Introduction
Most older adults prefer to grow old in their own home rather than relocating to institutions (Lum et al., Reference Lum, Lou, Chen, Wong, Luo and Tong2016; Kendig et al., Reference Kendig, Gong, Cannon and Browning2017; Ahn et al., Reference Ahn, Kang and Kwon2020). The term ageing in place (AIP), which is conceptualised as ‘the advocacy allowing older adults to safely, independently, and comfortably remain in their homes’, responds to such needs (Centers for Disease Control and Prevention, 2013). Growing old in one's home enables a sense of familiarity, autonomy and control in later life (Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012). Until recently, the residential choice and experience has been recognised as an ongoing negotiation process, namely the residential reasoning process (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). Taking a resilient stance, this perspective recognises that older adults are not passive organisms but actively adapt to age-related challenges and change during the residential decision-making process (Golant, Reference Golant2011; Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014; Perry et al., Reference Perry, Andersen and Kaplan2014). However, this article argues that existing literature on residential reasoning does not pay sufficient attention to the struggling and tension during adaptation. Previous research tends to list the adaptation strategies while assuming that adaptation would lead to a desirable outcome, usually AIP (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014; Stafford, Reference Stafford2017). Through a qualitative interview conducted in three villages in Yunnan, China, we attempted to explore the residential reasoning process among a childless group. We recruited participants who lived in rural communities and institutions, seeking to understand how the residential decision and adaptation was an ongoing negotiation process that was full of struggling and tensions, rather than a momentary event (Golant, Reference Golant2015).
Residential choices for childless older adults in rural China
The long-term care system for older adults in rural China largely relies on family members, usually one's adult children. Consequently, childlessness in rural China is considered as one of the most undesirable situations that a person would avoid (Zhang and Liu, Reference Zhang and Liu2007). Childlessness in rural China may be driven from three life paths: (a) when a person (usually man) with lower socio-economic status has limited resources to find a mate, hence was lifelong single and childless (Jin et al., Reference Jin, Liu, Li, Feldman and Li2013); (b) when rural couple was biologically infertile, or (c) when couple loses their children for unexpected reason (Feng, Reference Feng2018). All situations lead to negative outcomes such as decreased income (Guo, Reference Guo2014), higher risk of functional disability (Feng, Reference Feng2018) or lower level of psychological wellness (Zhang and Liu, Reference Zhang and Liu2007). Zhang's (Reference Zhang2007) anthropological study revealed that, in rural China, the extended kin may provide limited instrumental support to childless members of family; even such support was constrained by the resources childless members occupied and the opportunities they could possibly ‘pay back’ to the support provider (Zhang, Reference Zhang2007). Overall, different from childlessness in the Western context where some may consciously decide not to have children for career achievement or other lifestyle reasons (Dykstra, Reference Dykstra and Peter2009; Stegen et al., Reference Stegen, Switsers and De Donder2020), in China, in most circumstances, having no children in later life was hardly voluntary. The long-term care arrangement among childless older adults in rural China deserves policy response and research attention.
In the Chinese ageing policy agenda, the childless group are targeted as one of the ‘poorest poor’ groups who need public assistance on the basic surviving level, including food, clothing, residential services and medical assistance (Lou and Ci, Reference Lou and Ci2014). In the 1950s, the State Council of China launched a welfare programme for Wubao residents – older adults and orphans who had no working ability or source of income, and provided food, clothing, medical care, housing services, education and funeral preparation (Feng et al., Reference Feng, Glinskaya, Chen, Gong, Qiu, Xu and Yip2020). This was until 2001 when economic growth in China was rapid enough to cover long-term care needs, and public-funded institutions were initiated as the ‘alternative’ option to staying in one's own home (Wu et al., Reference Wu, Mao and Zhong2009). In 2006, childless older adults were entitled to choose between two ‘welfare packages’: to stay in their homes and receive cash subsidies (in Chinese, fen san gong yang) or to move to rural institutions (ji zhong gong yang) (State Council of China, 2006). The two options were closely related to the definition of AIP and institutionalisation in the international ageing agenda (Feng et al., Reference Feng, Glinskaya, Chen, Gong, Qiu, Xu and Yip2020). In 2014, the Ministry of Civil Affairs renamed the Wubao programme as the Assistance for Extremely Poor Household Scheme, re-emphasising the vulnerability of childlessness and the urgency to protect them from extreme poverty (Ministry of Civil Affairs, 2016). As of 2018, 4.55 million eligible childless older adults in rural China were covered by over 13,885 rural institutions (Ministry of Civil Affairs, 2018).
The decision of whether a childless older adult is willing to age in place or relocate to a rural institution is voluntary. The qualifying age for institution admission varies across local regulations, but the overall admission age is over 60 years. Once the childlessness status has been confirmed by a village committee, applying for and staying in institutions requires no charge (Wu et al., Reference Wu, Mao and Zhong2009). If institutions are not preferable, childless older adults can also choose to stay in their own homes until they change their mind. Since 2018, 3.68 out of 4.55 million (approximately 80%) of rural residents without children have chosen to age in place instead of relocating to rural institutions (National Bureau of Statistics of China, 2018).
