Facing potentially high demands for long-term care of its fast-growing aging population, Shanghai has been devoted to building a sustainable long-term care system since 2001 (Chen & Han, 2016). Two decades ago, the Shanghai government began to develop and implement home- and community-based services (HCBS) for the increasing number of older adults in the city. Wu, Carter, Goins, and Cheng (2005) reviewed Shanghaiâs community-based long-term care system in the early 2000s, analyzing its benefits for community-dwelling older adults and praising its emergence. Chen and Han (2016) reviewed the most recent developments in community-based eldercare policy in Shanghai between 2007 and 2015. Our book builds upon this literature by focusing on the recent development of an HCBS program in the Jingâan District in Shanghai, which has emerged since 2001 and begun to fully develop since 2007. We chronicle its progress, along with the overall development of HCBS in Shanghai.
Indeed, HCBS was a new concept for Chinese older adults. Because eldercare in China has historically relied on family members, especially adult children, introducing HCBS has been an innovative way to share caregiving responsibilities across family and community. Some people have welcomed the idea while others have resisted it; Chinese families have witnessed a trend of evolving caregiving: adult children are sometimes invested in the tradition of taking care of their older parents at home and sometimes choose other caregiving alternatives instead. Scholars, policymakers, and even laypeople have been heated debates on this subject. In light of the traditional expectations, does this generation of Chinese adult children really want to relinquish family caregiving responsibility by taking advantage of HCBS? However, some older adults have welcomed HCBS, first because they did not have to prepare their meals every day and second, because they were able to spend time in the community and make new friends. Based on feedback from various stakeholders and especially service recipientsâolder adults themselvesâthe Shanghai Civil Affairs Bureau has published and implemented a series of policies, regulations, and standards to develop HCBS for older adults living in the community (Table 1.1).
Table 1.1
Chronology of the policy development of community-based eldercare published by Shanghai Civil Affairs Bureau since 2001
Date | Policy |
|---|---|
April 10, 2001 | Opinions on the comprehensive development of home-based care services: âTo adapt to the increasing aging population in Shanghai, home- and community-based services for older adults should be promoted to the entire city.â |
November 4, 2003 | Notice on further deepening the pilot work of home- and community-based eldercare services |
April 20, 2004 | Notice on further promoting and deepening home- and community-based eldercare services: âThe Shanghai government plans to establish a comparatively comprehensive home- and community-based eldercare service network with good operation mechanisms in the next two years.â |
October 20, 2006 | Opinions on further promoting the development of eldercare services in Shanghai: âIn the eleventh Five-Year Plan⊠home- and community-based eldercare services in Shanghai should cover 250 thousand older adults, about 8% of the total aging population.â |
April 2, 2008 | Notice on encouraging communities to set up community cafeteria for older adults: âIn 2008, there will be 200 service centers for older adults to dine or take out in the community across the city. Each service center should provide for at least 50 people for every meal.â |
June 9, 2009 | Notice on further regulating home- and community-based eldercare services in Shanghai |
February 11, 2010 | Notice on implementing Shanghai local standards on home- and community-based eldercare services |
March 19, 2014 | Opinions on adjusting relevant policies on home- and community-based eldercare services in Shanghai |
December 11, 2019 | Notice on distributing the âGuidelines for embedded home- and community-based eldercare services in Shanghaiâ |
By reviewing one of the most advanced HCBS programs in Shanghai, now 13 years old, this book aims to provide fresh insight into community care ecology for eldercare in urban China. Taking a social-ecological perspective, we view the community as an organic system, where older adults interact on the macro, meso, and micro levels of the community care ecology. Drawing on mixed-method approaches, including surveys, in-depth interviews, and government archives, we explore the emergence of HCBS in Shanghai, its development over the past decade, its administration and services offered, its resource allocation, staff membersâ work experiences, older adultsâ service experiences, and service evaluation and improvements. Both quantitative and qualitative data illuminate multilayered interactions among these aspects of the community ecology. The purpose of our analysis is to show how the HCBS program in the Jingâan District has addressed older adultsâ needs, influenced their interpersonal and social networking dynamics, fostered a new form of caregiving relationship in the community setting, and shaped a new discourse on caregiving policy. Our theoretical analysis reflects the implications of the changing sociocultural context for eldercare in urban China.
1.1 Community Ecology and Aging
Gerontologists have long viewed community as a perfect venue for aging and have proposed the concept of âaging in place,â which refers to âremaining living in the community, with some level of independence, rather than in residential careâ (Davey, Nana, de Joux, & Arcus, 2004, p. 133). While growing research shows the benefits of aging in place for older adults, some scholars have pointed out that the essential element of aging in place is to build an engaging, inclusive, and interdependent environment to offer sustainable, healthy opportunities for older adults (Thomas & Blanchard, 2009)ââan adaptive process of ongoing person-place transactions over timeâ (Scharlach & Moore, 2016, p. 420). In a recent review of the evolving topics and studies in the field of aging in place, scholars have investigated shifts in research focus from housing and environmental modification to interpersonal interactions, care, and services (Vasunilashorn, Steinman, Liebig, & Pynoos, 2012).
More recently, scholars have further distinguished âaging in communityâ from âaging in placeâ (e.g., Blanchard, 2013; Greenfield, Black, Buffel, & Yeh, 2019); aging in place indicates a relatively static status, such as remaining in an apartment or other housing, whereas aging in community suggests older adultsâ spatial, geographical, and interpersonal relationships with the community where they live, as well as with various organizations and sectors of the community (Blanchard, 2013).
Although the concept of community has remained elusive and kept evolving since its emergence in the late nineteenth century (e.g., Ahn, Kwon, & Kang, 2020; Chipuer & Pretty, 1999; Putnam, 2000), in this book, we follow the notion that community provides geographic proximity, social networks, feelings of belonging, services, and so forth, to support older adultsâ daily life and further sustain their independence and autonomy (e.g., Callahan, 1993; Chen, Ye, & Kahana, 2019; Lawler, 2001; Palley, 2009; Wiles, 2005). In fact, community covers all aspects, arrangements, and organizations in individualsâ aging process; that is, their aging process is intertwined with their life in the community (Greenfield et al., 2019). Both the World Health Organization (WHO) and the (American) Centers for Disease Control and Prevention (CDC) have recommended that older adults remain in...