of our respondents expressed that they felt sad and guilty from time to time because of their separation from their parents. This was a common theme raised in the interviews:

We are the only children of our parents. Though my parents are still young and healthy, I still hope that I could be with them. Sure, it’s impossible right now, but I will accompany and take care of them in the future. (Male, 27 years old)

Of course, I feel sad that I can’t accompany my parents! Actually I left home since high school because I went to high school and college in other cities. Leaving parents was not a problem when I was young. But I began to miss my parents so strongly in recent years. Especially this summer, after I went back home (to China), I began to consider why do I stay in this foreign country? Why should I leave my parents? I asked myself: Am I doing this for a better life? But my parents are not here, how can I be happy? When I came back to Canada this time, I felt so sad, but I can’t tell them (her parents). My mom is very emotional, if I told her, she would be much sadder than me! (Female, 23 years old)

Since most respondents’ parents were under 60 and in good health, none of the respondents said that they currently worried about their parents’ health. What they worried about most, however, was that their parents would feel lonely because of their absence. According to some respondents, these worries were stronger during holidays:

When I see those local students getting together with their families during holidays, I feel very sad. I miss my parents, and they miss me too. If they had other children, I would feel much better. But I’m their only daughter, and I cannot be with them, even during Chinese New Year. They must feel sad too when they see other people reunite with their children. (Female, 24 years old)

When asked about their relationships with parents, many respondents became very emotional and told some touching stories. For instance, one young woman, a university student, said that she felt torn when considering whether to apply to graduate school abroad; as the only child of her family, she found that leaving her parents was hard for both her parents and herself. However, her parents strongly encouraged her to continue her studies:

My parents encouraged me to study abroad and see the world. Although I’m their only child and they don’t want me to leave, they still wish that I could pursue my studies and career without worrying about them. The only thing they care about is my happiness. (Female, 25 years old)

Another female student who came from Beijing described that when she was in Canada, her parents tried to call her one morning to chat with her. But she got up too late and had turned off her phone. When she finally got up, it was already midnight in Beijing.5 Once she turned on her phone, she received her mother’s call:

My mom said: “Honey, did you just get up? Are we (her parents) disturbing you? We called you several times this evening… We miss you, just want to hear your voice…” When I heard this, I really could not hold back my tears. (Female, 25 years old)

Overall, our respondents described close relationships with their parents, and they maintained frequent contact while they were living in Canada. Several respondents noted that, although geographical separation from their parents was painful, leaving home and pursuing their studies in Canada was still a deliberate decision in their families. Respondents said that parents encouraged them to study overseas in order to “see the world,” and open their minds. Other frequently mentioned reasons for going abroad were better education quality, more employment opportunities and less competition (because of lower population density), a more ordered and transparent social system, and a good living environment.

Being separated from their parents was difficult for these young people. They still kept many traditional Chinese family values, including the belief in filial piety and the emphasis on close intergenerational relationships. In some ways, being only children may have heightened their sense of closeness with and obligation to their parents; it was apparent that the parents were also very attached to their only children. During the interviews, the respondents repeated from time to time that “I am the only child of my parents, so…” and “no one else could accompany them.” Hence, their identities as only children in their families, they thought, differentiated them from previous generations and placed them in a unique position. As only children, they often acquired more attention from parents and grandparents, while the closeness of their relationships probably exacerbated the perceived challenges of their geographic separation. Furthermore, the only children benefitted from their parents’ investments in their economic and human capital (Lee and Xiao 1998), which have describes as particularly evident among parents of the only-child generation (Zhang and Goza 2006), thus further reinforcing parent-child relationships and perceived filial obligations.

Respondents’ Plan on their Parents’ Future Elder Care

As mentioned earlier, when it came to future plans, ten respondents expressed that they preferred to settle down in Canada, seven planned to go back to China, and three did not have specific plans. All of the respondents who planned to settle down in Canada, without exception, stated that as their parents’ only caregivers, they felt that they needed to bring their parents to Canada. Six planned to take care of their aging parents all by themselves in the future, and four stated that sending parents to long-term elder care institutions would be a possible choice for them if they were not able to handle the caregiving tasks themselves.

