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Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey

Published online by Cambridge University Press:  08 November 2019

Wei Yang Open the ORCID record for Wei Yang [Opens in a new window]  and
Si Ying Tan Open the ORCID record for Si Ying Tan [Opens in a new window]
Wei Yang
Affiliation:
Department of Global Health and Social Medicine, King's College London, London, UK
Si Ying Tan*
Affiliation:
Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
*
*Corresponding author. Email: s.tan14@u.nus.edu
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Abstract

Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.

Keywords

informal careunmet needsintensity of carelong-term careChina
Type
Article
Information
Ageing & Society , Volume 41 , Issue 5 , May 2021 , pp. 980 - 999
Copyright
Copyright © Cambridge University Press 2019

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References

Allin, S, Grignon, M and Le Grand, J (2010) Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Social Science & Medicine 70, 465–472.CrossRefGoogle ScholarPubMed
Bhandari, A and Wagner, T (2006) Self-reported utilization of health care services: improving measurement and accuracy. Medical Care Research and Review 63, 217–235.CrossRefGoogle ScholarPubMed
Broese van Groenou, MI and De Boer, A (2016) Providing informal care in a changing society. European Journal of Ageing 13, 271–279.CrossRefGoogle Scholar
Campbell, JC, Ikegami, N and Gibson, MJ (2010) Lessons from public long-term care insurance in Germany and Japan. Health Affairs 29, 87–95.CrossRefGoogle ScholarPubMed
Chen, L (2015) Deciding to institutionalize: caregiving crisis, intergenerational communication, and uncertainty management for elders and their children in Shanghai. Journal of Gerontological Social Work 58, 128–148.CrossRefGoogle ScholarPubMed
Chen, L and Ye, M (2013) The role of children's support in elders’ decisions to live in a yanglaoyuan (residential long-term care). Journal of Cross-cultural Gerontology 28, 75–87.CrossRefGoogle Scholar
Citro, CF and Michael, RT (1995) Measuring Poverty: A New Approach. Washington, DC: National Academies Press.Google Scholar
Da Roit, B and Le Bihan, B (2010) Similar and yet so different: cash-for-care in six European countries’ long-term care policies. The Milbank Quarterly 88, 286–309.CrossRefGoogle ScholarPubMed
Feng, Z, Liu, C, Guan, X and Mor, V (2012) China's rapidly aging population creates policy challenges in shaping a viable long-term care system. Health Affairs 31, 2764–2773.CrossRefGoogle ScholarPubMed
Fu, C, Li, Z and Mao, Z (2018) Association between social activities and cognitive function among the elderly in China: a cross-sectional study. International Journal of Environmental Research and Public Health 15, 231.CrossRefGoogle ScholarPubMed
Fu, YY, Guo, Y, Bai, X and Chui, EWT (2017) Factors associated with older people's long-term care needs: a case study adopting the expanded version of the Anderson model in China. BMC Geriatrics 17, 38.CrossRefGoogle ScholarPubMed
García-Gómez, P, Hernández-Quevedo, C, Jiménez-Rubio, D and Oliva-Moreno, J (2015) Inequity in long-term care use and unmet need: two sides of the same coin. Journal of Health Economics 39, 147–158.CrossRefGoogle ScholarPubMed
Geerts, J and Van den Bosch, K (2012) Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts. European Journal of Ageing 9, 27–37.CrossRefGoogle ScholarPubMed
Gu, D and Vlosky, D (2008) Long term care needs and related issues in China. In Garner, JB and Christiansen, TC (eds), Social Sciences in Health Care and Medicine. New York, NY: Nova Science Publishers, pp. 52–84.Google Scholar
Hanaoka, C and Norton, EC (2008) Informal and formal care for elderly persons: how adult children's characteristics affect the use of formal care in Japan. Social Science & Medicine 67, 1002–1008.CrossRefGoogle ScholarPubMed
Hayashi, M (2016) The Japanese voluntary sector's responses to the increasing unmet demand for home care from an ageing population. Ageing & Society 36, 508–533.CrossRefGoogle Scholar
