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Residential Care for Elderly People in Beijing, China

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RESIDENTIAL CARE FOR ELDERLY PEOPLE IN BEIJING, CHINA: A Study of the Relationship between Health and Place by YANG CHENG A thesis submitted to the Department of Geography in conformity with the requirements for the degree of Doctor of Philosophy Queen‘s University Kingston, Ontario, Canada April 2010 Copyright © Yang Cheng, 2010 Abstract This thesis is a study of the residential care for elderly people in Beijing, China. First, a set of statistical indicators are developed for mapping the spatial distribution of the elderly population and residential care facilities (RCFs). Secondly, in-depth, semi- structured interviews are used to understand the socio-cultural meanings of access, the decision making process in relocation, the well-being of elderly residents, as well as the challenges of residential care and social welfare reform. In total, 27 elderly residents, 16 family members, and five RCF managers were interviewed in six RCFs in Beijing. The constant comparative method is used to analyze all the transcribed interview materials. There are several major findings resulting from the research: the distribution of the elderly population and residential care resources is geographically uneven across the districts of Beijing and the supply of resources does not match the potential need. Elderly people and their family members choose residential care because of the shortage of community and home care resources and/or the advantages of residential care. The decision making process is a process of balancing geographical factors, quality of services, and financial affordability. Access to residential care is an interactive process influenced by geographical, economic, and social-cultural factors. The physical and socio-cultural environments of RCFs and individual‘s sense of place play important roles in their adaptation and well-being after the relocation from the home to a RCF. Building up the active aging model with joint efforts from governments, society, RCFs, and individuals is helpful and effective for promoting the well-being of elderly residents in i RCFs. At the end, the study also provides suggestions for the government, organizations, and RCFs on aspects such as administration, policy making, planning, volunteering, and management of RCFs to meet the challenges of residential care in China. The study confirms the importance of healthy living environments to the well- being of elderly residents. It also provides knowledge for understanding the reconfiguration of filial piety in decision making processes and utilization of residential care in current Chinese society. From a health geography perspective, this thesis is one of the first studies on residential care in China. ii Acknowledgements Staring at my over 200 pages thesis, four years of overseas life quickly went through my mind. All the precious and memorable moments are clearly coming into my sight. There are so many people I should acknowledge and so many experiences I should appreciate. This thesis would not have been possible without their help, support and encouragement all the time. In the first place I would like to express my sincere gratitude to my supervisor Dr. Mark Rosenberg for his continuous support of my study and research since I started the program in 2006. His profound insight on research directions and abundant research experiences helped me from the very early stage to finishing my thesis. His constructive suggestions and editorial feedback on my numerous manuscripts of papers, proposals, and chapter drafts are of great help to my writing and publishing. His deep generosity in terms of financial support and travel opportunities to conferences has been greatly beneficial to me. Above all and most appreciated, his distinguished scholarship and constant passion in research inspired me to be a researcher in my future career. I gratefully acknowledge my thesis committee members: Dr. Gavin Andrews, Dr. Hok-Lin Leung, Dr. Annette Burfood, Dr. Audrey Kobayashi, and Dr. Dongmei Chen for their profound suggestions for my thesis and future research. I am grateful to the School of Graduate Studies at Queen‘s University for the academic and funding support. Many iii thanks go in particular to my research participants for their interest in the research project, participation and suggestions. I am deeply grateful to the faculty, staff and graduate students in the Department of Geography at Queen‘s University. Many thanks to the department head Dr. Anne Godlewska, graduate coordinator Dr. Audrey Kobayashi, department secretaries Ms. Sheila MacDonald, Ms. Kathy Hoover, Ms. Joan Knox and Ms. Sharon Mohammed. Special thanks go to Melanie Bedore who has companied with me for every step in the Ph.D. program as my dear friend and officemate. I would also thank Cheryl Sutherland, Janette Brual, Jie Yu, Victoria Henderson, Sethunya Simela, Kay-Ann Williams, Natalie Waldbrook, Ron Roy, and other colleagues. I convey special acknowledgement to Professors Wuyi Wang and Linsheng Yang, Drs. Hairong Li, Yonghua Li, and Bixiong Ye, at the Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences for their support and care all these years, and special thanks go to Ms. Lijiao Sun for her support in my fieldwork. I am sincerely grateful to all my friends I met in Canada and back in China. I am much indebted to Miao Li and Grace Baey for their help and support in my study and life at any time. My special thanks go to Dr. Wei Li for her guidance and encouragement all these years since we first met in 2006. Our road trip across Canada was a lifetime experience to me. I was fortunate to meet Drs. María Eugenia Prieto and Jesús Rogero García during my first term at Queen‘s, who helped me overcome the transitional challenges. I will remember all the happy moments we spent together, all the iv encouragement they offered me, and their company with me especially when I met difficulties and challenges. To my beloved family, saying thank you seems to be not enough. I deeply appreciate having such a supportive family. My parents are always there for me, their only child, no matter where I am, what challenges I meet, and what happiness I want to share. Their love and support encourage me to achieve my goals. I am also deeply grateful to my cousin‘s family and Jida Zhang for their caring and supports. Finally, I would like to thank everybody who is helpful and important to my study and life. I will cherish all the supports, encouragement and experiences and carry these spirits on in my future career and life. v Table of Contents Abstract ............................................................................................................................... i Acknowledgements .......................................................................................................... iii Table of Contents ............................................................................................................. vi List of Tables ................................................................................................................... xii List of Figures ................................................................................................................. xiii Chapter 1 Introduction ..................................................................................................... 1 1.1 Introduction ............................................................................................................... 1 1.2 Population Aging ....................................................................................................... 2 1.3 Elder Care .................................................................................................................. 6 1.4 Research Goals, Questions, and Significance ........................................................... 9 1.5 Outline of Thesis Chapters ...................................................................................... 12 Chapter 2 Literature Review ......................................................................................... 15 2.1 Introduction ............................................................................................................. 15 2.2 Theoretical Studies in English-speaking Countries ................................................ 18 2.2.1 Life course ........................................................................................................ 18 2.2.2 Active aging ...................................................................................................... 18 2.2.3 Continuity theory .............................................................................................. 19 2.2.4 Public finance and social welfare ..................................................................... 20 2.2.5 Theoretical studies in geography ...................................................................... 22 2.2.5.1 Concept of access ....................................................................................... 23 2.2.5.2 Aging, place, and health ............................................................................. 24 2.3 Empirical Studies in English-speaking Countries ................................................... 25 vi 2.3.1 Characteristics of residents ............................................................................... 25 2.3.2 Decision making process .................................................................................. 26 2.3.3 Access to residential care
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