However, some of these young people also expressed anxiety about the feasibility of their plans. First, although they expressed confidence with Canada’s healthcare system and the quality of long-term care institutions, they were very concerned about their parents’ language abilities and barriers. Most of their parents spoke neither English nor French, hence, communicating with health care providers would be a serious obstacle in these parents’ lives. Besides, many parents were also reluctant to leave their homeland and move to a foreign country in their later life. Acculturation is always a hard process for new immigrants, especially older immigrants. For these parents, moving to Canada would mean abandoning the familiar circumstances that they had lived in for decades and adapting to a whole new set of cultural practices. Moreover, as expressed in an ancient Chinese proverb, “though a tree goes ever so high, the falling leaves return to the ground6;” for many Chinese older people, the prospect of dying in a foreign land was hard to accept. As the following two respondents said:

I’m already a permanent resident and I have been working in Canada for years, I don’t think I would go back (to China), but it’ll be a problem when my parents get old. I feel anxious when I think about this question… I wish I could bring my parents here (Canada) when they get old, but whether they are willing to come is another problem. It’s quite possible that they won’t be willing to leave their hometown, their friends and relatives. They can do everything by themselves in China, and it’s much easier for them to see the doctor if they live in China. If they came to Canada, they can’t communicate with medical personnel. However, when they get too old and sick, they would need me to be with them, I can’t leave them without me. It IS a hard choice. Of course I wish I could be with them. But things are complicated. (Male, 26 years old)

Actually I think I would stay in Canada. I come from a very small town, so I won’t go back. My parents said that they would come to visit me frequently, but I don’t think they are willing to stay in Canada permanently because they have their own life in China. I don’t know how to solve this problem when my parents get old and sick. Before I came here, I was very naïve. I thought I would study here, get permanent residency, then bring my parents here. But after leaving home and coming abroad, I feel like a wanderer. My parents are getting old. It would be much harder for them to start over in a completely new environment. (Female, 23 years old)

Second, as Canada’s provincial and federal governments have gradually tightened immigration policies in recent years, it has become harder for adult children to get immigration status for their aging parents. According to Canada’s current immigration policy, citizens and permanent residents could sponsor their parents or grandparents to become a Canadian permanent resident under the Family Class. In 2012 and 2013, Canada admitted approximately 50,000 parents and grandparents as permanent residents. However, since 2014, the federal government set a cap of 5000 applications per year for the parent and grandparent sponsorship program. Sponsor’s minimum necessary income level has also been increased by 30 % since 2014, and sponsors must prove that they have been financially stable for a longer period of time. In addition, the sponsorship period has been extended from 10 years to 20, which means that “sponsors will be responsible for repaying any social assistance given to their parents or grandparents by a province for 20 years after they become Permanent Residents, as well as health care costs not covered by provincial health care” (Citizenship and Immigration Canada 2013). This trend is expected to continue in the future and make parents’ elder care a heavier burden for new immigrants.

Among those who planned to go back to China, five wished to take care of their aging parents all by themselves in the future, and two expressed that they would consider long-term care institutions as an option. Those who had not decided yet where they would work and settle down still assumed that they would live closer to their parents in order to take care of them when they got old and sick. As their parents’ only caregivers, they noted that balancing elder care tasks and their own lives would become a serious issue in midlife. One young woman said:

When I am in my forties or fifties, my [future] husband and I would have to take care of four old parents. We have our own life and career, so it would be a hard time. But everybody in my generation has to face it. (Female, 25 years old)

In addition, some respondents mentioned that they might not work and settle down in their hometown when they go back to China, because “everybody wants to live in major cities such as Beijing and Shanghai.” Thus, returning to China may still require relocating parents to a completely new environment. Due to the household registration system (Hukou system)7 which is associated with a series government benefits (e.g. health care, social security, schooling), it is not easy for those relocated seniors to acquire necessary health insurance and other social security benefits in a new area. China’s pension system is highly fragmented, with components financed by local governments with different ground rules. When an individual moves to another city or province, s/he may encounter a series of barriers to pension portability such as not being able to obtain the full portion of the accrued pension benefits, different rules or rule interpretations, etc. (Pozen 2013). China’s health insurance system is also still highly connected with the household registration system, particularly for retired individuals, which makes it difficult for seniors to receive health care or medical treatment in a place where they do not hold a permanent residence permit (Yang and Zhu 2011). This interaction between household registration and the pension and health care systems significantly increases barriers to labor and retiree mobility (Pozen 2013).

