Review of Growing Old in a New China: Transitions in Elder Care. Rose Keimig, Newark, NJ: Rutgers University Press, 2021, 208 pp.

Reviewed Book

Growing Old in a New China: Transitions in Elder Care. Rose Keimig, Newark, NJ: Rutgers University Press, 2021, 208 pp.

Growing Old in a New China: Transitions in Elder Care. Rose Keimig, Newark, NJ: Rutgers University Press, 2021, 208 pp.

Book cover of Growing Old in a New China. Red background with a yellow-orange circle.
Cover of Growing Old in a New China

Jeanne Laraine Shea

University of Vermont

As a medical anthropologist and scholar of aging in China, I was delighted to read Rose Keimig’s book Growing Old in a New China: Transitions in Elder Care. Based on original ethnographic research in elder care institutions in contemporary China, the book describes the contours of the growing trend moving from home-based care to institutional care for elders there and changes in experiences of providing and receiving care. Combining rich ethnographic vignettes with glimpses into China’s social and cultural history, this book is well researched, well written, and highly accessible. It is an excellent resource for scholars and students in medical anthropology, the anthropology of aging, Asian Studies, and social gerontology.

The book has six chapters, plus the introduction and conclusion, all of which make an important contribution to understanding aging and caregiving in contemporary China. Chapter 1 explores the challenges of the traditional cultural ideal of filial children and benevolent parents in light of the current social environment in China, while showing the importance of not only an adult child’s but also an elderly parent’s point of view on family ethics. Chapter 2 examines how historical events have shaped the viewpoints and bodies of elders in China today, affecting their experiences of aging and of changing caregiving arrangements in contemporary times. Chapter 3 provides detailed descriptions of different institutional eldercare settings in contemporary China and how place, rhythm, and routine in those institutions affect the experiences of elderly residents and caregivers, as well as how residents and caregivers actively interpret, resist, create, and define spaces within those institutions. In Chapters 4 and 5, Keimig explores the questions of who should care for elders and in what way, whether in the context of informal unpaid care or in the context of paid care work, and how caregivers and residents attempt to stimulate and allocate the potentially scarce resource of “attentional energy” that is a key foundation of care. Chapter 6 examines how end-of-life interventions like resuscitation, on the one hand, and lack of sufficient palliative or treatment options for many, on the other hand, contribute to suffering pain and feelings of meaninglessness in the zone of “chronic living and delayed death.”

I enjoyed the way in which Keimig wove together rich ethnographic portrayals of everyday elder care scenarios within different kinds of institutional care settings, highlighting varying personal experiences of caring and being cared for within and across settings. The book focuses on describing a variety of different institutional settings for eldercare that are emerging in contemporary China, examining the social forces that generate them and the social effects that they have on elderly residents who live in them, their family members, and the caregivers who work in them. Some examples of the varied institutional settings examined include hospital-based geriatric and palliative care wards, private eldercare facilities, a public eldercare home, and a private luxury retirement estate. In describing these settings, the book weaves together discussions of issues related to experiences of aging, caregiving, personhood, health, illness, disability, living, suffering, and dying. In doing so, it considers the roles of cultural values, moral tensions, social relationships, social structures, societal inequalities, varied life histories, and sociocultural change. Overall, the book explores social changes in the relationships that older adults in China have with themselves, family members, caregivers, society, and the state. The search for balance and harmony amidst changing values, desires, and structures and competing priorities is another central theme throughout.

The book is not only ethnographically rich, but it is also theoretically well constructed. Theoretically, Keimig employs phenomenological and critical medical anthropology approaches. She takes a phenomenological approach to the lived embodied meanings of the tensions between old and new cultural ideas and values in the personal elder care experiences of older adults and their caregivers, yielding new emergent subjectivities. She adds a critical medical anthropology approach to analyze the varied and changing social structures that give unequal access to the conditions needed for receiving and giving good care. Here and there, the book also adds insightful reflexive glimpses into the author’s own experiences with both fieldwork dilemmas and with eldercare issues.

The book is especially valuable in shifting between the perspectives of those receiving care and those giving care, with each angle adding new layers to the picture of social change in care arrangements. For the older adults receiving care, the book explores what brought them into a particular institutional care arrangement and how that setting solves some problems for the elder and their family, while creating other problems. In doing so, it explores the views of institutional residents on their health, their quality of life, the quality of care they are receiving, the degree to which life is meaningful for them or to which they feel others view them as valuable, the degree to which they are suffering, and whether they feel they have access to good pain control and the conditions for a good death.

For care workers, the book explores what led them to work in a particular institutional care setting, whether they perceive their working conditions to be decent in comparison to their previous work, and whether such employment allows them to provide for their own families. The difficult working conditions and low compensation, as well as the rewards of such work are vividly described. For family caregivers, the book explores how many Chinese families who place an elderly family member into an institution need to continue substantial informal care work for that family member due to the limits of the institutions.

Joining efforts to show how older adults not only receive care but also contribute to care, the book shows how many older adults receiving care in an institutional setting also do a good deal to take care of themselves and sometimes to take care of other residents. For example, unrelated roommates or hallmates will often help each other out with various tasks or emotional support. It also shows how some spouses capable of independent living move into an institutionalized setting as a resident with their husband or wife to provide supplemental care to, and to be with, them.

While the book contains rich ethnographic insights, a potential weakness is that the author was limited in the number and types of care institutions that she was able to visit to collect stories of caregivers and residents. However, this is balanced against the more important strength that in those institutions that she did visit, she investigated in great depth, getting to know many of the residents and caregivers so well that they were willing to share troubling dilemmas with her.

The book has a broader appeal beyond a specialist audience in asking how and why we care for older adults and the ways in which that matters in people’s lives and in the life of a society. It provides a fascinating account of the ways in which different eldercare arrangements not only solve certain problems but also create other problems surrounding issues of living and dying for older adults and those who care for them. The simultaneous focus on how both informal and paid caregivers and elders themselves in China are grappling with these issues in a variety of settings is highly informative and thought-provoking.