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How to overcome care deficit in Chinese families

ZHONG XIAOHUI and PENG MINGGANG | 2023-01-19 | Hits:
Chinese Social Sciences Today

A boy plays football with his grandfather at a park in Hefei City, Anhui Province, on Jan. 10, 2023. Photo: CNSphoto

Providing care for a rapidly aging population is an unprecedented challenge for Chinese society. An aging population means an increased need for family care. Adult children are the main caretakers in daily life and rehabilitation for the elderly in China. However, amid population aging and with fewer children, Chinese families face twice the care burden with the superposition of elderly parents and young children. With the implementation of the “universal three-child” policy, the number of children per family is likely to increase, which would lead to a spiking possibility of overlapping care needs for the elderly and children, further straining family resources.

A lack of care resources, also known as a care deficit, refers to a decline in the ability of a society or family to meet the care needs of children, the elderly, and other individuals. Social policy research has discussed the family care deficit extensively, mainly examining the impact of welfare systems and care policies. 

However, there is an evident “split” in Chinese caregiving research. On the one hand, the care of the elderly and that of children are discussed as two separate topics. These studies seem to assume that families only face the pressure of raising children or caring for the elderly. In reality, the concept of family care in China has always included both the elderly and the young. On the other hand, family care and social care services are also discussed separately, overlooking the interaction between the two. In fact, market-based social care services are developing rapidly in Chinese cities, second only to family care. 

Therefore, the study of Chinese caregiving practices in a “two-generation model” of parents and children does not fully reflect family care responsibilities in Chinese society and cannot detail the differences in the spectrum of family caregiving.

Three-generation model

Based on the aforementioned considerations, this article adopts a “three-generation model” to comprehensively investigate how Chinese families organize and allocate care resources as old-age care and childcare compound and superpose. Chinese scholars Di Jinhua and Zheng Dandan once used the three-generation model to study the intergenerational distribution of economic resources in rural families in terms of elderly care. Inspired by this research, we viewed family care under the three-generation chain of “elderly grandparents—adult sons and daughters—underage grandchildren,” to analyze the distribution of the middle generation’s care resources in Chinese urban families. At the same time, social care is also reviewed through an analytical framework as a way for families to complement the care deficit.

The existing literature indicates that current care policies in China do not provide adequate support for ordinary families, and families mainly rely on their private resources to care for the elderly and children. This means that intergenerational competition for family care resources is likely to occur when childrearing and elderly care needs present themselves simultaneously. Some scholars have noted that the middle generation faces the dilemma of taking care of both elderly parents and underage children. If there is intergenerational competition, how will the middle generation choose and allocate care resources?

Though few studies discuss the allocation of family care resources from the three-generation model, research on intergenerational relationships in Chinese families suggests that there are two possibilities for the allocation of care resources. One is the theory of “prioritizing the young over the old,” and the other is the theory of “valuing the young as well as the old.”

To figure out which possibility prevails, we will examine the intergenerational allocation of resources under the family care deficit in China, and specifically answer three questions. First, is there an intergenerational competition between elderly care and childcare in China? Second, if there is competition, how will the middle generation balance and make care arrangements? Third, if family care resources are insufficient, how can the middle generation seek market-oriented social care services to address the dilemma? Our study identified the risk groups experiencing family care deficits and proposed how the government should adjust the division of care responsibilities with individual families in the context of the “universal three-child policy.”

In this article, a hybrid research method combining quantitative and qualitative research was adopted to investigate how Chinese families deal with the overlapping needs of childcare and the elderly care, so as to avoid the pitfalls of a single method in terms of depth and representation. Specifically, quantitative analysis was performed using large-scale survey data to study whether there is intergenerational competition in the care resources of urban families, and the basic characteristics of intergenerational family care distribution. Qualitative research was used to carry out an in-depth analysis of the family care distribution process and its consequences.