Hengelaar, AH, Hartingsveldt, M, Wittenberg, Y, Etten-Jamaludin, F, Kwekkeboom, R and Satink, T (2017) Exploring the collaboration between formal and informal care from the professional perspective – a thematic synthesis. Health & Social Care in the Community 26, 474–485.CrossRefGoogle Scholar
Herr, M, Arvieu, JJ, Aegerter, P, Robine, JM and Ankri, J (2014) Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey. European Journal of Public Health 24, 808–813.CrossRefGoogle Scholar
Hu, B and Ma, S (2018) Receipt of informal care in the Chinese older population. Ageing & Society 38, 766–793.CrossRefGoogle Scholar
Hu, B and Wang, J (2019) Unmet long-term care needs and depression: the double disadvantage of community-dwelling older people in rural China. Health & Social Care in the Community 27, 126–138.CrossRefGoogle ScholarPubMed
Jang, SN, Avendano, M and Kawachi, I (2012) Informal caregiving patterns in Korea and European countries: a cross-national comparison. Asian Nursing Research 6, 19–26.CrossRefGoogle ScholarPubMed
Jegermalm, M and Grassman, EJ (2011) Helpful citizens and caring families: patterns of informal help and caregiving in Sweden in a 17-year perspective. International Journal of Social Welfare 21, 422–432.CrossRefGoogle Scholar
Katz, S, Downs, TD, Cash, HR and Grotz, RC (1970) Progress in development of the index of ADL. The Gerontologist 10, 20–30.CrossRefGoogle ScholarPubMed
Kemper, P, Weaver, F, Short, PF, Shea, D and Kang, H (2007) Meeting the need for personal care among the elderly: does Medicaid home care spending matter? Health Services Research 43, 344–362.CrossRefGoogle Scholar
Kumagai, N (2017) Distinct impacts of high intensity caregiving on caregivers’ mental health and continuation of caregiving. Health Economics Review 7, 15.CrossRefGoogle ScholarPubMed
La Porte, A and McMahon, M (2016) Aging and long-term care. In Scheffler, RM (ed.), World Scientific Handbook of Global Health Economics and Public Policy. Singapore: World Scientific Publishing Co., pp. 43–82.CrossRefGoogle Scholar
Lawton, MP and Brody, EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 9, 179–186.CrossRefGoogle ScholarPubMed
Li, J, Cacchione, P, Hodgson, N, Riegel, B, Keenan, BT, Scharf, MT, Richards, KC and Gooneratne, NS (2017) Afternoon napping and cognition in Chinese older adults: findings from the China Health and Retirement Longitudinal Study baseline assessment. Journal of the American Geriatric Society 65, 373–380.CrossRefGoogle ScholarPubMed
Li, M, Zhang, Y, Zhang, Z, Zhang, Y, Zhou, L and Chen, K (2013) Rural–urban differences in the long-term care of the disabled elderly in China. PLOS ONE 8, e79955.CrossRefGoogle ScholarPubMed
Lin, K, Yin, P and Loubere, N (2014) Social support and the ‘left behind’ elderly in rural China: a case study from Jiangxi Province. Journal of Community Health 39, 674–681.CrossRefGoogle ScholarPubMed
Litwin, H and Attias-Donfut, C (2009) The inter-relationship between formal and informal care: a study in France and Israel. Ageing & Society 29, 71–91.CrossRefGoogle ScholarPubMed
Liu, S, Li, C, Shi, Z, Wang, X, Zhou, Y, Liu, S, Liu, J, Yu, T and Ji, Y (2016) Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. Journal of Clinical Nursing 26, 1291–1300.CrossRefGoogle ScholarPubMed
Liu, T and Sun, L (2015) An apocalyptic vision of ageing in China. Zeitschrift für Gerontologie und Geriatrie 48, 354–364.CrossRefGoogle ScholarPubMed
Liu, YH, Chang, HJ and Huang, CC (2012) The unmet activities of daily living (ADL) needs of dependent elders and their related factors: an approach from both an individual- and area-level perspective. International Journal of Gerontology 6, 163–168.CrossRefGoogle Scholar
Lou, VWQ and Ci, QY (2014) Ageing under the one-child policy: long-term care needs and policy choices in urban China. International Journal of Public Policy 10, 231–242.CrossRefGoogle Scholar
