Population ageing is affecting many countries. A key issue of the demographic trends is how to provide care for the growing ageing population. In many countries, filial responsibilities are longstanding social norms; adult children are expected to take care of their ageing parents (Finley et al., 1988). Some countries including Canada, China, India and Singapore and some states in the US have written the norms of filial responsibilities into filial obligation laws, compelling adult children to care for their ageing parents (Serrano et al., 2017; Snell, 1990; Pearson, 2013).
In this literature review, I critically review the evidence against the proposition that adult children should be legally compelled to care for their ageing parent. 1 | am focusing on whether the filial obligation law should be implemented in the UK, as it may become a real policy consideration to deal with the funding cuts in social care systems and the potential influence of Brexit on social care workforce (Humphries et al., 2016; Independent Age, 2016). The review will start with the evidence against two hidden assumptions behind the rationales of the filial obligation law. After that, the possible adverse effects of the filial obligation law will be explored. Finally, the review will analyse a particular case which provides a strong challenge to filial obligation law and identifies a gap for future research.
The first hidden assumption
The first hidden assumption is that adult children are currently not caring their parents enough, so legislation is needed to remedy the gap. Proponents of the filial obligation law seem to assume that due to the prevalence of individualism, people may no longer care about the traditional norms of taking care of their own parents. However, there is no existing evidence supporting this assumption. Data from Office for National Statistics (2016) and Understanding Society (2015) suggests that both the number and the proportion of people who provide unpaid care for family and friends have been increasing in the UK: from 2011 to 2015, the number of carers has risen from 8.2 billion to over nine billion, and the proportion has increased from 16.6 per cent to 17.8 (Age UK, 2017). Multiple resources and analyses suggest that adult children and spouses have always been the primary sources of informal care for old people (Della Giusta and Jewell, 2014; Pickard et al., 2007; Jivraj and Nazroo, 2012). Moreover, not only the quantity but also the intensity of informal caring is increased to meet the progressively complex needs (Age UK, 2017). Therefore, existing evidence does not support the assumption that adult children are not caring for their parents enough. On the contrary, Age UK (2017) even suggests that families and communities are reaching the practical limits of the care they can provide in the current circumstances of funding cuts in care services and rapidly ageing population.
A potential issue of these pieces of evidence is that many of them classify family care as a whole, so it is hard to distinguish the contributions of adult children from the care of spouses. This issue is a result of the survey designs. Many surveys analysed by the aforementioned studies use measures such as the percentage of caring family members, the percentage of being cared by family members, or the time spent on caring. There are not many direct measures of the percentages of care provided by adult children. A study on caring for disabled old people in the UK finds that over 80 per cent of informal care is from the spouse, adult children or both, among which just over half is from adult children and just under half is from spouses (Pickard et al., 2007). It could be better to have similar studies on all old people in need of care.
Nevertheless, whether care is provided by adult children or spouses does not influence the challenge to the first assumption. The current state in the UK is that family care as a whole is maximising its capacity. It is not necessary to force adult children to care for their ageing parents if their parents are ready cared for by their parents’ spouses. The purpose of the discussion is to match the unmet needs of ageing old people rather than to increase the percentage of adult children caring for their parents.
The second hidden assumption
The second hidden assumption of the proponents of filial obligation law is that their adult children can provide the unmet needs of old people. In the UK, about 55 per cent of old people with ADLs (Activities of Daily Living, such as bathing) difficulties and 24 per cent of old people with IADLs (Instrumental Activities of Daily Living, such as shopping for groceries) difficulties report that they are not receiving any support (Vlachantoni, 2017). Adult children seem to be suitable supporters for these difficulties, but they have many constraints.
One key constraint is distance. Bell and Rutherford (2013) proposed that geographical factors are critical in care network formation. As one may expect, they found that adult children provide more care for their parents when they live closely to their parents. More importantly, the study shows that many families move and rearrange their houses to meet old people’s care needs, which result in a significant amount of families live relatively close together. In their sample from the British House Hold Panel Survey, more than half of adults live within a thirty-minute travel time of one of their parents, and a third live within fifteenminute travel time. Many families live closely is an encouraging fact, but there are still many families live far apart. The distance limited the support of adult children, which is not merely resolvable by a law.
A more complex constraint is from multiple social roles. Men aged 52-64 and working-age women are the leading care providers for old people (Jivraji and Nazroo, 2012). This group of working carers typically experience restricted working and caring hours, excessive stress and resulting health problems, financial pressures, and family or work-related conflicts (Hoff et al., 2014). The situation is worse for the “sandwich generation”, the mid-life adults who care their dependent children and frail parents at the same time. The cases of the exact sandwich generation are rare, but it is relatively common for some families that people need to support their older parents and partly dependent children (Grundy and Henretta, 2006). There are other forms of multiple roles, especially for women. Women have been the critical care providers for both children and older people, there are cases when a woman need to care for both her grandchildren and older parents, and she may also need to be a breadwinner (Ben-Galim and Silim, 2013). These complicated situations do not necessarily prevent caring for old people, but they may limit the financial and emotional resources the adult children can provide for their old parents.
In fact, many pieces of literature suggest that adult children in the UK have done their best, the remaining unmet needs should be provided by other sources. Due to the demographic trends that the numbers of older people are increasing faster than the numbers of the younger people, the supply of care from adult children to older people is unlikely to match with the future demand (Pickard, 2015). The reports and reviews from various organisations including governmental departments, think tanks and charities all points out that the capacity of family care is reaching its peak, the care duty should be shared by the rest of the society (Age UK, 2017; Hoff, 2015; Humphries et al., 2016). The recent interviews of 127 older people by Age UK reveals that older people think that family members are supportive, but the problems are the cost, quality and information of social and health care systems (Age UK, 2018). Overall, compelling adult children to care for their old parents may provide limit improvements for the unmet need of old people in the UK.
