Before arriving into Shanghai, I wasn’t really sure what to expect of the elderly and their lifestyle here in the big city. All I had was my experience with a nursing home in Queens, the Keystone Project, and my past experience living with my grandmother. After a few weeks of readjusting myself to the new environment, I had some time to do some preliminary research for my thesis project.
Well embedded into the Chinese culture lies a strong family structure. Traditionally, parents live with their eldest child into their old age where they would be cared for by the younger generations. Unfortunately, these traditions are slowly being unwound due to the mobilization of society, e.g. career options outside of ones hometown. This scattering of generations around the world comes into direct conflict with China’s “4:2:1” phenomenon, which according to the NEJM, means “that increasing numbers of couples will be solely responsible for the care of one child and four parents.” The “4:2:1” phenomenon is a direct result of China’s one-child policy, which was implemented in 1979 under Deng Xiao Ping.
In addition, the percentage of the elderly living in China is expected to “rise to more than 15 percent by 2025.” The NEJM also states that “a lack of adequate pension coverage in China means that financial dependence on offspring is still necessary for approximately 70 percent of elderly people.”
So with all of these potential problems the future elderly in China may face, what will be the support structure for those who do not have younger generations around to care for them?
After a little over a month of living in Shanghai, I have not yet come across a nursing home. Unsurprisingly, I found the following posted on Medscape,
The existing system [nursing homes] accommodates only 0.8% of China’s total aging population, far fewer than expected according to international standards. Based on numbers from the Ministry of Civil Affairs, to increase capacity even to 3%, China needs to invest at least US$200 billion.
Besides the huge monetary investment required by the government, the lack of nursing homes is also a result of how previous generations of families were structured. As mentioned before, prior to the one-child policy, the care provided for the elderly was shared amongst a larger family and hence did not require nursing homes.
Hired caretakers seem to be the most popular solution for a quasi-support structure in Shanghai. In a small park right across the street from where I work, I’ve witnessed several accompanying the elderly on a one-to-one basis. They have conversations with their elder; they feed their elder; they push their elders around the neighborhood in a wheelchair. It seems that they have successfully fulfilled the duties of their absent child, but what about the caretakers own parent?
According to Medscape, “because of her [caretaker’s] employment, [she] is less available to her own relatives. It is also not clear what the future holds for this part of the population. It is likely that the supply of service workers, such as the baomu [caretaker], may not keep up with the demand for care of older people as the population pyramid changes between now and 2050.”
This is probably the most impressive support structure out of all of the solutions presented so far. I am completely amazed by the strong ties that the elderly in Shanghai have developed within their communities and neighborhoods. I’ve been fortunate enough to witness this firsthand with my relatives (my uncle’s in-laws) that I’ve been living with for the past two months.
Throughout the week, they have a full schedule. In the morning, they exercise both physically and mentally by taking walks around the neighborhood and conversing with other members of the community. During the day, they go to church, which consists of mostly people from their neighborhood. During the evening, they are visited by various family members and friends for dinner. Also, I’d like to also mention that the husband is 79 and his wife is 70 and they are mostly independent.
Besides my relatives, strong communities can also be seen elsewhere. Again, going back to where I work, every night at the small park on the corner of Liyuan Road and Mengzi Road, there is always something going on. From Tai Chi to the Cha Cha, people are participating and interacting with one another no matter the age. It is definitely something you have to witness firsthand.