National Bureau of Statistics of China (2011) 2010 People's Republic of China Census. Beijing: National Bureau of Statistics of China.Google Scholar
Ng, TP, Niti, M, Chiam, PC and Kua, EH (2006) Physical and cognitive domains of the instrumental activities of daily living: validation in a multiethnic population of Asian older adults. Journals of Gerontology: Biological Sciences and Medical Sciences 61A, 726–735.CrossRefGoogle Scholar
Rhee, JC, Done, N and Anderson, GF (2015) Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany. Health Policy 119, 1319–1329.CrossRefGoogle ScholarPubMed
Robards, J, Vlachantoni, A, Evandrou, M and Falkingham, J (2015) Informal caring in England and Wales – stability and transition between 2001 and 2011. Advances in Life Course Research 24, 21–33.CrossRefGoogle ScholarPubMed
Shea, D, Davey, A, Femia, EE, Zarit, SH, Sundström, G, Berg, S and Smyer, MA (2003) Exploring assistance in Sweden and the United States. The Gerontologist 43, 712–721.CrossRefGoogle ScholarPubMed
Sole-Auro, A and Crimmins, EM (2014) Who cares? A comparison of informal and formal care provision in Spain, England and the USA. Ageing & Society 34, 495–517.CrossRefGoogle Scholar
Stevenson, D (2004) Training informal caregivers of patients with stroke improved patient and caregiver quality of life and reduced costs. Evidence Based Nursing 7, 118.CrossRefGoogle ScholarPubMed
Tamiya, N, Noguchi, H, Nishi, A, Reich, MR, Ikegami, N, Hashimoto, H, Shibuya, K, Kawachi, I and Campbell, JC (2011) Population ageing and wellbeing: lessons from Japan's long-term care insurance policy. The Lancet 378, 1183–1192.CrossRefGoogle ScholarPubMed
Tao, H and McRoy, S (2015) Caring for and keeping the elderly in their homes. Chinese Nursing Research 2, 31–34.CrossRefGoogle Scholar
Tennstedt, S, McKinlay, J and Kasten, L (1994) Unmet need among disabled elders: a problem in access to community long term care? Social Science & Medicine 38, 915–924.CrossRefGoogle ScholarPubMed
Tsui, ELH, Leung, GM, Woo, PPS, Choi, S and Lo, SV (2005) Under-reporting of inpatient services utilisation in household surveys – a population-based study in Hong Kong. BMC Health Services Research 5, 31.CrossRefGoogle ScholarPubMed
Verbakel, E (2017) How to understand informal caregiving patterns in Europe? The role of formal long-term care provisions and family care norms. Scandinavian Journal of Public Health 46, 436–447.CrossRefGoogle ScholarPubMed
Verbeek-Oudijk, D, Woittiez, I, Eggink, E and Putman, L (2014) Who Cares in Europe? A Comparison of Long Term Care for the Over-50s in Sixteen European Countries. Available at https://www.scp.nl/english/Publications/Publications_by_year/Publications_2014/Who_cares_in_Europe.Google Scholar
Wimo, A, Elmståhl, S, Fratiglioni, L, Sjölund, BM, Sköldunger, A, Fagerström, C, Berglund, J and Lagergren, M (2017) Formal and informal care of community-living older people: a population-based study from the Swedish National Study on Aging and Care. Journal of Nutrition, Health & Aging 21, 17–24.CrossRefGoogle Scholar
Wooldridge, JM (2013) Introductory Econometrics: A Modern Approach, 5th Edn. Mason, OH: South-Western/Cengage Learning.Google Scholar
World Health Organization (2018) Ageing and Health. Available at http://www.who.int/news-room/fact-sheets/detail/ageing-and-health.Google Scholar
Zhao, Y, Hu, Y, Smith, JP, Strauss, J and Yang, G (2014) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). International Journal of Epidemiology 43, 61–68.CrossRefGoogle Scholar
Zhen, Z, Feng, Q and Gu, D (2013) The impacts of unmet needs for long-term care on mortality among older adults in China. Journal of Disability Policy Studies 25, 243–251.CrossRefGoogle Scholar
Zhu, H (2015) Unmet needs in long-term care and their associated factors among the oldest old in China. BMC Geriatrics 15, 46.CrossRefGoogle ScholarPubMed
Zhu, Y and Österle, A (2017) Rural–urban disparities in unmet long-term care needs in China: the role of the Hukou status. Social Science & Medicine 191, 30–37.CrossRefGoogle ScholarPubMed
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