Traditional Elderly Care
In China, elder care has been confined to the family sphere over thousands of years (Liu et al., 2014). Under the tradition Confucian concept of Filial Piety or xiao, it encompasses a broad range of behaviours for children to fulfil the duty of care to their aged parents, including ‘respect, obedience, loyalty, material provision, and physical care’ (Zhan & Montgomery, 2003. pp. 210). Children were expected to raise for the security of their elder parents by providing emotional, financial and physical care activities (Zhan et al., 2006).
In China, elder parents are commonly live with sons because the blood tie relationship have been seen as a crucial kinship culture concept (Zhang & Goza, 2006) and sons are recognized to pass on the family name uniquely. It therefore indicates that sons are are expected to provide the ultimate financial and physical care to their aged parents in the cultural value of Filial Piety (Zhan & Montgomery, 2003). However, wonmen have traditionally been care provdiers for parents in China as well as in the West countries (Zhan & Montgomery, 2003). The major difference is Chinese women were expected to take care of their parents-in-law, whereas daughters have been more likely to provide personal parnetal care in the West (Zhan & Montgomery, 2003). According to Chinese patrilocal tradition, after women married to their husbands, they were recognised have been given over to husbands’ families and are not responsible for their birth parents’ elder life (Zhan & Montgomery, 2003). As a result, daughters are not invloved in their own parents elderly care, but instead, they share the responsibilities with husband for parents-in-law. Regardless the gender of care, the traditional forms of family care dominates the major elderly care provision in China.
Aging issue factors
Since the communists came to power in 1949, the total population of China was not only young, but also at a level of 541.7 million (Zhang & Goza, 2006). However, Mao Tse-tung believed that more people meant additional strength to build a strong socialist state for the fight against capitalism (Blumenthal & Hsiao, 2005). As a result, the population nearly doubled over the next 25 years (Zhang & Goza, 2006). By 1971 when Mao relaised the population issues and started encouraging Chinese family later marrige, fewer children and longer birh intervals, the population still growing continously. The consequences revealed by more than 1.35 billion population in 2013 (National Bureau of Statistics of China, 2013).
Flaherty et al. (2007) point out that China is becoming to an aging society as its aged population grow dramatically since 1970s. National Bureau of Statistics of China (2013) clearly states the aged 65 or over residents increased from 4.9% to 8.9% of the total population over thirty years from 1980. In 2012, there are 127 million of aged 65 or over elder people which dominate 9.4% of national population in China (National Bureau of Statistics of China, 2013). These patterns should continue and there will be 400 million aged 60 or over Chinese residents by 2040 (Zhang & Goza, 2006). Zhang and Goza (2006) comment it will represent 26% of the total population and be more than the combined current population of Japan, France, Germany and the UK. In addition, followed by the improved life condition, the Chinese Census data reveals the life expectancy in China extended from age 68 in 1982 to 75 in 2010 (National Bureau of Statistics of China, 2013). Zhang & Goza (2006) also commnet a reduced replacement fertility level shed lights on the limitiations of available care provider to take family care responsibilities in future. China is facing a great challenge to provide sufficient aged care.
However, the low replacement fertility is criticised by voluntary action. In contrast, followed by the rapid population growth from 1940s. The Chinese government established the one child policy from 1979 which indicates each household is only allowed to have one child when either parent has siblings (Flaherty, et al., 2007). The policy was introducted to alleviate social, economical and environmental issues by control the population in China (Zhang & Goza, 2006). It reached 85%-96% of one child rate by the end of 1990s (Zhan & Montgomery, 2003).
However, the rapid ageing and diminishing family size means China faces a called ‘4-2-1’ family structure. The phenomenon confronts each couple is responsible for four aging parents and their single child (none, 2012 economist). It is criticised by Chinese younger generation as they will unable to afford such a burden to look after their aged families by themselves even they have sufficient savings (None, 2012 economist). It therefore demonstrates only 57% of older people live with children in 2005 compared to 73% in 1982. In large cities, there are more than 70% of elderly only live with spouse or live on their own (Zhang & Goza, 2006). The elderly were concerned to live in ‘empty-nest’ families.
Although the Chinese constitution, Criminal Law and the Law on the protection of the Rights ans Interests of Older People, the altered family structure resist children to provide comprehensive care practices to their elder families. Therefore, the increased demand of social healthcare services emerged in China by the change of care practices of the aged-old pattern of xiao (Zhang & Goza, 2006).
Elderly care facilities
Elder homes which used to be literally called ‘Homes of Respect for the Elderly’ in China. They were built by government for physically dependent childless elders. However, the Health Care System became privatised by 1980s (Zhan et al., 2006). The central government transferred much of its responsibilities to provincial and local authorities for funding the medical and health facilities (Blumenthal & Hsiao, 2005). Former public-sponsored elderly homes were decentralised and a large number of private homes merged in the market (Zhan et al., 2006).
