Preferences for Institutional Care Among Older Adults in China: Is Family Composition Important?

Family care has been the primary form of eldercare in China as it is reinforced by the Confucian value of filial piety. However, recent demographic and social changes have made family care less accessible, potentially increasing demand for institutional care. Based on a national survey of older adults in China, this study examined how family structure and children’s socioeconomic achievement influenced the willingness of older parents to use nursing homes. We found that 38% of urban older adults and 19% of rural older adults were willing to move to a nursing home under some conditions (e.g., poor health, family conflict, or loneliness). Family structure (i.e., number of children and their gender composition) and children’s socioeconomic achievement were associated with parent’s willingness to use a nursing home. Specifically, urban parents having fewer children was associated with willingness to use a nursing home. Among one-child rural families, parents with a son were less willing than those with a daughter to use a nursing home. Rural and urban parents with a college-educated child were more likely to favor using a nursing home, as were rural parents whose children were experiencing financial difficulties. Results are discussed in the context of family change in China that may result in an expanded market for institutional care in the older population.