While exploring the respondents’ future plans for their parents’ elder care, we also inquired about their perceptions of aging and long-term care institutions in China and Canada. Three respondents expressed that they had no idea about these institutions; nine expressed that they generally had negative impressions of long-term elder care institutions in China, and they thought that elder care institutions in Canada were “generally better” than those in China. Eight respondents noted that it was hard to compare institutions in these two countries.

According to those who had negative impressions of China’s long-term elder care institutions, these impressions came mainly from China’s media, such as television, newspapers, and the Internet. As one respondent said,

I remember that I’ve seen news on the Internet about seniors being maltreated in nursing homes (in China). Actually I know little about elder care institutions but I think that nursing homes in Canada are more reliable. (Female, 23 years old)

Respondents who had more positive impressions of nursing homes in Canada than those in China expressed that Canada had a better-developed, government-run social security system. They also felt that Canada’s small population made these long-term care institutions more accessible:

I think Canada’s nursing homes are generally better than those in China. Because they have a better social security system, so long-term care institutions are also maturer than those in our country. And I think the nurses and doctors in nursing homes are more professional in taking care of older people. (Male, 27 years old)

I think that Canada has a higher nursing home bed-to-population rate than China, and the equipment and service are better in Canada’s nursing homes. China has such a large population, and fewer long-term care institutions. And I think that the number of nurses and doctors who are specialized in elder care is far from enough in China. Some nursing homes are also too expensive. (Female, 27 years old)

Several noted that that it was hard to compare long-term care in Canada and China, but three respondents with science or nursing backgrounds, who had interacted with hospitals and nursing homes, noted that the two countries have some shared weaknesses. For instance, both countries face similar problems with the demand for public nursing home services outrunning the available supply, and the waiting times are getting longer with population aging, regarded as a more acute problem in China. Private elder care institutions were also seen as less affordable for the majority of people. Several other respondents mentioned that the quality of elder care institutions also varied greatly due to the great regional disparities in China. The quantity and quality of nursing home care in major cities such as Beijing and Shanghai are far more satisfactory than those in less developed areas. As the following respondents said:

I think it depends on areas. Major cities have more good nursing homes, but poorer areas have less, or even don’t have any. I think the quantity of nursing homes is far from enough, and the waiting time is too long. Maybe things will get better when my parents will need this service. (Male, 26 years old)

I’ve heard that some of my friends’ grandparents are living in good nursing homes in China, but there are far fewer nursing homes in the area where my family resides, so we have much fewer choices. But I know that the health care reform (in China) in the recent decade has brought a lot of improvements, so maybe nursing homes will be more available in a few decades. (Female, 23 years old)

While discussing the quality and accessibility of long-term care institutions in China, several respondents also mentioned that seniors are much less willing to be cared for by “strangers” because of the emphasis on filial piety and family-based elder care.

Respondents also contrasted the lifestyles of Chinese and Canadian seniors. Having lived in Canada for years, these respondents perceived seniors in Canada as having “quite different lifestyles” that value privacy, freedom, and individualism. East Asian cultures, on the other hand, were described as placing more value on responsibility, sacrifice, and collectivism. They saw Canadian seniors as more likely to live on their own and more independent in old age, whereas Chinese seniors were seen as having more interactions with and relying on their adult children. Some respondents expressed an appreciation for the “Western seniors’ lifestyles” that they have observed while living overseas. In their opinion, Canadian seniors have a “younger mentality,” because they are more likely to spend time on their own hobbies rather than focusing on their grandchildren or adult children’s lives; for Chinese seniors, on the other hand, happiness is more strongly tied to interactions with their adult children and grandchildren. Some respondents mentioned that the culture of filial piety brings “too much stress,” and they think that both adult children and aging parents should have their own lives. Beyond the cultural differences, three respondents also pointed out that the mature social security system brings Canadian seniors a greater sense of security, which supports them to lead a more independent life. The less developed pension and health care systems in China, on the other hand, limit Chinese seniors’ possibilities to pursue more independent lifestyles. However, four respondents described the Western lifestyle as “lonely.” They preferred the Chinese seniors’ lifestyles, as one of them said:

