How childless older adults in rural China choose between ageing-in-place (AIP) and institutionalization

Abstract

Background: Ageing-in-place (AIP) referred to ‘the ability to live in one’s home and community safely, independently, and comfortably’. From social policy perspective, it was encouraged by policy makers to address the challenge of population ageing and the long-term care (LTC) needs for older adults. While the AIP agenda in rural China anchored the long-term caring responsibilities to family members – especially adult children, the voice of childless group remain unexplored. In other words, little is known about how childless older adults living in rural China make their residential decisions (regarding to AIP or institutionalization). Research objectives: This research aimed to gain in-depth understanding on the residential decision-making process (AIP or institutionalization) among childless older adults in rural China. The concept of residential reasoning – defining as the whole process of assessment, adaptation and residential decision-making – was applied to guide this study. The overall research question of, ‘how and why childless older adults choosing between AIP and institutionalization’ was investigated, followed by two sub-questions from residential reasoning model: (a) how they assess the residential circumstances in rural community; (b) how they struggled to adapt before making the residential decisions. Method: This research was informed by the constructivism grounded theory approach, as it enabled ‘dialogue’ between new evidence with existing theoretical framework (e.g., the residential reasoning model). There were total of 27 childless participants (aged 60 to 92) were recruited from rural area in Yunnan, China from face-to-face interview, including 17 community-dwellers and 10 institution-dwellers. 6 informants (including village cadre, anti-poverty working team members) were interviewed to enhance method rigor. Data collection and analysis were conducted simultaneously, separating from four steps: (a) the initial sampling and coding; (b) initial sampling and focused coding; (c) theoretical sampling, axial coding and theoretical coding; (d) verification. Method rigor was enhanced by triangulation, member checking, peer debriefing meeting and researcher’s self-reflective note. Results: The long-term residential decision (regarding AIP and institutionalization in rural China) is an ongoing negotiation process; sense of mastery centred on the whole process. The mastery experience is full of ambivalence, encompassing simultaneously self-reliance and the uncomfortable experiences of rural living, including stress, suffering and powerlessness. Further, achieving mastery requires ongoing struggle and adaptation. This research identifies two levels of adaptation, namely individual and interpersonal, respectively: (a) ‘enduring ku’, that is, conducting farming and farm-related activities; (b) ‘having someone at home’. If childless older adults could endure ku or have someone at home, AIP would be preferable to institutionalization. Conversely, if they were overwhelmed by the stressful and suffering aspects of farming, or they perceived ‘having no one at home’, relocating to a rural institution would be more likely. Essentially, the findings of this study suggested that maintaining a sense of mastery was the key for childless older adults in choosing to age in place. Discussion and implications: This study investigated the long-term residential decision process among childless older adults – one of the most disadvantaged yet unexplored groups in rural China. It provided in-depth understanding of why certain residential decisions are made and how. This research pointed out that, even though an adaptive effort has unfolded during the residential reasoning process, what remains ignored is the individual and structural disadvantage of childlessness in rural China. No matter how childless older adults struggled to endure ku or having ‘someone at home’, the adaptation process struggling and messy. This reflects the disadvantageous situation of childlessness in rural China, which was further intersect with layers of constrictions such as ageing, poverty and gender inequality. Overall, the long-term care needs of childless older adults require a specific policy response.