Even though growing old in one's own home constitutes the prevailing preference for most (80%) childless older adults in rural China, as argued before, the prospect of AIP might be challenging when taking into account layers of disadvantages a childless person may encounter. A profound knowledge of how childless older adults determine the residential decisions (regarding AIP or institutionalisation) and how they manage their long-term care needs is required. This research would contribute to literature on AIP by providing experiences from the childless group – one of the ‘riskiest’ groups in terms of institutionalisation in the Chinese context (Gu et al., Reference Gu, Dupre and Liu2007; Wang et al., Reference Wang, Yang and Wu2020). It would benefit the long-term care policy design in rural China, as the Chinese government has endeavoured to provide the ‘most appropriate’ long-term care services to the ‘most demanding group’ (Lou and Ci, Reference Lou and Ci2014).
Residential reasoning, adaptation and struggling
The term residential reasoning was initiated by Granbom (Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014), who followed the residential normalcy model and defined the term as the ‘changing process that covers both residential decisions and adaptations’ (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014:10). The residential normalcy model aims to answer the question of why a certain residential choice was made; it regards the residential choice as a subjective, negotiation process during which older adults struggle to fulfil their needs and goals – to achieve ‘residential congruence’, to use Golant's (Reference Golant2011) term. There are two broad residential experiences that older adults perceive: residential comfort, i.e. pleasure, hassle-free and memorable feelings; and mastery, i.e. control and competence. When older adults fall into both a comfort and mastery zone, congruence is achieved. If older adults fall out of either zone, they have to make adaptive efforts to regain residential congruence (Golant, Reference Golant2012). There are two adaptive efforts older adults may use when falling out of either zone: the accommodative (mind) strategy and assimilative (behaviour) strategy (Golant, Reference Golant2011, Reference Golant2015). If neither strategy produces a positive outcome, older adults may choose to relocate to institutions as the ‘last solution’ (even if unwelcome) (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014).
This perspective challenged the traditional paradigm of residential gerontology, which regarded the choice of AIP or institutionalisation as being prompted/hindered by a set of individual, interpersonal and environmental factors (e.g. health status, civic engagement, residential satisfaction) (Perry et al., Reference Perry, Andersen and Kaplan2014; Ahn et al., Reference Ahn, Kang and Kwon2020; Pani-Harreman et al., Reference Pani-Harreman, Bours, Zander, Kempen and Van Duren2020). It set the stage for regarding the residential decision as an ongoing negotiation process rather than momentary events (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). For example, older adults could reframe the residential aspiration (Stafford, Reference Stafford2017), fostering a sense positive identity (Peace et al., Reference Peace, Holland and Kellaher2011) or a downward comparison (Lou and Ng, Reference Lou and Ng2012) while staying in one's own home. Behavioural strategies included: changing daily activities (e.g. walking, going to church), using supportive devices (e.g. alarm system, wristwatch or wheelchair) and using home modifications to achieve desirable outcomes (Mackenzie et al., Reference Mackenzie, Curryer and Byles2015; Stafford, Reference Stafford2017). If the adaptation strategies did not enable competence and control, institutionalisation was triggered, at the least being reckoned with as a ‘necessary result’ (Lofqvist et al., Reference Lofqvist, Granbom, Himmelsbach, Iwarsson, Oswald and Haak2013).
There have been studies, even if scant, conducted in a rural context to reveal the adaptative strategies taken by older adults. Self-sufficiency and self-reliance were intensively mentioned in the literature on rural ageing, as rural residents must be able to obtain food and other life materials through day-to-day engagement with farmland (Winterton and Warburton, Reference Winterton and Warburton2011). In a materially constrictive rural location, older adults tended to lower their material expectations to maintain psychological wellness (Milbourne and Doheny, Reference Milbourne and Doheny2012). A qualitative study conducted in Australia revealed that male farmers insisted on maintaining a strong identity of ‘toughness’, which enhanced their psychological wellness but problematised the overall prospect of AIP (O'Callaghan and Warburton, Reference O'Callaghan and Warburton2017). For those who remain childlessness in rural places, dependence and self-reliance were valued even though they reached out for help from neighbours and friends (Wenger, Reference Wenger2009).
While it is true that older adults make adaptive efforts to gain control and competence to avoid institutionalisation (Lofqvist et al., Reference Lofqvist, Granbom, Himmelsbach, Iwarsson, Oswald and Haak2013; Söderberg et al., Reference Söderberg, Ståhl and Melin Emilsson2013; Anderson et al., Reference Anderson, Larkins, Beaney and Ray2018), some research argues that the existing literature does not capture the residual decision as an ongoing negotiation (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). Two limitations of the literature account for this argument. Firstly, while most research lists the adaptation strategies while assuming that it leads to desirable outcomes (e.g. AIP) (Stafford, Reference Stafford2017), in real life, adaptation comes with messiness and flaws (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). The process may involve painful efforts, changes and negotiations; it may be especially a struggle among the disadvantaged, for whom the feasibility of adaptation exceeds their limited resources (Finlay et al., Reference Finlay, Gaugler and Kane2020). Secondly, and relatedly, most research on residential reasoning tends to focus on one group of older adults (usually the AIP group), neglecting the voice of current institution dwellers who may struggled to adapt before relocation. Such limitations are partially due to the research tradition where the topics of AIP and institutionalisation have been treated separately (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). However, we argue that, if regarding the residential reasoning as an ongoing negotiation process, those who choose AIP and relocation should be considered simultaneously.
