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Since China enacted its draconian one-child policy nearly 40 years ago, the country has effectively curbed its explosive population growth, and simultaneously clawed its way into being the world's second largest economy. However, in contrast to its benefits, the one-child policy has also caused a number of serious complications in China's modern society, namely a gender imbalance, a labor shortage, and, most importantly, a significantly accelerated aging society. As China pours almost all of its planning and resources into its future, the country has all but forgotten about the people who built it in the first place. Research into the effects of the one-child policy has typically focused on the younger or future generations of China. But now, more than ever, the challenges faced by China's aging population are at the forefront. The disparity between traditional eldercare and today's reality under the one-child policy, along with the severe impacts of inadequate care, clearly illustrates China's responsibility to reform its eldercare policies.

China's one-child policy has radically impacted the country's demographic, which, when combined with massive internal migration, has left millions of aging Chinese without care or support. As noted by Zhang and Goza (2006), the combination of lower mortality rates, increased life expectancy, and below-replacement fertility has accelerated China's aging society, heralding new challenges in eldercare for the country. Eldercare has traditionally fallen onto the shoulders of younger generations, with parents and grandparents expecting to be cared for by their grown-up children. However, the demographic shifts under the one-child policy has strained the younger generations ability to provide ample care and support. Gui and Koropeckyj-Cox found that many of China's youth felt as though their identities as only children placed them in a unique position to be the sole provider and caregiver, but struggle with the reality of providing that care. They wrote, "the conflict between work and family roles has become a major source of concern in their lives and has contributed to eroding traditional family arrangements" (2016, p. 257). The younger generations now bear the heaviest portion of the eldercare burden all on their own.

The weight of providing eldercare differs across the country, as internal population migration has shifted the countries demographic topography. The greatest impact on eldercare provision has been in rural areas where massive migration into the cities by young Chinese seeking economic opportunities has led to a significantly higher proportion of elderly residents in villages and towns without traditional care or support (Zhang & Goza 2006). Nie estimates that over 200 million young adults have migrated from rural areas into the cities, with that number possibly growing to reach 400 million by 2025 (2016). This departure from both hometowns and tradition illustrates how China's antiquated notion of filial piety is no longer sufficient to ensure that the elderly live happy, healthy lives. The growing distance between traditional care and reality has had as much as an impact as the physical distances between grown children and their parents on the lives of China's aging population.

Research shows that the erosion of traditional familial eldercare has had several worrying impacts, mainly increased rates of mental health issues as well as financial hardships. Loneliness and depression are endemic to China's aging population, and those affected have a scarce few options. Nie's research revealed what he called an "epidemic of elder suicide, especially in rural areas", finding that the 44% of all suicides in China were elders over the age of 65. Disturbingly, he writes, rural elderly are three to five times more likely to commit suicide, with rural males ten or even twenty times more likely than their urban counterparts (2016). In addition to the psychological impacts, China's elderly must also contend with financial difficulties. Song reveals that very few elderly people in China have stable incomes, with most relying on support from family members. However, the costs of medical and elderly care, as well as funeral arrangements, have increased significantly, even as family sizes shrink drastically. Song points out that government's pension system is not available to all regions of the country, and only 24% of the aging population qualified for a pension in 2010 across the entire country (2014). Additionally, the pension system first benefits civil servants and state enterprise employees, followed by urban residents. Pension in rural areas is nearly 40 times lower than that of a non-state employee in Beijing, if they are allowed any pension at all (Nie 2016). Although mental health and financial issues are found in almost any elderly population worldwide, China's antiquated approach to eldercare has exacerbated these problems.

