In China, a More Western Approach to Elder Care

By PAULA SPAN, New York Times, July 27, 2011,

Residents of a home for the elderly in Nanjing, China.Residents of a home for the elderly in Nanjing, China.

In any discussion here about the decision to move an older person into some sort of care facility, we can virtually count on a denunciation in the comments section, often from someone citing immigrant roots. Americans are too self-centered, too careerist, goes the criticism.

“I come originally from Argentina and in my culture we respect and honor the elderly and consider it disgraceful and selfish to put a parent in a nursing home,” Maria Gonzalez from Cleveland wrote last spring.

Dr. Kat Lieu from New York City sounded only slightly less disdainful. “Maybe it’s because I’m an Asian-American, but I never see myself far away from my parents,” she wrote. “They had always been there for me. I will always be there for them.” She’d never consider a nursing home, she vowed.

Of course, it’s demonstrably untrue that Americans by and large are somehow abandoning their parents. The great majority of our older adults don’t live in any kind of institution and aren’t receiving any paid help, but rely, as always, on their families. Most family members aren’t cavalier about the decision to place a family member in assisted living or a nursing home, nor do they walk away after doing so.

I’ve often wondered: Do these attitudes really stem from innate national or cultural differences? Or are they a function of the way different societies operate, in which case those values may alter as societies change?

I found it fascinating, therefore, to learn that homes for the elderly are popping up all over China, where the Confucian principle of “filial piety” has held sway for millenniums. Zhanlian Feng, the researcher who just reported his findings on the growing minority populations in American nursing homes, immigrated from China in 1997 to do graduate work at Brown University, where he now teaches.

At the time he left his homeland, the old ways still held. “If you talked to an adult child and asked, ‘If your mother or father gets too sick to care for at home, would you consider some sort of home or facility?,’ they would be shocked,” he told me in an interview. “It was a shameful idea.” Adult children, particularly sons, were expected to take in their parents. End of story.

But when Dr. Feng returned to China in 2006 with a National Institutes of Health research grant, “people’s attitudes had changed a lot in just a few years,” he said, “even in rural areas where you’d think traditions would have a stronger hold.”

Contemporary China is experiencing many of the same demographic and socioeconomic pressures as the United States, he recently reported in The Journal of the American Geriatrics Society. People are living much longer; family structures are changing; women have entered the work force in greater numbers. With no national health insurance program like Medicare and with the one-child policy that places elder care responsibilities on fewer shoulders, Chinese families also face some challenges greater than ours.

There’s no safety net, Dr. Feng said, and “that has created an escalating need for care for a lot of aging people.” (A whole lot: roughly 112 million people over age 65 now, and a projected 329 million by 2040.)

Surveying seven Chinese cities, he found a proliferating number of elder care homes, a great majority privately built and operating with negligible government subsidies. The ancient capital of Nanjing, for example, had 27 homes in 1990 and 52 a decade later. By 2009, when Dr. Feng and his team began investigating, the city had 148. Beijing and Tianjin showed similar growth. Shanghai had 552 facilities.

It’s probably not entirely accurate to call them nursing homes. With younger and healthier residents than those in American nursing homes, these facilities seem more analogous to independent or assisted living. Most didn’t employ any nurses or physicians.

Still, they represent a seismic change in the way China cares for its elders. “We’re talking about changes in both generations,” Dr. Feng said. “The younger generation wants more privacy” and prefers to live in nuclear families.

“You’d imagine the elders would be upset,” Dr. Feng went on. “But they’ll tell you, ‘I’d rather live by myself. I’m pretty happy here. I can chat with people, I can do activities with my peers instead of spending every day with my son’s family.’” He’s not sure they’re all as delighted as they sound, but most seniors have small pensions, and “they can purchase autonomy.”

(A similar shift took place in the United States in the 1940s, with the advent of Social Security.)

If attitudes about elder care can change so swiftly in China, it’s hard to believe that any industrializing society is immune. I expect we’ll continue to hear from some quarters about how other cultures compare with heartless Americans, but that’s not how Dr. Feng sees it.

“Immigrants tend to beautify and mystify a lot of things in their home countries,” he said. But when he looks at the way older people and families live in the United States and China, “I see amazing similarities.”

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