This research was conducted among childless older adults in rural China because both residential options (AIP and institutionalisation) are similarly viable. By recruiting participants from both rural communities and rural institutions, this research aims to gain in-depth understanding of the residential reasoning process among the childless in rural China, exploring the adaptational efforts as well as its struggles during residential negotiation. Specifically, we sought to understand (a) why the childless make a certain residential choice (AIP or institutionalisation) and (b) how they struggle to adapt during the residential reasoning process.
Method
A qualitative design was applied in this research, as this approach is appropriate for discovering the thoughts, reflections and experiences of certain phenomena (Creswell et al., Reference Creswell, Hanson, Clark Plano and Morales2007). This research was informed by a constructivist grounded approach, since the iterated design allowed us to have ‘dialect’ between previous theoretical frameworks (e.g. the residential reasoning model) and interview data (Charmaz, Reference Charmaz2014). Existing concepts, such as residential comfort and mastery, would sensitise our understanding, stimulating new thoughts and inspirations in order to compensate or revise the existing knowledge (Bryant and Charmaz, Reference Bryant, Charmaz, Bryant and Charmaz2007). Besides, the constructivism approach allows the researcher to have ‘critical awareness’ on the researcher's positionality, which enables the research practice to be ‘reflective’ in terms of the possible power imbalance between participants and researcher (Charmaz, Reference Charmaz2020). The first author of this article, as well as interviewer of this research (SC) is an urban-born young female who has limited experience in rural living. The constructivism grounded theory approach helped SC to question her taken-for-granted interpretation (e.g. why participants appeared to be ‘optimistic’ and ‘resilient’ during interview) while opening alternative explanation to her observation (e.g. the participants may attempt to take control of their narrative by illustrating the ‘resilient side’ of their life, which triggered the necessity to concern the struggling experience of adaptation) (Charmaz, Reference Charmaz2020). Following the guidelines of the constructivism approach, data collection and analysis of this research were iterated and emergent; analytic results from the formal stages guided the next stage of data collection and analysis (Charmaz, Reference Charmaz2014). Research memos and reflective notes guided the whole research process (Charmaz, Reference Charmaz2020).
Participants and recruitment
This study included participants who were (a) aged over 60; (b) resided in rural villages or in rural institutions; and (c) did not have any living children. Childless older adults were invited to describe their current situation (‘How was your previous living situation in a rural community and your current institutional living situation?’, for the institutionalised group). They were also asked about the difficulties (if any) they had encountered during their stay (‘What were the difficulties you encountered while living in a rural community; and what are the difficulties you have had since relocating?’, for the institutionalised group). Participants were invited to discuss ‘Why do you remain in a rural community’ (‘Why did you move here?’, for the institutionalisation group) and ‘What are your future plans?’ (for both groups).
Data collection and sampling
Semi-structured interviews were conducted for data collection. All data were collected in rural Yunnan Province from February 2019 to January 2021. SC relied upon local authorities to recruit participants who lived in institutions. Thereafter, the AIP group was selected. Participants who lived in villages that near to rural institution were covered in the same administrative district with institutions, which simultaneously qualified them for AIP and institution admission. The village administrator and anti-poverty work team members accompanied SC on visits to the participants’ households or institutions. After the research purpose was introduced and ethical issues were addressed, the floor was opened for conversation.
Initial sampling followed the principle of availability (Charmaz, Reference Charmaz2014). Participants who met the participation criteria were invited to take part in this research; 14 childless participants (nine village residents and five institution dwellers) and three informants (e.g. the village cadre and staff of institutions) were recruited at this stage. After the researchers had gained a general understanding of why a certain residential choice was made (after the initial integrative framework emerged), a theoretical sampling strategy was conducted. Eleven childless participants (eight village residents and three institution dwellers) and two informants were recruited to maximise our comparison; seven follow-up interviews were conducted to supplement properties and gaps of the initially emerged framework (Charmaz, Reference Charmaz2014). Ultimately, 25 childless participants (aged 60–83) were interviewed; seven participants were interviewed twice (see Table 1). Five informants was interviewed for triangulation (Barusch et al., Reference Barusch, Gringeri and George2011). All interviews were conducted in the local Chinese dialect in order to capture the local flavour of the narratives (Charmaz, Reference Charmaz2020).
Table 1. Participants of this research
This research was approved by the Human Research Ethics Committee at the University of Hong Kong. All interviews were based on principles of voluntariness, confidentiality and no harm. Each interview lasted between 40 and 80 minutes.