Elderly parents who have lost their only child due to accidents, diseases, or disasters and who are unable to have a second child face exponentially greater hardship. Song's research shows that these families, often called shidu families, number over 1 million as of 2014, and Nie indicates that the number could increase by about 76,000 families each year. Although some of these families had no choice but to have only one child, Nie points out that many families willingly supported the one-child policy. Now, he argues, these families are forced to bear the painful consequences of elderly life with no children to help them (2016). Shidu mothers were often forced to have abortions under the one-child policy, to which Song wrote that "all were regretful of this fact, given the loss of their only children, but they did not really have any other choice at the time, as the one-child policy was rigidly implemented" (p. 120). Song also illustrated how some of the financial difficulties that shidu families face have compounded, as they cannot rely on their children for support and many do not have siblings to rely on. Shidu families whose children died from disease are often in severe debt, having spent their life savings trying to save the child. Song also writes that common life events for elderly people are restricted for shidu families, such as applying to senior care homes which requires a child's sponsorship regardless of who pays the fees. Likewise, children must authorize all common medical procedures and treatments for their parents in China (Song 2014). Nie adds that more than half of shidu parents suffer from chronic illnesses, and 60% suffer from depression, with almost the same amount show suicidal tendencies (2016). Apart from elderly suicide, the plights of shidu families are certainly one of the most critical crises in eldercare in China.

As the traditional notion of familial eldercare is no longer feasible, the Chinese government must re-evaluate their eldercare related policies and plans. Willingness by younger generations to care for their aging parents aside, some elderly couples have accepted that their children are unable to meet their needs and are now looking into non-traditional care options (Zhang & Goza 2016; Gui & Koropeckyj-Cox 2016). Nursing homes have historically been looked down upon, often seen as a last resort for the most desperate, but Zhang and Goza argue that promotion by the Chinese government could change these opinions and alleviate many of the population's fears. They also recommended to replicate city neighborhood committee programs that had found success in several urban areas and implement the model in more rural areas. These programs utilize community volunteers to provide support and communal care to groups of elderly living alone (Zhang & Goza 2016). Many scholars recognize that eldercare should be provided at the national level, rather than a burden placed on the individual. Nie argued that, "Eldercare is an arduous challenge not just for these single-child families, but for the entire country" (2016, p. 353). Gui and Koropeckyj-Cox also spoke out against putting the burden of eldercare entirely on the family, saying that "it is not really realistic to expect these young people to solve their family problems by themselves, nor is it fair to expect individuals to solely shoulder the consequences of national population policies and demographic changes" (2016, p. 270). It is painfully clear that China's eldercare related policies and programs must undergo significant reform, else there will be no better future for China's aging population.

As China continues to pursue a brighter future for its population, it cannot make the mistake of allowing its elderly population to suffer any more than it already has. It is time for the Chinese government to admit its failures in the wake of the one-child policy and strive to reform its plan of action. No longer can the burden of eldercare be left on individual families or strangled support systems, no longer can the people rely on antiquated notions of filial piety for care. China's elderly now face depression, suicide, impoverishment, and have no where to turn. Only a dramatic shift in China's policy and cultural ideology can save the elderly population from living out their days alone and in pain.


Since China enacted its draconian one-child policy nearly 40 years ago, the country has effectively curbed its explosive population growth, and simultaneously clawed its way into being the world's second-largest economy. However, in contrast to its benefits, the one-child policy has also caused a number of serious complications in China's modern society, namely a gender imbalance, a labor shortage, and, most importantly, a significantly accelerated aging society. As China pours almost all of its planning and resources into its future, the country has all but forgotten about the people who built it in the first place. Research into the effects of the one-child policy has typically focused on the younger or future generations of China. But now, more than ever, the challenges faced by China's aging population are at the forefront. The disparity between traditional eldercare and today's reality under the one-child policy spurred in part by massive internal migration, along with the severe impacts of inadequate care on the elderly population, clearly illustrates China's responsibility to reform its eldercare policies.

Care for the elderly in China has traditionally been provided by each successive generation, with little to no support from the government. Lu, Liu, and Piggott (2015) defined this traditional familial care method as informal care, one of the pillars of the culture's long-term care structure. Through their research, Lu et al. found that there are many factors that determine if an elderly couple will receive long term care from their children, to include education levels and personal wealth. Additionally, they found that male children statistically gave more time and resources in care of their parents than female children, which may have been a factor of China's gender imbalance, another effect of the one-child policy. Finally, Lu et al.'s (2015) research revealed that the likelihood of receiving eldercare dropped significantly if the family had more than one child, a sharp contradiction towards many researchers' theories that more children would result in better long-term eldercare. Informal care as a long-term care option has always been the key to ensuring that the aging population of China is not neglected.

