Generational Perspectives on Nursing Home Placement in Yangtze River Delta Region (n=67): A Qualitative Study on Attitudes and Influencing Factors

Abstract

China’s aging population and evolving family structures have reshaped attitudes towardlong-term care, making nursing home placement an increasingly relevant yet complex issue in the Yangtze River Delta (YRD) region. This qualitative study explores generational attitudes and perceptions toward nursing home placement in the Yangtze River Delta (YRD) region through focus group interviews. A total of n=67 participants participated in the focus group. Participants were divided into three age groups—young adults (18-34), middle-aged adults (35-64), and older adults (65+)—shared their perspectives on the key factors shaping their views, including financial constraints, cultural factors, service quality, emerging alternatives to traditional institutional care and individual health conditions. The aim of this study was to comprehensively investigate intergenerational attitudes and perceptions toward institutional-based aging in the YRD by examining how these factors collectively shape individuals’ decision-making regarding nursing home placement. The researcher employed thematic analysis to code and examine the perspectives of each age group. The findings indicate that financial burden is a critical factor shaping negative perceptions of nursing homes, though the specific financial concerns vary across different generations. While traditional filial piety remains a cultural backdrop, decision-making across all age groups is now primarily influenced by emotional bonds and practical considerations such as the need for professional care, balancing work and family responsibilities, and a desire to reduce the burden on children. Moreover, about service quality young adults are skeptical about the quality of nursing homes due to negative media coverage, while middle-aged adults question the professionalism of the staff and the quality of the facilities. In contrast, the older adults are generally satisfied with the facilities in nursing homes, but there is still room for improvement. In addition, all age groups are also more likely to expect a model of aging that meets their actual needs. Finally, some of the participants, especially the middle-aged as well as the older age groups, emphasized that the deterioration of personal health and possibly nursing homes would lead them to prefer institutional care.