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Improving Familial and Communal Eldercare in the United States: Lessons from China and Japan

by Hunter Bruton

Available here

As America struggles with healthcare reform the mid-twentieth
century baby boom has blossomed into an elder boom. As our
population continues to age, it becomes harder and harder to
ensure better eldercare without substantially increasing costs. An
often-overlooked possibility could help solve this problem:
eldercare provided or supplemented by families and communities.
Luckily, America is not alone in this endeavor, and many other
countries with populations aging at a faster rate have
experimented with policies geared towards familial and communal
eldercare. This Essay surveys two such countries—China and

The conventional wisdom on eldercare norms—that when
compared to the United States, China and Japan both have
stronger cultural norms urging families and communities to
participate in eldercare—is a better descriptor for history than
current reality. Both China and Japan have recently experienced a
decline in the prevalence of familial and communal eldercare
because of cultural, political, and economic forces. And each
country’s response has been wildly different. China has moved
away from government-provided eldercare benefits and programs,
instead employing filial responsibility laws to directly shift eldercare
duties to families. Japan has increased government-provided
eldercare benefits and programs in an attempt to encourage
familial and communal eldercare and reduce the overall burden
institutional eldercare imposes on the government’s budget. This
Essay explores both approaches so that American eldercare
policy can learn from their successes and failure.