China's one-child policy has radically impacted the country's demographic distribution, which, when combined with massive internal migration, has left millions of aging Chinese without care or support. As noted by Chen, Xu, Li, and Song (2018), the combination of lower mortality rates, increased life expectancy, and below-replacement fertility has accelerated China's aging society, heralding new challenges in eldercare for the country. The task of providing informal care, according to Lu, Liu, and Piggott (2018), has traditionally fallen onto the shoulders of younger generations, with parents and grandparents expecting to be cared for by their grown-up children. However, the demographic shifts under the one-child policy have strained the younger generations ability to provide ample care and support. A large portion of China's younger population struggles to balance the cultural idea of filial piety, expressed in part by long-term care provision, with societal realities in modern China (Glass, Gao, & Luo, 2013). Gui and Koropeckyj-Cox (2016) found that many of China's youth felt as though their identities as only children placed them in a unique position to be the sole provider and caregiver, but struggle with the reality of providing that care. They wrote that "the conflict between work and family roles has become a major source of concern in their lives and has contributed to eroding traditional family arrangements" (Gui & Koropeckyj-Cox, 2016, p. 257). The younger generations now bear the heaviest portion of the eldercare burden all on their own. 

The obstacles of providing eldercare differ across the country, as internal population migration has shifted the countries demographic topography. The greatest impact on eldercare provision has been in rural areas where massive migration towards cities by the younger population seeking economic opportunities has led to a significantly higher proportion of elderly residents in villages and towns without traditional care or support (Glass, Gao & Luo, 2013). Nie estimated that over 200 million young adults have migrated from rural areas into the cities, with that number possibly growing to reach 400 million by 2025 (2016). Numbers show that internal migration within China is distinctly delineated by age. Chen, Xu, Li, and Song (2018) reported that 65% of the 221 million migrant population in 2010 were between the ages of 20 and 49 and that nearly half of this "floating population" was between the ages of 20 and 29. This phenomenon, they said, has not only radically skewed the country's regional demographics but also increased the aging levels in rural cities and escalated the rate of aging as well (Chen et al., 2018). This departure from both hometowns and tradition illustrates how China's antiquated notion of filial piety is no longer sufficient to ensure that the elderly live happy, healthy lives. The growing distance between traditional care and reality has had as much as an impact as the physical distances between grown children and their parents on the lives of China's aging population.

Research shows that the erosion of traditional familial eldercare has had several worrying impacts, mainly increased rates of mental health issues as well as financial hardships. Loneliness and depression are endemic to China's aging population with over half of those above the age of 65 showing signs of deep depression, and those affected have a scarce few options (Nie, 2016). Nie's research revealed what he called an "epidemic of elder suicide, especially in rural areas", finding that 44% of all suicides in China were elders over the age of 65. Disturbingly, he wrote, rural elderly are three to five times more likely to commit suicide, with rural males ten or even twenty times more likely than their urban counterparts (Nie, 2016). In addition to the psychological impacts, China's elderly must also contend with financial difficulties. Very few elderly people in China have stable incomes, with most relying on support from family members. However, the costs of medical and elderly care, as well as funeral arrangements, have increased significantly, even as family sizes shrink drastically (Song, 2014). Song pointed out that the government's pension system is not available to all regions of the country, and only 24% of the aging population qualified for a pension in 2010 across the entire country (2014). Additionally, the pension system first benefits civil servants and state enterprise employees, followed by urban residents (Nie, 2016). Finally, the massive internal migration in China has exacerbated the regional imbalance of pension funds (Chen, Xu, Li, & Song, 2018), with pensions in rural areas nearly 40 times lower than that of a non-state employee in Beijing (Nie, 2016). Although mental health and financial issues are found in almost any elderly population worldwide, China's antiquated approach to eldercare has exacerbated these problems.

