UCLA

A rapidly growing aging population, the one-child policy, and the Economic Reform in urban China pose unprecedented challenges to its ingrained tradition of family caregiving. An increasing number of elders in Shanghai have entered nursing homes to meet their needs for long-term care. The contradiction between self-reliant caregiving tradition and growing nursing home utilization calls for an exploration of how these elders and their children decide to institutionalize. Integrating crisis theory, social identity theory, and uncertainty management theory, this study proposes a framework to conceptualize the phases of this decision-making process.

This phenomenological study retrospectively described both generations' experiences of deciding to institutionalize. The author conducted semi-structured interviews with 12 dyads of matched elders and their children (total N = 24) in a government-sponsored, municipal-level nursing home in Shanghai. From a dyadic perspective, data analysis emphasized the relational aspects of participants' intergenerational communication about reaching consensus on institutionalization.

In accordance with a phenomenological approach, the essence of participants' experience of deciding to institutionalize is that elders and their children proactively or reactively chose institutionalization. Decision-making occurred in the face of family caregiving crises, such as elders' declining health conditions, disrupted caregiving arrangements, and strained intergenerational relationships. Proactive families chose institutionalization to prevent potential caregiving pressure that might exceed family caregiving capacity, while reactive families sought institutionalization after they had encountered tremendous caregiving pressure and depleted caregiving resources. Within dyads, each generation, respectively, had its own motivation to institutionalize while preserving positive social identity in intergenerational communication, but ultimately children held decision-making power. When family caregiving crises occurred, filial piety may have become less practical for children, though it remained an integral part of the decision-making process.

This study addresses the importance of catering to various needs for long-term care of Chinese elders--the world's largest aging population in the coming decades. This study informs policy to develop diverse and specialized home- and community-based long-term care in urban China and emphasizes social work practice to establish specific needs assessment criteria, improve overall caregiving communication, advocate for elders' decision-making autonomy, and enhance geriatric training for frontline workers.