JMIR Publications

ABSTRACT

Background:

Long-term care is changing how older adults live with and remain connected to their families in China. For older women with long histories of family caregiving, residential care changes living arrangements, family roles, and everyday care. Filial piety may shape how women understand these changes and family responsibilities.

Objective:

This study examined how older women in an urban Chinese long-term care facility understand filial piety and intergenerational relationships after admission, and how professional care and family involvement are understood in relation to filial responsibility.

Methods:

Ethnographic fieldwork was conducted at K Long-Term Care Facility in Fuzhou, China, from January to April 2025. Data comprised 4 to 5 repeated semistructured interviews with each of 10 older women, participant observation, semistructured interviews with 4 social workers and 3 care workers, and institutional documents. Data were analyzed thematically through comparison across interviews, field observations, staff accounts, and documentary materials.

Results:

Older women used filial expectations when interpreting residential distance, household boundaries, visits, communication, and everyday care. Some regarded co-residence as an important expression of filial responsibility, while others viewed separate residence, short stays, and regular contact as compatible with close family relationships. Earlier family caregiving experiences also informed how they understood current relationships with adult children. Professional caregivers assumed routine daily care, while adult children remained involved through visits, communication, financial contributions, and care-related decisions. Social workers facilitated family contact and gave residents space to discuss family relationships while maintaining professional boundaries around judgments of filiality.

Conclusions:

Among older women in this urban Chinese long-term care facility, filial piety remained relevant after residential admission, while its practical expression varied across living arrangements, forms of contact, household boundaries, and care roles. The Chinese case shows how older women negotiate filial piety after entering residential care, balancing family obligation with independence, distance, and changing forms of contact and care. Future long-term care research and practice should attend to these culturally grounded negotiations.