Data analysis
All interview data were taped, transcribed, compared and repeatedly analysed in Chinese using four stages of constructivist grounded theory (Charmaz, Reference Charmaz2014). Open coding was conducted by SC to make sense of a participant's overall residential decision-making experience. We noticed that participants referred to the term ku (in English, literally means bitterness) to describe their residential choice (e.g. ‘I was still able to ku to stay’ or ‘I'm not able to ku so I moved’). This native expression contains ambivalent feelings of mastery (e.g. ‘I can ku for a living’) and discomfort (e.g. ‘My life was full of ku’, meaning that my life is full of suffering) in the Chinese context, which triggered our interests. Besides, other related elements such as ageing, health decline and receiving support from extended kin was identified as relevant to the residential decisions. We remained open and curious on the upcoming analysis process.
During the initial coding process, a researcher with a sociology background was invited into the process to conceptualise ku. We firstly clarified the meaning of ku on its narrative form, which includes: (a) the mastery experience to describe the behaviour of ‘doing activities to make a living in a rural area’ (e.g. farming, raising chickens, doing housework); and (b) the uncomfortable experience to describe the emotional status of ‘doing activities’ that are stressful and suffering (see Table 2). Defining ku as ‘conducting farming and farm-related activities in a stressful and suffering way’, other physical and social-related codes (e.g. ageing or health decline) could be contained into the ‘ku family’, as farming capacity was susceptible to the physical, social and age-related elements.
Table 2. The meaning of ku
As data analysis processed into the focused coding stage, newly emerged codes were re-named, re-examined and merged into previous codes (Holton, Reference Holton, Bryant and Charmaz2007). We focused on how the perception of ku may (or may not) influence the residential decisions. We noticed that both the AIP and institutionalised groups struggled to ‘endure ku’ for as long as possible. The adaptation behaviour/intention remained an important reason for them to decide where to grow old. Based on findings from focused coding, an axil coding strategy was applied to connect the emerged codes and themes (Holton, Reference Holton, Bryant and Charmaz2007). We pinpointed: (a) participant's perception of ku, (b) how did this person endure ku, and (c) the residential decisions. Three levels of adaptation strategies (the psychological, behavioural and existential levels of adaptation strategies) were highlighted in this stage; the struggling side during adaptation was also marked.
After we had the initially intergraded framework from the axil coding, we returned to the filed to conduct thermotical sampling. Constant comparative analysis and theoretical coding were conducted; a central theme (enduring ku to AIP; overwhelmed by ku to institutionalisation) emerged during this stage. After careful consideration and effort to enhance the method rigour, we argue that the language of ku could contain most of the experiences of participants and could predict the residential decision (Charmaz, Reference Charmaz2014). Theoretical saturation was achieved when (a) no new properties (regarding the sub-category of ku or adaptive effort) emerged from analysis, (b) the framework of ku was integrative, and (c) the framework fulfilled our research goal (‘to explain how participants make the residential decision and how they struggled to adapt’) (O'Reilly and Parker, Reference O'Reilly and Parker2013).
Results of our analysis were verified with triangulation and peer debriefing meetings (Barusch et al., Reference Barusch, Gringeri and George2011). Our informants were familiar with the expression of ku and confirmed our findings. We also examined the fitness (the extent to which the research goal, participants’ narratives and our analysis were integrative), generality (the extent to which our framework was able to be applied in multiple circumstances) and understandability (the extent to which our framework was understandable to people in this area) of our findings during peer debriefing meetings (Cutcliffe, Reference Cutcliffe2005).
Findings
Childless older adults referred to the extent they could endure ku to describe the reason for choosing to age in place or in an institution. If a person could endure ku, it was more likely that they would choose AIP over institutionalisation. Twelve participants chose AIP and eight relocated to institutions (see Table 1).
Ku means ‘doing activities in a stressful and suffering way’ (mainly, but not limited to farming) (see Table 2). To make a living in a disadvantageous rural location requires individuals to be substantially active. Grains and vegetables have to be grown on the farmland; chickens have to be raised; firewood has to be gathered from forests. Even though most food necessities (e.g. grain, flour, oil) were available in local groceries, older farmers still habituated to ku – to growing their own vegetables and grains to economise on everyday spending (Jiang et al., Reference Jiang, He, Qu, Zhang and Meng2016). It is undeniable that ku involves stressful, suffering and discomforting facets. However, it remains the ‘working ability’ on which a farmer relies. A person who could endure ku (the negative side of farming) signified a strong willingness to be self-reliant, as only through ku (conducting farming and farm-related activities) could he or she secure food. We argue that, despite its stressfulness and suffering side, ku signified mastery experience where a person's existential needs could be achieved by farming and farm-related activities (Golant, Reference Golant2011).
Childless older adults have applied a variety of psychological, behavioural and existential strategies to endure ku. This research identified three broad strategies: (a) positive reappraising of ku as unimportant, (b) routinising ku, and (c) transcending the narrative of ku as toughness identity. Participants struggled to balance the environmental hardship and age-related challenges with residential mastery for as long as possible; and the choice of institutionalisation was regarded as the ‘last resolution’ to regain mastery (Golant, Reference Golant2011).