I think older people in Canada are lonely. Adult children have their own lives, and many of them seldom visit their aging parents. This is inacceptable for me. I think emotional fulfillment is more important for older people… People need companionship more in their later life, so I think that spending more time with children and grandchildren is better for older people’s mental and physical health. (Male, 27 years old)

Thus, the greater social integration of Chinese elders with their families was regarded as a positive feature and was seen as preferable to what they saw as greater separation and independence of elders in Canada.

Of the 20 respondents, twelve stated that they would “definitely” not consider sending their parents to long-term elder care institutions, but eight expressed that professional long-term care institutions could be an option. From the interviews, it was evident that the belief in filial piety was still a primary factor that prevented many respondents from considering professional long-term elder care as an option. “Taking care of aging parents is a traditional virtue in Chinese culture” was a theme that was frequently emphasized in respondents’ discourse. These adult children explained that trying their best to take care of parents by themselves was an important obligation, while being unable to perform this obligation would bring them moral condemnation. A young woman even said, “As children, how can we send parents to that kind of place (nursing home)?! Parents would feel that they are abandoned!” The parents also expected to be cared by their own adult children in their later life. Several respondents remarked that if they were not able to perform caregiving tasks when their parents needed 24-h care, they would rather hire a home care worker. Compared with those who simply rejected the professional long-term care option, a young man gave a more nuanced answer:

I don’t want to send them to a nursing home even if they get old and sick, but this is just what I think right now. Actually I don’t consider nursing home as a bad choice, but Chinese people always think that if you don’t take care of your parents by yourself, then you are unfilial, you are a bad person. Seniors would also feel it as degrading if they were sent to a nursing home by their adult children. In Canada, I see many old people living happily in nursing homes. But we have completely different cultures. Chinese people have a lot of moral pressure when it comes to this issue. (Male, 26 years old)

Another young man mentioned that for seniors living in nursing homes it was like “being abandoned or childless.” Interestingly, this young man noted that his grandmother was living in a nursing home because his father and father’s siblings were too busy to take care of his grandmother, and he was quite satisfied with the quality of the services in the nursing home. However, he described his grandmother’s life as “tragic,” because although the nursing home provided a good material life for his grandmother, she “must still feel very lonely.” Several other opponents of nursing homes expressed similar opinions. They felt that long-term care institutions may provide seniors with professional services, but they cannot provide emotional fulfillment, which is especially important in later life.

Several respondents who held positive attitudes towards long-term elder care institutions proposed that Chinese traditional family values “need to be changed.” A young woman said that Chinese traditional family values are “too oppressive,” because they give people too much “unnecessary moral pressure.” Since society has changed, family values also need to be changed. In addition, adult children’s level of acceptance of nursing homes appeared to be tied to parents’ attitudes. As a young woman said:

I think a nursing home is a positive option. I have discussed this issue with my parents. They are quite open-minded, and they also think that a nursing home would be a good option for them. There are other seniors who are currently living in nursing homes in my extended family, and we’ve heard that the nurses and employees there are very professional. (Female, 23 years old)

Several of them also mentioned that as Chinese family structure has changed dramatically, they expected that seeking help from professional long-term care institutions would be an “inexorable trend” among the only-child generation. However, it should be noted that all of our respondents who had positive perceptions of long-term care institutions came from more developed areas in China, where these institutions are more accessible and of higher quality.