Triple dilemma

The main findings of our research are threefold. First, the combination of an aging population and fewer children burdens families with a dual care pressure. In urban families, the older generation’s economic security and quality of life have significantly improved due to China’s economic prosperity, so older adults’ expectations for care and companionship from their children have also increased. At the same time, modern life has fostered a child-centered family culture. In comparsion with many decades of childrearing, children’s care and education today consumes a larger amount of parents’ time, energy, and money. Therefore, as the middle generation, the dual pressure of raising children and supporting the elderly has become quite overwhelming compared to previous generations.

Second, urban families’ care resources are insufficient to handle the dual pressures, resulting in a care deficit. This is apparent mainly on the elderly end of the spectrum. When the care needs of the elderly and children overlap, the middle generation usually adopts a “child-centered” care distribution model. In this model, families prioritize care resources such as time, manpower, knowledge, and money for children, while caring for the elderly becomes more of a crisis response. Even for middle-class families, spending on elderly care falls short, especially in terms of emotional companionship and knowledge. The elderly care deficit is more prominent for those who are in poor economic conditions, those who can’t take care of themselves anymore, and one-child families. In families where both the elderly and the young require 24/7 care, work opportunities for women in the middle generation are severely affected.

Third, the family care deficit for the elderly cannot be alleviated by means of social care services at present. The lack of mature, diversified care services is to blame for this. There is a chronic shortage of human resources to provide social care services, among which childcare services are relatively adequate but the supply of elderly care services is scant. This has to do with two factors. One is that there is a difference in the social recognition of old-age care and childcare. The occupational social status of a nanny for children is higher than that of elderly caregivers. Second, there are differences in the willingness and ability of families to pay for elderly care. Families are less willing to pay for care of the elderly than they are to pay for childcare, and senior pensions often do not cover the cost of long-term care services. As we can see, market-based social care services cannot mitigate for the lack of family care resources, trapping many families in anxiety over how to take care of children and their elderly parents in a balanced manner.

Future studies

In summary, the superposition of care needs, care deficits, and care anxiety has formed the triple dilemma faced by urban families in China against the background of an aging population with fewer children. The insufficient support of government policies for family care exacerbates the dilemma of child-to-elderly family care. This is an urgent issue of great concern, especially among the elderly and women who have become the primary caregivers. From a social policy and welfare research perspective, this study puts forward some thoughts for future research.

Since the reform and opening up, Chinese care policy has followed “non-supportive familism.” In this policy, the government provides few alternative public care services for ordinary families. Furthermore, subsidies, tax rebates, and other supporting measures are rarely provided to help families access market-oriented care services. During the “one-child” policy period, families shared the care burden through intergenerational mutual assistance and other ways. However, as the population ages, intergenerational mutual assistance is no longer applicable. The middle generation has the obligation to provide elderly care, but they are struggling with work and life balance, sometimes feeling powerless to meet rising needs. In the absence of a care policy, anxiety arises, especially for two working parents and for women who are juggling work, childcare, and elderly care.

Our study shows that insufficient policy support for family care intensifies the pivot towards raising children and forms a crowding out effect which impacts care for the elderly. At the same time, existing literature and the results of our study both confirm that most of the elderly in China tend to prefer home-based old-age care. They hold a rather conservative attitude toward social care.

From the perspective of the three-generation model, there will always be a structural tension in the allocation of family care resources. We believe that a policy support system can be developed to ease these tensions in two ways. Going forward, the aging population’s care dependence on family members should be reduced on a policy level, whereas the unique value of family care in terms of companionship and emotional support should be highlighted. That said, a knowledge support system should be in place to support family care and a public resource support system is essential. In doing so, first, it is necessary to comprehensively assess the needs and capabilities of families with elderly care and childcare demands using the three-generation model, which means subsidies, allowances, tax reductions, and other measures specifically used for elderly care should be arranged. Second, we should vigorously promote the development of community-level nursing institutions for the elderly and broaden the supply capacity of specialized and individualized elderly care services in the public sector.

Zhong Xiaohui is an associate professor from the School of Government at Sun Yat-sen University; Peng Minggang is an associate professor from the School of Public Administration at Guangzhou University.

Edited by YANG XUE