Positively reappraising the negative side of ku
On a cognitive level, childless older adults struggled to convert the negative experience into a new perspective: ‘The dissatisfying aspects were not important and not worthy of mentioning’. Given such a general perspective, childless older adults applied (a) expectation reappraising and (b) downward comparisons to release the tangible feelings of stressfulness, suffering and discomfort. Some of them (c) focused on the present to avoid the anticipated anxiety of ku. Conversely, if the residential discomfort was too overwhelming to allow for adaptations, participants tended to relocate to institutions.
Some participants normalised the suffering and stressful aspects of ku (conducting farm and farm-related activities) as a ‘way of living’. From their narrative, the residential-related difficulties such as a disintegrating house, leaking roof or distant farmland were ‘out there but not tangible’. They used words such as ‘barely enough’ and ‘fairly fine’ to describe their current living situation. TL (65, male), a community-dweller, responded to questions of ‘how do you feel by living in this village’:
If you are talking about food and clothing, I would say ‘barely enough’. It is not extremely difficult, but yes, I have difficulties, and I get used to them. I cook the things I have; if I don't have food, I'll go to the market. This is how living by yourself is.
For some participants, residential discomfort was less important when it was positioned as a ‘common issue’, noting that the process of adaptation was also full of struggles. They compared their own ku with others, especially the imaginative figures who were ‘also experiencing the same difficulties’ to legitimise the positive assessment. Residential mastery was achieved by imaginative and downward comparison:
S: How do you feel by living here? Do you like your house?
TS: It's just difficult to tell, you know. If you say, ‘It is bad’ … well, there are places that are worse than here. But we do life better than those who live in the foothill areas.
The participant, TS (male, 63), was a retired village cadre who was once in charge of the village relocation programme, mobilising the whole village to move from a foothill area to a plain area to avoid debris flow. After voicing the negative side, he justified it by adding:
There are places that are better off than us, much better. But … we are just too poor. We moved from one place to another. There's no way we could be rich … everyone is ku [suffering] in the village. We were worse off than some, better off than many.
Struggling experience shadowed the mastery narrative of participants and was intensified by issues of increased age, declining health and a sense of uncertainty. In the end, most childless participants illustrated how they would focus on the day-to-day, immediate ku to avoid making long-term, unrealistic residential plans. They fostered a life attitude of ‘making every day count’ to maintain control and competence, even if momentarily. BY, a 65-year-old man, illustrated his ‘future plan’ as:
Plan? I don't have any plans. First, I'm old; second, I'm sick [BY's left foot has been fractured due to an accidental fall]. The illusionary bragging is unrealistic. Let's be practical. I would value my health, take care of my body and live for as long as possible. That's the plan … I'm 65 years old now.
Similarly, TTC (73, male) did not regarded any residential changes to be ‘necessary’ due to the uncertainty of death:
I'll die soon, in one or two years. What's the point or moving [to an institution] … I'd rather die in my house. Maybe I'll die tomorrow, who knows? I've stayed at home for a long time. Why bother to leave?
The narrative above demonstrated how adaptation was susceptible to physical, psychological and age-related challenges. When reappraising the discomfort aspect as unimportant, participants also realised how ku, conducting farming and related activities, encompassed the negative side of the residential experience: the environmental hassling, sense of helplessness and uncertainty of the prospects of ageing. This finding supports the argument that residential reasoning was a process full of messiness, hesitation and tensions (Granbom et al., Reference Granbom, Himmelsbach, Haak, Löfqvist, Oswald and Iwarsson2014). Conversely, for those who regard the ku as overwhelming, the choice of institutionalisation remained a way to escape. DH, 66, remembered his previous experience of a rural community with a tone of suffering and powerlessness. He grew up as an orphan, ‘experiencing multiple adoption and relocations’ since childhood. He even built his own house and became ‘independent’ at the age of 17. However, for DH, conducting farming activities in such a disadvantageous rural community was never mastery or comfortable:
The village cadre told me that if you are unable to ku, you may consider moving [to an institution]; I agreed. If I stay at my house, it's just farming. No farming no food, and even farming cannot guarantee food. The farmland was dry, and water is limited. Trees on the mountain have been mostly chopped down. I cannot endure ku anymore [the participants have to pick wood from the mountain forest for firewood].
Routinising ku in a flexible way
Despite the stressfulness and suffering of the narrative, farming and farm-related activities were overall routinised and controllable. Daily activities, such as boiling water, cleaning the house, farming, raising chickens and picking pigs’ food took everyday attention and energy. TS, the retired village cadre, was satisfied with his ‘busy schedule’ in the rural community:
I go to the farm every day, walking there. I have a cow to take care of near my farmland, and I need to harvest grass [to feed the cow]. I leave home at 7 am, eat lunch at about noon, leave at 1 or 2 pm and came back until 8 pm. My life is just maintained in this way, and I do as much as I can.
Day-to-day ku was foreseeable but not rigid. Participants implemented their schedule in a flexible way, deciding when to move, what to do and when to stop farming, depending on their own will. Childless older adults were worried that relocating to institutions may lead to interruption of everyday routines, hence potentially undermining their autonomy. As TL illustrated:
I wake up in the morning and farm. If there's not a lot to do, then I will go home; it depends. I leave before sunset at the latest. If I move [to an institution], they [the staff at the institution] won't let me even go out. There's no way I can get used to that. I'm used to farming on farmland, not being regulated.
