By Samuel Green

In the previous article we introduced the numbers behind rural-urban migration and how that skews the demographic in these ‘left-behind’ areas. This time we will take a detailed look at the effects of this migration on individual people, how it impacts their ability to receive care and the effect on their mental well-being (in the Chinese cultural context). Part III is here.

In 1999, Davis & Martinson studied the home care needs of seventy-five chronically ill elderly patients in China. More than 75% required more than two hours of care per twenty-four hour period, with 50% needing seven to twenty-four hours of care per day. In their study, the caregivers were predominantly members of the family. Primary carers were daughters, daughters-in-law and wives. While women are one of the three groups ‘left-behind’, this situation is not sustainable. During the mid-1980s, the one-child policy was strictly enforced; this resulted in the 4:2:1 family ratio (4 grandparents, 2 children and 1 grandchild). The ultimate effect of this policy on the number of potential caregivers should become clear by 2030, although it is not difficult to assume that resources will be stretched to their limits. Observing projected figures for the number of elderly requiring nursing-home level care, Flaherty et al. (2007) calculate that the rate of change will be more than 500%;

“To put this in perspective, if Beijing were to decide to build more facilities as a response, this would mean going from the approximately 300 nursing homes that served only 0.6% of Beijingers aged 60 and older in 1998, to 1,500 over the next 25 years. This represents a construction rate of 48 new facilities per year.”

-Flaherty et al. (2007)

If one factors in migration of children to urban areas, there is the potential for a real crisis in Chinese health care. Who will be left to care for these people in need?

Migration undoubtedly makes things physically difficult for the elderly, especially those who are chronically ill. However it is also understandable that being left-behind will be more than just a physical issue. Observing through their study in Chaohu (Anhui province), Silverstein et al. (2006) concluded that older parents living with both their adult children and grandchildren experienced significantly favourable psychological outcomes (although this was not equally the case without grandchildren). Interestingly they found that “better psychological outcomes” were experienced during skipped-generation households, meaning older parents and grandchildren living together, without the middle generation, is a favourable situation for elders.

Silverstein et al. (2006) believe that the optimal family arrangement in rural China is of this form, where adult children are not present but elders can care for their grandchildren. Their research showed a direct link between the amount of monetary support sent home and better psychological outcomes. The value of remittances older parents received from their children was the primary reason for explaining the improved attitudes of skipped-generation families. The monetary value of these financial exchanges is undoubtedly beneficial, as well as the act of receiving compensation for their “custodial care of grandchildren as part of a time-for-money exchange, [exemplifying] the functional integration between generations,” (Silverstein et al., 2006).

Chinese culture holds filial piety in the highest regard and, while migration does not directly oppose this, living with one’s children (particularly the eldest son and his wife and children) “represents the most complete fulfilment of filial piety and may directly protect the well-being of older Chinese parents,” (Silverstein et al., 2006).

Consequences of migration not only have the potential to shift rural health profiles in the short term, but will undoubtedly cause a demographic change in urban areas. Filial piety motivates families to stay together in the countryside, thus it also motivates migrated families to stay in the city. As the urban migrants begin their families, they will eventually age and remain in the city. These two trends seem to run counter to one another. The elderly parents of the migrants are likely to be left behind if their children stay in cities with their families. While some elderly will undoubtedly move to the city, the high costs of a move, both monetary and physical, as well as the regulatory complications involved (see hukous in the next instalment), will preclude the majority of elderly from doing so. Either way, the burden of mass immigration is both a long and short-term problem which is a uniquely Chinese and a large part of any holistic exposés on China’s aging problem.

Next time we will look at the institutional factors of human resources and the hukou system. We will also discuss a possible answer to the missing caregiver situation that, with the right support, could alleviate at least some of the pressure the system is facing.