Blumenthal and Hsiao (2005) argue the the reduction in governmental support of the health caere system largely effects health care facilities by forcing private organisations heavily rely on sale of services to subsdise their expenses. In hospitals, the major revenues are generated from sales of expensive new pharmaceuticals and high-tech services (Blumenthal & Hsiao, 2005). In nursing facilities, residents monthly accodmendation and sercice payments are crucial to support each home’s daily operations. It therefore indicates that the private organisations are operated by profit-driven approcah becme more and more expensive compares to government facilites which emphasis on residents’ social and walefare benefits. It therefore results unafforadable for most Chinese citizens.
In addition, Blumenthal and Hsiao (2005) also citisied the qualtiy of care that patients or residents received from private facilities. As a result of privatisation in social and health care sector, there is limited fund invest into elderly care services from Chinese central government. In particular, training is a primary concer as private orgnaisations are mainly implement afforts on fiscal restraint to maximise their profitbaility (Blumenthal & Hsiao, 2005). The insufficient government supply encouraged private nursing homes to enter the market and they have dominated the major growth of care providers since 2000 (Liu et al., 2014). However, it raise the concern of care quality as the short history of operating with insufficient experience of community elderly care practices in China.
- Community and Family Care
In contrast, the United Kingdom has a long history of community care for elderly. The initial communally life for older people to live in the UK was emerged from the eighteenth century. People were living in workhouses which accessed to better conditional on behaviour, sponsorship and health. The workhouses remained throughout the nineteenth century and became to residential care facilities or hospitals for the long-term sick since 1940s when the National Health Service established (Jolley, Dixey and Read, 1995?). The public assistance institutions were spartan in 1950s but the local authorities were keen to offer appropriate capacity to meet the social demand. Therefore, the UK Health secretary defines residential care is seen as first option for elderly to spend their aged life rather than care by families in Britain (Butler, 2013).
However, Bambra et al. (2007) state there is a renewed interst in family caregiving across developed countries, including the UK. It is been recognised that families to make considerable contributions to the care of elderly people. Argubely, carers in the younger age are generally provide less hours of care compared to carers who are older in the UK families. Bambra et al. (2007) point out the age between 45 to 69 are major care providers to their families or friends and people over the age of 70 spent the most time on caregiving. In particular, the age 80 to 89 are reported more likely to provide as much as 50 hours family care per week (Bambra et al., 2007). The family caregiving is therefore described in terms of burden, stress and strain for carers in the UK (Bambra et al., 2007), not only by the hours of service, but also by the age of carerproviders themselves.
- Aging issue factors
The ageing population is a global issue, including the United Kingdom. Ageing of the population refers to both the increase in the age of the population and the growth in the number and proportion of older people in the total population (ONS, 2012). Over the period from 1985 to 2010, the percentage of older people in the UK increased 2 percent by 2010 from 15 percent in 1985 (ONS, 2012). According to Age UK (2014), there are currently more than 11 million aged 65 or over people which indicates one in six of the UK population is old people and it is the first time in history. ONS (2012) announces there will be 23 per cent of the UK population is projected to be 65 or over by 2035. In addition, it is estimated that the elderly number will raise to 19 million which represent every one in four by 2050 (UK Parliament, 2014). Although the UK ageing growth rate represents a less trend compares to China, it is a result of the improvement and continuing improvements in mortality rates combined with declined in fertility rates (ONS, 2013).
The improved mortality rates in terms is reflected to a longer life expectancy. Over the 25 years period, the UK life expectancy at birth rose from 71.7 years in 1985 to 78.5 years in 2010. It is estimated to increase 4.9 years over the next twenty years to 83.4 years by 2035 (ONS, 2011). In addition, the total number of centenarians is projected to rise from 14,000 in 2013 to 111,000 in 2037 (ONS, 2013) and almost 85,000 aged 65 in 2013 are expected to celebrate their 100th birthday in 2048 (ONS, 2013). In contrast, after reaching a peak birth rate of 2.94 in 1964 in United Kingdom, there is steady decline from 1965 until to a low of 1.63 in 2001. However, it has remained stable for nearly a decade between 1.88 and 1.94 until 2013 (ONS, 2013). Comparing to China’s mortality and fertility rates, the UK demonstrate a more optimism scope in ageing population issues.
