Changing caregiving relationships for older home-based Chinese people in a transitional stage: Trends, factors and policy implications

Background In the transitional stage of socioeconomic development, the traditional practice of home-based care in China is being tested. The evolution and factors of home-based care utilization are the prerequisites for the formulation of a support policy. However, no extant research has studied home-based elder care on a national scale. Aim This paper aims to examine changing caregiving relationships nationwide for home-based elderly individuals and investigate the changing factors of care utilization in a ten-year period, with special attention to the effects of “location” on care patterns. Methods The data come from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Andersen and Newman's behavioral model is employed as the theoretical framework for this research. The trends in care use from 2002 to 2011 are explored and multilevel multinomial analyses are performed to investigate the changing factors of care patterns between 2002 and 2011. Results From 2002 to 2011, China saw a sharp decrease in children as caregivers, a significant increase in spousal caregivers, and a gradual decrease in other caregivers. Compared to 2002, the effects of the predisposing and enabling factors are more important than the need factors in 2011. Location and the interactions of the north-south divide and the urban-rural divide had a significant effect on care patterns. Conclusions From 2002 to 2011, there was a decline in the traditional values-advocated care system and the elderly had to rely more on their own resources to find caregivers. In the design of a support program, there is an urgent need for policy makers to take social inequality among elderly individuals and the effects of location into consideration.