Elderly parents who have lost their only child due to accidents, diseases, or disasters and who are unable to have a second child face exponentially greater hardship. Song's (2014) research showed that these families, often called shidu families, numbered over 1 million as of 2014, and Nie (2016) indicated that this figure could increase by about 76,000 families each year. Although some of these families had no choice but to have only one child, Nie pointed out that many families willingly supported the one-child policy. Now, he argued, these families are forced to bear the painful consequences of elderly life with no children to help them (Nie, 2016). Song (2014) illustrated how some of the financial difficulties that shidu families face have compounded, and Shidu families whose children died from diseases are often in severe debt, having spent their life savings trying to save the child. Song also wrote that common life events for elderly people are restricted for shidu families, such as applying to senior care homes which requires a child's sponsorship regardless of who pays the fees. Likewise, children must authorize all common medical procedures and treatments for their parents in China (Song, 2014). More than half of shidu parents suffer from chronic illnesses, and 60% suffer from depression, with almost the same amount showing suicidal tendencies (Nie, 2016). Apart from elderly suicide, the plights of shidu families are certainly one of the most critical crises in eldercare in China.

As the traditional notion of familial eldercare is no longer feasible, China's elderly population now turns to non-traditional means of long-term care. The willingness by younger generations to care for their aging parents aside, some elderly couples have accepted that their children are unable to meet their needs and are now looking into non-traditional options (Gui & Koropeckyj-Cox, 2016). Nursing homes have historically been looked down upon, often seen as a last resort for the most desperate. Those who do choose nursing homes as a long-term care option, Lu, Liu, and Piggott found, discover that the industry rations eligibility by need and there are long waiting lists for anyone who applies. However, Lu et al.'s research also revealed that there are as many as 2.3 million empty beds in government-run nursing homes in urban areas which suggests a mismatch between demand and supply, possibly influenced by long-standing prejudices (2015). It seems that even though there are nursing homes available to at least some of China's population, longstanding fear and prejudices have stopped many from utilizing them.

There are many ways the Chinese government could tackle the countries aging problem, either by increasing local support or by widespread policy reform. Lu, Liu and Piggott called for increased support and promotion of nursing homes in China, as a way to alleviate long-standing prejudice towards them (2015). Other researchers argued that China needs to solve the problem at a higher level, mainly by finding a way to balance the economic gap between rural and urban areas which would stem the tide of internal migrants (Chen, Xu, Li, & Song, 2018). Lu et al. (2015) also articulated that no matter how China reforms their eldercare related policies, they should not attempt a system that ignores informal care. Their findings differed from most researchers because they argued that, while lacking in some areas, there was enough informal long-term care provision to help most of the elderly in the country. They noted that wherever long-term care policy structure existed, they only targeted families who had one child or whose child had died. Central policy guidelines, they wrote, have been "informed by perceptions of informal care scarcity driven by the one-child policy" (Lu et al., 2015 p. 29). Finally, Lu et al. warned that should China's reformed policy only focus on families with one child, many millions in rural areas who were allowed multiple children would be left out (2015).

Many scholars recognize that eldercare should be provided at the national level, rather than a burden placed on the individual. Nie argued that "Eldercare is an arduous challenge not just for these single-child families, but for the entire country" (2016, p. 353). Gui and Koropeckyj-Cox also spoke out against putting the burden of eldercare entirely on the family, saying that "it is not really realistic to expect these young people to solve their family problems by themselves, nor is it fair to expect individuals to solely shoulder the consequences of national population policies and demographic changes" (2016, p. 270). It is painfully clear that China's eldercare related policies and programs must undergo significant reform, else there will be no better future for China's aging population.

As China continues to pursue a brighter future for its population, it cannot make the mistake of allowing its elderly population to suffer any more than it already has. It is time for the Chinese government to admit its failures in the wake of the one-child policy and strive to reform its plan of action. No longer can the burden of eldercare be left on individual families or strangled support systems, no longer can the people rely on antiquated notions of filial piety for care. China's elderly population now faces depression, suicide, impoverishment, and have nowhere to turn. Only a dramatic shift in China's policy and cultural ideology can save the elderly population from living out their days alone and in pain.

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