Receiving instrumental and emotional assistance from an informal supportive network (neighbours, friends and extended kin) enabled participants to implement the day-to-day ku. LD, a 68-year-old disabled man, revealed his experience before relocating to an institution:
When I stayed in the rural community, I raised chickens, pigs and conducted farming. I did the light work [e.g. collecting firewood, transplanting] while my nephew and niece helped me with heavier work [e.g. caring heavy things].
However, LD admitted that such assistance was ‘hardly enough’ to sustain AIP. LD's left leg was broken from an accidental fall when he was eight-months-old; the disability accompanied his whole life. He had a brother who ‘provided as much as LD needed’ in the village, but the financial difficulty of LD's brother rendered any assistance ‘inappropriate’. LD relocated to a rural institution in 2010 because ‘farming would become too demanding’ for his ‘disabled body’.
For most participants, the flexible routine of farming contained ‘small treats’ such as smoking and alcohol consumption. They attempted to balance their sense of pleasure of having such 'treats' with enduring the ‘danger of health decline’. BY struggled to stop smoking for financial and health concerns yet was reluctant to abandon the ‘limited luxury’. CL (68, male) enjoyed ‘hanging out’ on the village street, which was later revealed as ‘participating in some gambling activities’ by the village cadre. CC, a 69-year-old never-married women, shared her reluctance to stop drinking alcohol:
CC: I have cholecystitis, I can't drink alcohol or eat chicken or eggs.
SC: Do you miss them?
CC: I can't … well, I drink alcohol, occasionally (laugh). I bought the local-made alcohol from the grocery.
Maintaining the routine ku catered the preference of most participants, however, it was possible when farming and farm-related activities was interrupted by unexpected events, such as fall. HM, 83, remembered how she suffered and how powerless she was when staying in a rural community. She illustrated the narrative below with tears in her eyes:
HM: [When staying in the rural community] I carried a bag of grain to the market to thresh it, and I fell into a channel near my land. I didn't thresh my grain. They [neighbours] found me, sending me home. I was dizzy for almost three days, but still tried to thresh the grain.
SC: (shocked) And did you finish it?
HM: Yes. But I was too sick. After that they [neighbours and village committee] sent me to the hospital. When I recovered, they send me here [the institution].
HM was ‘driven’ to a rural institution due to an accidental fall. The living conditions after relocation were ‘acceptable’, even though it took her ‘a period of time to get used to it’:
I get up before sunrise, having dinner when they [the institutional staff] are ready to prepare it. 12:00 noon and 6 pm. After eating it is television time, or sleeping time, it depends. If I feel good, I will tour around or go to the market [after notifying the institutional staff].
This theme illustrates how childless older adults struggle to balance a sense of control with everyday autonomy. They took behavioural strategy from (a) routinising ku, (b) implementing ku in a flexible way, and (c) sustaining ‘small treats’ to gain a sense of mastery. Conversely, when everyday routines were interrupted by unexpected changes (e.g. health decline), it was likely that childless older adults had to relocate to institutions for advanced support (Golant, Reference Golant2011).
Transcending the narrative of ku into a toughness identity
Despite the stressfulness, suffering and discomfort indicated in the narrative, childless older adults struggled to make meaning from ku. They (a) transcended ku as a positive identity of toughness to legitimise the choice of AIP; they also (b) accommodated such identity into social progress, regardless of health-related challenges. Through adaptation, enduring the stressfulness, suffering and discomfort aspects of ku, they gained individual and cultural approval.
Enduring ku was associated with a positive identity of being tough and hardworking; it was framed as a way to safeguard one's self-reliance. Following this argument, it was not surprising to notice how institutionalisation was perceived as ‘harmful’ to the toughness identity. As BY illustrated:
A tree can be cut for firewood. They [the electric company] give me 15 kilowatts of electricity for free. I can buy one bag of rice [10 kilograms] for 60 RMB [approximately US $9] and save 300 RMB [US $45]. One RMB for a small bag of salt. I can grow vegetables for myself. (Interview 1)
If you ask me, the most important thing in this society is self-reliance. I don't want to rely on others [the institutions]. A phoenix in distress is worse than a chicken. (Interview 2)
One interesting finding of this research is that the mastery narrative of ku was emancipatory. Participants accommodated their autobiographical ku with the grand discourse of economic growth and social progress, legitimising the discomfort of ku as a way to ‘defend the past and the more stressful and suffering old society’. TS remembered the farming experience in the 1950s (the Collectivism Period) with mixed feelings of suffering and proudness:
In the Collectivism Period, the village had a shortage of water supply. The channel needs to be dug; grain needs to be threshed. The electricity was beyond our imagination; we just had firewood. You can imagine how difficult it was. Even if you are willing to ku [farm], there was no chance that you could feed yourself. Now you ku for yourself, you farm for your own pocket. It's a good time.
