Modes of Care for the Elderly in Vietnam: Adaptation to Change

Abstract

Caring for its members is the main function of the family. In Vietnamese culture, respect and care for the elderly, or filial piety, is the norm. This thesis examines the care and support of the elderly in Vietnam, based on nationally representative survey data and fieldwork. The study describes how the traditional mode of aged care – centered on the multi-generation household – has been adapted in recent decades because of rapid demographic, social and economic change. It explores existing adaptations in order to document and understand how the Vietnamese tradition of filial piety is practiced in aged care in Vietnam today. The impact of adaptation on the subjective well-being of the elderly is also examined. Adaptation is evidenced in the existing range of modes of care, which are defined in terms of living arrangement and intergenerational transfers. The multi-generation household now accounts for less than half of living arrangements, itself indicative of substantial adaptation. Non-traditional living arrangements include two-generation households, couple households, living alone, skipped-generation households and other households. In addition, state and private residential institutions constitute important adaptations. Patterns of intergenerational support have evolved to care for the elderly. Transfers of cash and material goods are made by both coresident and non-coresident children, and by both daughters and sons. These represent significant departures from the norm, whereby only the eldest son would provide support through coresidence. The provision of domestic help, disability support and emotional support by daughters, rather than by the coresident daughter-in-law, is a major adaptation. Further evidence of adaptation is found in two-way intergenerational transfers, the elder both receiving support from and providing support to their children. The analysis shows that the subjective well-being of the elderly, measured by psychological well-being and life satisfaction, is not adversely affected by living in a couple or skipped-generation household when intergenerational transfers are taken into account. However, living alone has substantial negative effects. The role of daughters is found to be crucial for elder well-being, and two-way intergenerational support enhances elder well-being. Attitudes towards the expression of filial piety have changed significantly among the elderly and their children. The thesis uses modernization theory and social exchange theory to understand the changing modes of care. It argues that a re-interpretation and re-negotiation of the intergenerational contract is taking place, involving a new multiplicity of actors as care responsibilities involve not only the son and his wife, but also involve the daughter. The thesis challenges arguments that modernization adversely affects the status and well-being of the elderly because of a decline in familial support. The thesis also demonstrates that elders are not totally dependent on their children for support and care, but actively participate into the web of support exchange with their children. The thesis has relevance for the development of aged care in the rapidly changing economies of East and Southeast Asia. A greater understanding of the different and multifaceted modes of care is essential for policies addressing the well-being of the elderly.