- Health care system
The British health care system is dominated by the National Health Service as part of the postwar welfare settlement (Busfield, 2000). The NHS provides publicly funded and incorporates universalism principles of equality and firness services with entitlement to contribute its popularity to the whole popultion (Busfield, 2000). The entitlement based on labour market for those who are employed are eligible for health care through compulsory insurance. In addition, it also build on financial subsidise for the residual group who cannot afford to purchase themselves and who are not covered by their emoloyment (Busfield, 2000). It is mostly like China that the majority of funding comes from taxation rather than complulsoy state insurance.
While state or public health sercies are available to all as a right of citizenship, however, it vary in precisely what they cover such as mental health and unavailable for enormous number of elderly to cover all range of care aspects. It thereofre indicates that pharmaceuticals and equimpment are healy depend on private sector supply on the one hand, and private hospitals, nursing homes and doctors on the other (Busfield, 2000). The UK is depended upon voluntary or private sector to provide enthusiastic ‘sheltered’ schemes which include supervision, physical assistance and accommodation to aged population from 1970s (Jolley et al., 1995?). The private long-term care places increased from 28 in 1977 to 164 in 1994 (Jolley et al., 1995?) and the market grew even faster in past twenty years. In present, the care homes are provided primarily by the private sector since the early twenty-first century (Johnson et al., 2010) and over half of all beds allocated for older people health care are in independent nursing homes (Kerrison and Pollock, 2001).
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According to Kerrison and Pollock (2001), it is well known that the UK private sector has established a crucial role in providing long term care of the elderly. The private provision of nursing homes is provided by individuals, partnerships or companies not limited by guarantee. It sometimes referrers to as the ‘for profit’ sector and except in special circumstances there is no far on the amount of profit made nor on its distribution (Challis and Bartlett, 1988). Arguably, Busfield (2000) states that invariable coexist with private health care is only for those who can afford it. In addition, the quality of service is also critisied by Busfield (2000) which initialled by the profit driven oriention in private facilities.
As the private sector dominates the majority elderly nursing care market in the United Kingdom as well as in China. However, the care quality in private facilities are debatable in both countries. It is mostly demonstrated by the financial monetary such as the lack of investment and profitability. But the major discovered fact which directly affect the quality of care will be explained on the following section.
Bambra, C., Demack, S., & Dahlberg, L. (2007). Age and gender of informal carers: a poulation-based strudy in the UK. Health and Social Care in the community, 15(5), pp.439-445.
Blumenthal, D., & Hsiao, W. (2005). Privatization and Its Discontents–The Evolving Chinese Health Care System. The New England Journal of Medicine, 353(11), 1165-1170.
Busfield, J. (2000). Health and Health Care in Modern Britain. New York: Oxford University Press Inc.
Flaherty, J. H., Liu, M., Dong, B., Ding, L., Ding, Q., Li, X., & Xiao, S. (2007). China: The Aging Giant. International Health Affairs, 55(8), 1295-1300.
Stastics, O. f. (2012, March 02). Population Ageing in the United Kingdom, its Constituent Countries and the European Union. Retrieved August 12th, 2014, from ONS.GOV.UK: www.ons.gov.uk/ons/dcp171776_258607.pdf
Zhan, H., & Montgomery, R. J. (2003). Gender and elderl care in China: The Influcne of Filial Peity and Structure Constraints. Gender and Society, 17(2), 209-229.
Zhang, Y., & Goza, F. W. (2006). Who will care for the elderly in China? A review of the promblems caused by China’s one-child policy abd their potential solutions. Journal of Aging Studies, 20(2006), 151-164.
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None, 2012. China’s Achilles heel [online]. Available from: http://www.economist.com/node/21553056 [Assessed 08th August]
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UK Parliament, 2014. The ageing population [online]. Available from: http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-money-in-public-services/the-ageing-population/ [Assessed 08th August]
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- Butlet, P., 2013. Jeremy Hunt: UK should adopt Asian culture of caring for the elderly [online]. Available from:
http://www.theguardian.com/politics/2013/oct/18/jeremy-hunt-uk-families-asia-elderly [Assessed 08th August]
Office for National Statistics, 2012. Population Ageing in the United Kingdom, its Constituent Countries and the European Union [online]. Available from: www.ons.gov.uk/ons/dcp171776_258607.pdf [Assessed 08th August]
Office for National Statistics, 2013. One third of babies born in 2013 are expected to live to 100 [online]. Available from: http://www.ons.gov.uk/ons/rel/lifetables/historic-and-projected-data-from-the-period-and-cohort-life-tables/2012-based/sty-babies-living-to-100.html [Assessed 08th August]
Office for National Statistics, 2013. Why has the fertility rate risen over the last decade in England and Wales? [online]. Available from: http://www.ons.gov.uk/ons/rel/vsob1/birth-summary-tables–england-and-wales/2011–final-/sty-fertility.html [Assessed 08th August]