Farmers in the 1950s in rural China needed to earn ‘working points’ through participating in collective farming. The allocation of food and fabric was evaluated based on the working points a farmer earned during the previous month (Li, Reference Li2013). It was not until the 1970s, when the System of House Contract Responsibility was implemented, that farmers could ‘ku [farm] for their own pocket’ (see Table 2). Following this perspective, the negative aspect of ku was gradually relieved by economic growth and social development. Childless older adults believed that by living in such a ‘developing’ society, a sense of mastery was enhanced. As TS illustrated:
The more I ku [farm], the more confident I am. I ku to make my life better. Only those lazy people would consider moving [to institutions].
While many participants accommodated the past suffering experience into a grand discourse of social progress, only one participant estranged himself from such discourse and relocated to the rural institution with the perception that he would become ‘incompetent’ someday:
I have flaws, my body has flaws. The economy is good, and money is easy to earn. But I'm a flawed person. I planned this [the moving] a long time ago. I'm flawed in general.
By referring to ‘flawed’, this participant, HH (60, male), pointed to his stoop – a physical disability he had had since he was born. HH had planned to relocate to institutions before the village cadre informed him of this option. The choice of relocation was a way to manage the anticipated risk of ageing and physical disability: ‘I moved here for two reasons, my increasing age and my disability’. In other words, the discourse of economic growth did not enrich the meaning of ku, nor did it improve his general wellness and sense of mastery.
Some participants struggled to make meaning from ku, regardless of the age-related difficulties they encountered. YZ (65, male), a stroke survivor, chose to endure ku with great pain: ‘I feel dizzy during farming. I didn't even know today's date … (curse) ku! I cannot do anything.’ However, when offered the residential plan, he rejected it because the anticipated relocation might render him ‘subordinate to others’ – the staff in institutions:
If I move to that place [institution], the house would belong to the village committee, and the land would belong to the state. I said no. I would rather have an eye on my leaking house than … to be honest, if I move, I'd be regulated. It would be an outrage and a disgrace. I'd rather farm for myself here.
One village cadre verified that farmland was an important reason preventing the childless from relocating, as farmland would belong to the village collective after they relocated or died (to be specific, the land usage right would belong to the village collective; Chinese farmers only have a right to land usage rather than ownership) (Jiang et al., Reference Jiang, He, Qu, Zhang and Meng2016). We argue that the anticipated loss of one's farmland was related to identity and mastery loss: after relocating, the chance that a person could make meaning from ku was eliminated. This finding revealed how residential mastery was sustained in a struggling and messy way (Golant, Reference Golant2015). It is possible that the mastery narrative prevented participants from seeking advanced support when needed, binding them to the farm, with its potential risks and hassles (O'Callaghan and Warburton, Reference O'Callaghan and Warburton2017).
Discussion
This research explored the residential reasoning process among childless older adults in rural China, that is, why certain residential decisions were made in regard to AIP or institutions and how they adapted during the decision process. Findings of this research extended beyond the residential normalcy model, which suggested that a person had to fall into both residential mastery and comfort to fulfil their goals and needs (Golant, Reference Golant2011). For childless older adults living in rural places, congruence was sustained from ku, a mastery narrative involving farming and farm-related activities, regardless of the stressfulness, suffering and discomfort a person may experience. Childless older adults assessed the extent to which they could endure ku to sustain food and basic living through farming and farm-related activities when deciding where to grow old. If ku was endurable during rural living, participants of this research tended to choose AIP; otherwise, if they were overwhelmed by ku, institutionalisation became more likely.
The narrative of ku in a rural context covered a variety of farming and farm-related activities, which were under threats of environmental constrictions, increased age and functional decline. Unlike in Western literature which has romanticised rural space as a refuge from urban capitalism (Skinner and Winterton, Reference Skinner and Winterton2018), rural places in contemporary China are still perceived as ‘backwards’ and rife with poverty (Zhao et al., Reference Zhao, Guo and Shao2017). Agricultural development in China, especially in the mountainous and undeveloped areas (e.g. Yunnan Province), was bound by geographic disparity, ecological vulnerability and the insufficient use of agricultural machinery (Guo et al., Reference Guo, Zhou and Liu2019). Farmers tended to divide the farmland into pieces (approximately 400–600 square metres for a childless farmer) to farm. In most circumstance, rural residents, including both childless and parental groups, had to resort to physical strength, ‘working to survive’ and ‘working until they drop’ (Pang et al., Reference Pang, de Brauw and Rozelle2004; Zhang, Reference Zhang2007). The narrative of ku was similar to, but moved beyond, the concept of ‘self-sufficiency’ in AIP literature in the Western context (Wenger, Reference Wenger2009). While self-sufficiency encompassed the positive identity of independence, autonomy and self-efficacy (Söderberg et al., Reference Söderberg, Ståhl and Melin Emilsson2013), the narrative of ku in rural China came along with the practical concern that living in such disadvantageous rural areas has to prioritise surviving needs while enduring substantive physical, psychological and social discomfort. When residential choices have to be made, a person would assess their farming capacity – the extent one could maintain mastery – to decide where to grow old.
