Challenges of paid caregiving in China

Abstract

China's aging population has intensified reliance on paid caregivers, yet systemic neglect in policy and research perpetuates workforce vulnerabilities. This study employs Social Network Theory to analyze how fragmented structural and relational networks shape the experiences of rural-to-urban migrant caregivers in Shanghai. A qualitative multiple case study approach was utilized, incorporating interviews and observations with paid caregivers (n = 26), care recipients (n = 22), family caregivers (n = 22), and supervisors (n = 4). Findings reveal that caregiving outcomes are shaped by the interplay between upstream factors (cultural expectations, migration patterns) and downstream factors (social support, agency resources). Cultural incompatibilities, such as dietary practices and dialect differences, strain caregiver-family trust, while live-in work conditions limit caregivers' social networks and exacerbate emotional stress. Despite institutional efforts like digital platform use, rural migrant caregivers face technological barriers due to uneven literacy. Policy gaps in standardized training and labor protections further marginalize this workforce, undermining China's elder care sustainability. Recommendations include culturally adaptive training programs, equitable migration policies, and technology upskilling to bridge structural divides. These findings offer a blueprint for aging societies worldwide to realign long-term care systems around human-centered networks, emphasizing caregiver well-being to enhance elder care quality and equity.