Discussion and Conclusion

China has an old proverb that states “children are reared to be a support in old age.8” Today, this mentality has been challenged by both economic and cultural changes, especially in urban areas, yet the belief in filial piety remains deeply rooted in contemporary Chinese society. From our interviews, we observed that all of our respondents emphasized that their first choice was to take care of their aging parents by themselves. Realizing that they are their parents’ only source of care in later life, they expressed a strong willingness to take on this responsibility. At the same time, their culture also tells them that this is the only “right” way to make their aging parents happy. This cohort has experienced the economic reforms and opening up of their country, resulting in great changes of Chinese society. They had also lived in a foreign country for years and had pursued individual educational and work pursuits in a period of vastly expanding opportunity. Nonetheless, the belief in filial piety and close intergenerational relationships was still deeply rooted in their minds.

It should be noted, however, that none of these young-adult respondents had been confronted with actual problems of reconciling their parents’ elder care needs with their own family and professional lives. As their parents were still in late middle-age and in good health, they described their concerns and ideal arrangements for the future. Those who planned to go back to China expected that they might not be able to manage the conflicts between their own lives and elder care tasks; those who planned to settle down abroad expected to face even more difficulties. As their parents’ only-children, these young people were already considering possibilities for the future and the structural ambivalences that were likely to lie ahead. If they could not fully perform the responsibilities of caregivers for their parents, how would they resolve the dilemmas between traditional family values and the realities of geographic distance, conflicting demands on their time, and limited alternative resources?

As one of our respondents said, in Chinese culture, the family is such a heavy topic because everybody has to face a series of cultural burdens. One’s own life is continually intertwined with one’s family, and one’s own happiness depends on the fulfillment of family responsibilities. In this circumstance, an individual does not only live for oneself, but also for the happiness of his/her parents and children. Today’s Chinese young people from the only-child generation still carry these cultural expectations. As only children, these expectations are amplified by the closeness of their relationships with parents and their exclusive position as the only ones to fulfill traditional responsibilities of adult children. The conflict between persistent cultural obligations and changing socioeconomic context places these young people into a difficult situation: on one hand, the expanding horizon of employment opportunities and emerging individualism encourage young people to pursue their personal development in a broader world; on the other, the entrenched traditional family values and limited alternative elder care resources remain an irresistible force that binds them to their families.

The only-child generation’s parent-care dilemmas reside in structural contradictions created by sharply reduced family size, expanded economic opportunities, and greater mobility and a lack of new systems that could support families amidst these new arrangements. The demographic challenges of population aging, migration, and reduced family sizes will likely require adaptations in social security systems, community resources, and long-term care arrangements over the next several decades.

As C. Wright Mills (1959) proposed, what people often perceive as personal troubles are in fact indicative of larger social issues. Undoubtedly, the only-child generation’s parent-care dilemmas are shaped by existing social structures, institutions, and norms. It is not realistic to expect these young people to solve their family problems by themselves, nor is it fair to expect individuals to solely shoulder the consequences of national population policies and demographic changes. The challenge of improving the availability of various elder care supports and healthcare will be complicated, however, by the persistent and strong cultural norms of filial piety and family-based elder care; the personal troubles of caring for loved ones and meeting one’s normative obligations must be deeply rooted in larger social issues that call for societal and community-based solutions.

Finch and Mason (1991) pointed out that we cannot assume that family members provide care to each other based only on abstract principles of moral obligation, duty, and structural position. Family responsibilities are in fact shaped by socioeconomic context and developed through negotiation. Hence, family life is truly dynamic, and in this dynamic process, individuals are “constructed and reconstructed as moral beings” (p. 170). The increasing level of mobility of today’s Chinese young people has “interrupted the traditional functioning of the family as an important mechanism of exchanging resources across generations in Chinese culture, where the extended family plays an indispensable role in welfare and care provision for the elderly” (Zhou 2013, p. 59). The concept of ambivalence (Connidis 2015) provides a framework for considering intergenerational relations and solutions to the only-children’s parent-care dilemmas from the macro, meso, and micro levels.

