Cultural change and long-term care in China: A case study of the transition of the role of family for care provision in Guangzhou

The family is the primary care provider for older people in many countries, as it is in China, with its conventional family-centred care provision pattern and deeply rooted family values. Despite the newly implemented public long-term care insurance pilot funding the care provision, China’s care system has been severely challenged by its substantial ageing population and worsening demographic structure. In some pilot sites, family-provided care has been integrated into the insurance-funded care system. With multiple social transitions, such as changing cultural values, it remains unexplored whether the family's role in providing care has changed and how it has adapted to the development of the long-term care system. This study, which focuses on family, long-term care and cultural values, is therefore designed to address these research gaps.
This mixed-methods study examines the role of the family in providing long-term care in China, considering the impacts of cultural values. Based on secondary data analysis, the findings show that people have higher care expectations of the state in recent years, despite the majority agreeing with the family's principal caregiving role. According to the findings from a case study of one pilot site, Guangzhou, there is a more explicit division in terms of money and labour dimensions for the family in providing care from the defamilialisation perspective. Cultural values are significant not only for individual care decisions but also for the provision of long-term care within the care arrangement. In the light of care alternatives associated with a labour shortage and cultural values, the family continues to play an essential role for many for whom insurance-funded family care is available. Given that China is ‘getting old before getting rich’, this thesis can contribute to better fulfilling the family’s function in satisfying the care demands of its older members in future care provision in contemporary China.