The possible negative effects
The filial obligation law not only have limited effect on meeting old people’s need but also may cause detrimental effects on caregivers. Besides the conflicts and stress caused by the multiple roles as mentioned, the caregivers also may suffer from carer burden, “a multidimensional response to physical, psychological, emotional, social, and financial stressors associated with the caregiving experience” (Kasuya, Polgar-Bailey, & Takeuchi, 2000, p. 1 19). Care burden can be experienced by caregivers in various cases and may result in the decline in mental and physical health, low life satisfaction and depression (Adelman et al. 2014; Morgan and Kunkel, 2016; National Alliance for Caregiving, 2009). Care burden raises alerts on the possible adverse effects of the filial obligation law, and also provide a shred of evidence against the claims that filial obligation law can ease government financial stress by cut funds on social and health care. The potential health problems caused by care burden could eventually add pressure on care systems, which may offset the gains from compelling filial care. Also, as many carers are in working age, the carer burden may reduce their productivity, which in turn influences the economic growth and tax revenue.
The filial obligation law may also contaminate the rewards for caregivers from caregiving experience. Adult children can gain some rewards such as the satisfaction from spending more time with their ageing parents and close family bonds (Morgan and Kunkel, 2016). These rewards may be ruined by legal obligations. A recent study found that informal caregivers in the UK who perceive their caregiving as free choices have better health outcomes and are more likely to feel rewarding by their caregiving experience than people who perceive their caregiving is a constraint; a sense of free choice is beneficial for caregiving experience (Al-Janabi, Carmichael and Oyebode, 2018). In this study, a group of people feel constrained because of financial situations and social norms. It is reasonable to infer that if the filial obligation law were enforced, more people would feel constrained and even people who previously feel that they have the choice would also lose the sense of freedom.
Through the challenges to the hidden assumptions and explorations of the caregivers’ experience, it seems to be reasonable to conclude that filial obligation law is not suitable for the UK. Adult children in the UK are already doing their best without the law. This law not only cannot target the unmet need of old people but also may jeopardise the caring experience of caregivers. The next section of this article reviews a specific case to challenge the implementation of the filial obligation law further.
The case of child maltreatment and later caregiving
The literature reviewed so far mainly focuses on general trends and factors. As the discussion is about a law applicable to all, it is beneficial to try to cover a large scale of population. However, it is also important to pay attention to specific cases. A group which could be negatively influenced by a law will provide strong evidence against its implementation. In this case, the group is the adult children who were maltreated by their parents in their childhood and face the care need of their old parents.
Child maltreatment is defined by WHO and in the research literature as abuse and neglect occurs to children under 18, which result in actual or potential harm to the children (Kong and Moorman, 2015; Radford et al., 2011; WHO, 2016). Research in 201 1 by NSPCC (The National Society for the Prevention of Cruelty to Children) shows that in the UK, 13.4 per cent of people aged 11-17s and 14.5 per cent of people aged 18-24s have experienced severe maltreatment by a parent or guardian during their childhood (Radford et al., 2011). Intuitively, it seems to be cruel to force this group of people to care for their ageing maltreaters.
There is not much existing evidence on the caregiving experience of this group of people Only three studies in the US which all involve a same researcher are found. One study using data from the Wisconsin Longitudinal Study finds that caregivers who care for their abusive or neglectful parents have more frequent depressive symptoms than caregivers with no history of abuse or neglect (Kong and Moorman, 2015). Another study using a crosssectional but nationally representative data of US finds that people who were maltreated by their mothers tend to present a maladaptive coping behaviour in the caregiving to their mothers, which may eventually result in social isolation, anxiety and depression (Kong and Moorman, 2016). Kong also involves in an innovative study design which uses telephone interviews in eight continuous days with the caregivers to explore their experience of daily assistance; the study finds that caregivers with child maltreatment experience are more vulnerable to the negative impacts of providing daily assistance (Liu et al., 2018).
These studies provide useful information on the experience of child-maltreated people when caring for their maltreaters, but further research is needed to get a better understanding of this issue. First, the studies are in the US; it could be helpful to explore this issue in other countries. Second, the studies are all based on surveys. The measure of child maltreatment comes from several self-reported questions, which may not be reliable. Third, the survey data also means that researchers cannot gain more details of specific contexts and experience of caring. It may be better to combine the survey with in-depth interviews with the caregivers. Overall, a well-designed mix method research on this topic in the UK could both contribute to the research gap and the evidence against the filial obligation law.
This article offered a literature review of the evidence against the implementation of filial obligation law in the UK. After reviewing the evidence against the two hidden assumptions of the filial obligation law, it appears to be clear that adult children in the UK are maximising their effort to care for their ageing parent without the law, and filial obligation law is not the solution for the unmet needs of ageing population. Also, the filial obligation law may impose care burden to caregivers and jeopardise the existing caregiving experience by reducing a sense of freedom. Finally, an evidence gap identified is the comprehensive understandings of the experience of people with child maltreatment experience who later care for their maltreater in the UK. If the experience is indeed as negative as indicated in the currently limited studies, it is not reasonable to compel this group of people to suffer.
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