At the macro level, changes will be needed to adapt to the demographic, economic, and social changes of the past four decades. In response to the challenges of an aging population, the Chinese government has implemented a series of measures in recent years to improve the health and elder care system, and the central and local governments are also trying to construct more long-term care institutions, but there is still more work to be done. Addressing the fragmentation of China’s pension and health care systems and reducing the connection to the rigid household registration system would represent further helpful adaptations for today’s increasingly mobile population. For those Chinese people who settle down abroad, there will be a need for supports to help take care of older people and provide assistance in their acculturation process. As Baldassar and Merla (2014) have pointed out, “transnational caregiving must be understood not as an activity of individuals or families alone but as a function of relationship between agents and the social institutions within and across both home and hosting settings” (p. 15). Macro level forces including culture, nation, and politics “provide the borders, replete with rules and regulations, which shape the caregiving practices that cross and are contained by them” (Baldassar 2008, p. 288). In the case of Canada, family-friendly policies for new immigrants could represent an important acknowledgment of and support for these immigrants’ contributions to the economy, labor force, and the otherwise declining working-age population (Yssaad 2012; Gignac 2013). Integrating family-friendly policies into immigration procedures could ensure new immigrants’ commitment to the host countries and reduce the strains of managing transnational caregiving obligations. At the community and individual levels, informal supports and self-help organizations for caregivers could encourage mutual support and decrease caregiving stresses (Baldassar and Merla 2014). Communities and nonprofit organizations could also facilitate seniors’ adaptation and help them to develop new social network.

Some scholars and cultural critics have also argued that the rigid belief in filial piety needs to be changed. Nagel (1994) point out in her classic work, Constructing ethnicity: Creating and recreating ethnic identity and culture, that “Culture is not a shopping cart that comes to us already loaded with a set of historical cultural goods. Rather, we construct culture by picking and choosing items from the shelves of the past and the present” (p. 162). Cultural norms and beliefs are dynamic, they need to be constantly modified and transformed within different socio-historical contexts. Hence, it would be helpful for both adult children from the only-child generation and their parents to be released from the cultural burden, create and embrace alternative elder care resources. The individual agency and interpersonal negotiations among social actors allow room for redefining social expectations and constructing alternative supports in ways that may be more flexible and adaptive to changing circumstances (Connidis and McMullin 2002).

It is important to note both the contributions and limitations of the current study. These interviews provided insight into the concerns raised by a small sample of young people who are living abroad and considering the future dilemmas of caring for aging parents as part of China’s only-child generation. With this limited number of cases, we cannot generalize our results to an entire generation or to those who are studying or working abroad. In fact, most of our respondents were from relatively affluent families and were privileged to pursue various opportunities internationally. Parents’ elder care would bring them much less financial burden compared with the large number of lower class families, many of whom face similar challenges of physical separation and mobility (within China) but without the kinds of supports that exist in more developed countries like Canada. Hence, it is necessary for future researchers to explore this topic through more diverse samples. Moreover, we underscore that the current study focused on concerns about and arrangements for the future: none of these young people had yet been confronted with the problems of reconciling their parents’ elder care with the constraints of their own lives. Further research is needed to examine how individuals and families will respond to these challenges in the future, especially in the next few decades as the parents of the only-child generation grow older.

Footnotes
1

The World Band data, retrieved from: http://data.worldbank.org/indicator/SP.DYN.TFRT.IN?

 
2

In late 1970s, Chinese government started its economic reforms, aimed to transform China’s economy system from planned and socialist economy to market oriented economy. The reforms involved the decollectivization of agriculture, opening door to foreign investments, encouraging private businesses, etc. Accordingly, these economic reforms also brought profound social change.

 
3

Relevant provisions can be found in Marriage Law, Elderly Rights Law, etc.

 
4

The data is retrieved from the website http://www.chinabgao.com/reports/56315.html, consulted on December 2, 2011.

 
5

The time difference between Montreal and Beijing is 12 h in summer and 13 h in winter.

 
6

In Chinese, this proverb is written as “树高千尺,落叶归根,” which means that in one’s old age, one should return to one’s hometown.

 
7

The Hukou system (户籍制度) is a record system of household registration that imposes limits on citizens changing their permanent place of residence. Since the residence permit is associated with political, economic, and cultural rights, the Hukou system has long been criticized because of the inequality that it has brought.

 
8

In Chinese, this proverb is written as “养儿防老,” which means that one of the most important reasons for one to have and raise children is that children could provide physical care and financial support in one’s older age.

 

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Sociology and Criminology & LawUniversity of FloridaGainesvilleUSA

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