Enduring ku was an ongoing negotiating process that was full of adaptation and struggling. Childless older adults reappraise the negative aspects of ku, routinising it and making meanings from ku to achieve residential congruence. This finding confirmed the adaptation strategies identified in Golant's (Reference Golant2011) model, emphasising how adaptation includes a variety of cognitive, behavioural and existential efforts. In addition, this research highlighted how adaptation was shaped by the individual, environmental and structural resources and constrictions. For example, when a childless older adult struggled to ‘live in the present’, it reflected the deep anxiety and uncertainty of the long-term prospects of rural ageing as well as a sense of powerless on making long-term residential plans under constrictive circumstances (Lofqvist et al., Reference Lofqvist, Granbom, Himmelsbach, Iwarsson, Oswald and Haak2013; Haushofer and Fehr, Reference Haushofer and Fehr2014). This research calls for attention to how structural inequality infuses into everyday adaptation practices while creating struggles and tensions in the adaptation process. Essentially, adaptation was embedded in the constrictive circumstance where formal support is systemically in shortage and where childless older adults have nothing but their own physical strength to rely on in rural places.
The narrative of ku was not only existential but also emancipatory. Participants established a positive identity of toughness and laboriousness, accommodating such identity into a grand discourse of social progress and economic growth to sustain a sense of mastery. Enduring ku became the spiritual strength for childless older adults to respond to their existential concern and the emancipatory narrative to organise their autobiographical continuity (Peace et al., Reference Peace, Holland and Kellaher2011).
This finding challenged the previous finding in a Western context, which suggested that a sense of mastery was related to past memorable places (Stones and Gullifer, Reference Stones and Gullifer2016). For participants of this research, mastery was tied to contemporary achievements and future development. This situation may be attributed to the specific historical and social context of Chinese society. Since the 1950s, the People's Republic of China has advocated the political movement of suku (‘talking about bitterness’) to mobilise low-income farmers to share their stories of misery in China's former society. In its narrative form, this is in contrast to the present society that the Chinese Communist Party has established (Zhou, Reference Zhou2015). Since then, ku has remained a linguistic framework for farmers to organise and vocalise their (suffering) experience. As economic growth increased, participants were able to benefit gradually from the social development and prosperity (Liu et al., Reference Liu, Liu and Zhou2017), hence they established a perception that ‘the current time is the best time’. Such a development and progress discourse, in turn, sharpens the comparison between the past, suffering ku, with the contemporary, endurable ku. Residential mastery was legitimised by living in the developed, progressive Chinese society.
This research revealed three situations in which childless older adults may choose to relocate to institutions: when the residential suffering and stress surpasses individual mastery, when daily routines were interrupted and when they failed to make meaning from ku. This finding supports and extends the main arguments of Golant (Reference Golant2011), that is, institutionalisation was the last solution to regain normalcy and mastery, although it was unwelcome in most circumstances (Golant, Reference Golant2011). In addition, those who encountered unexpected events such as fall seemed to be extremely risky (e.g. HM's story). Further research and policy implementation may consider targeting this situation, exploring how they regain mastery and normalcy in new settings while providing intensive and person-centred care to those involuntary movers.
Several limitations of this study have to be underscored. Firstly, findings of this research were based on a small selective sample in Yunnan, which may limit the transferability of findings to other provinces and areas (e.g. the plains area with a higher agriculture commercialisation rate). Further research may consider such geographical disparities, paying attention to the extent to which a childless older adult has to rely on his or her physical strength to make a living when exploring residential decisions and adaptations. Secondly, regarding the research design, the question, ‘How was your previous living situation before moving?’ was retrospective for the institutionalisation group. This may have been biased by participants’ current circumstances and their ambivalent memories (Grossoehme and Lipstein, Reference Grossoehme and Lipstein2016). Future research may take this method deficit into consideration and collect longitudinal data to track the adaptation strategies over time. Thirdly, women are less likely to remain unmarried and childless than men (Jin et al., Reference Jin, Liu, Li, Feldman and Li2013). Although the authors balanced both genders of the participants, further research may benefit from examining how childless men and women differed in terms of the residential decisions and adaptations. Finally, it has to be noted that the authors of this article have socio-economical differentiation from the participants. Even though several efforts were applied to enhance method rigour, findings of this research are still open for criticism and further investigation.
Conclusion
Childless older adults make their residential decisions in regard to AIP or institutionalisation based on the extent to which they could endure ku, that is, whether a person could guarantee food through farming and farm-related activities. Ku in narrative form means ‘conducting farming and farm-related activities in a stressful and suffering way’. Ku represented the mastery experience, on the one hand, containing the stressful, suffering and discomfort aspects that required adaptations. Through the cognitive, behaviour and existential strategies of adaptations, residential decisions were made based on feelings of mastery.
Acknowledgements
Our thanks to participants who shared their fascinating life stories with us and to the anti-poverty work team who helped us to recruit participants. Our thanks to Dr Roberta Iversen for her kind support.
Author contributions
Shirly H.Z Chen planned, conducted and wrote the paper.Vivian W.Q Lou supervised the whole process and revised the manuscript.
Conflict of interest
The authors declare no conflicts of interest.
Ethical standards
This research was approved by the Human Research Ethics Committee at the University of Hong Kong. All interviews were based principles of voluntariness, confidentiality and no harm.
