Book Review Review of Keimig, Rose K. Growing Old in a New China: Transitions in Elder Care. New Brunswick, New Jersey: Rutgers University Press. 2021. pp. 208. Price: $120 (Hardcover); $27.95 (Paperback and eBook). Shuting Li New York University sl6142@nyu.edu Anthropology & Aging, Vol 42, No 2 (2021), pp. 180-182 ISSN 2374-2267 (online) DOI 10.5195/aa.2021.371 This work is licensed under a Creative Commons Attribution 4.0 International License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. Book Review | Li | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2021.371 http://anthro-age.pitt.edu 180 Book Review Review of Keimig, Rose K. Growing Old in a New China: Transitions in Elder Care. New Brunswick, New Jersey: Rutgers University Press. 2021. pp. 208. Price: $120 (Hardcover); $27.95 (Paperback and eBook). Shuting Li New York University sl6142@nyu.edu As modernization, urbanization, and marketization pervade everyday life, tensions between the Confucian tradition of filial piety and new socio-cultural structures arise in post-reform China. Despite the fact that family care is still central to filial piety, today, demand for institutional care is increasing rapidly. In her first book, Growing Old in a New China: Transitions in Elder Care, anthropologist Rose K. Keimig sheds light on this complex transition from home-based to institutional elder care in post-reform China and the various challenges that come with this change for all parties. Previous ethnographic research on elder care in China has primarily focused on practices of care conducted in the family sphere in rural areas. Social scientific studies on institutional care, in turn, mainly focus on elders’ attitudes towards the prospect of growing old in institutional settings instead of the family sphere. This book ethnographically examines institutional care in China through the everyday experiences of elders actually living there. Keimig conducted 13 months of fieldwork in Kunming in the province of Yunnan between 2013 and 2015. She started her research in hospital-based geriatric and palliative care wards, and then shifted to elder care facilities. The primary site of her fieldwork, Jade Hills Elder Care Home, is a private care institution in Kunming that represents the average care institution in Kunming, Yunnan in terms of cost, scale, and types of care offered. From her fieldwork in Jade Hills, Keimig documents how elders cope with the current shifts in settings of care from family contexts to institutional care. Findings are structured around five central aspects in this book: the parent-child relationship in filial piety, elders’ personal stories within a larger historical context, place-making in elder care institutions, entanglements of care, and discussions about end-of-life interventions. In post-reform China, the effects of the one child policy, a decrease in intergenerational living habits, and urban migration make more adult children opt into institutional care for their parents. However, as Keimig clearly demonstrates in this book, parents still think of their children as filial. In Chapter 1, “Filial Children, Benevolent Parents,” the author examines Confucian texts on filial piety and existing scholastic literature that discusses the relation of filial piety with issues of power, obligation, reciprocity, and expectation in the family structure, and thus explores how filial piety shapes and informs social structures in China. She also notices that in research on the “parent-child dyad” in filial piety, more attention goes to care work conducted by children in parents’ old age than to emotional and social care from elderly parents to children (29). Drawing from stories of Grandpa Zhang and Song Xin, Keimig http://anthro-age.pitt.edu/ Book Review | Li | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2021.371 http://anthro-age.pitt.edu 181 highlights that this kind of neglected care and benevolence from parents to children continues, even when parents step into the life stage that demands children to take care of them. Chapter 2, “Bodies in History, Embodied Histories,” shows how experiences of aging vary among three generational cohorts that are here named “Pre-Consolidation (born in the 1930s and early 1940s), Consolidation (as youths in the 1950s and 1960s), and Cultural Revolution (born in the late 1940s to 1960s)” (49). Keimig argues that elders’ subjectivities are shaped by their embodied experiences of historical transformations from the establishment of the People’s Republic of China, over the Reform period and the Cultural Revolution, to the present. Their memory of different historical realities not only impacts their mental and physical health, but also provides them with the resources for forming their senior selves. In Chapter 3, “Place and Space, Rhythm and Routine,” Keimig’s detailed descriptions of diverse institutional care settings, ranging from private elder care homes, rural public welfare homes, and hospitals, to retirement real estate, give readers a glimpse of the landscape of professional care in China. From a place-making perspective, Keimig argues that lived spaces of elder care institutions are created through the movements, rhythms, sounds, and smells of staff members, hugongs (care workers), and residents. Her ethnographic materials convey how elderly residents play a vital role in creating places out of the institutional space. For example, some elderly residents have lost control of certain body functions and may discharge excreta that traverses the containing margins of the body and hybridizes private and public space. Others, who still do control their bodily boundaries, compete with hugongs or other residents to otherwise draw the lines of their personal space. The space of the nursing home is also imagined and built against the backdrop of unequal wealth distribution in post-reform China. Economic conditions play an invisible but vital role in the process of place-making in nursing homes in China: wealthy investors see elder care as a lucrative market; elderly in a good financial situation imagine nursing homes in southern provinces as a place to escape to and age better; and poor and rural migrant workers see nursing homes as a potential workplaces. Chapter 4, “Entanglements of Care,” further explores the informal and unpaid forms of care to show how people’s expectations of care in filial piety change during the transitions to institutional care. Today, filial care that adult children should conduct can be substituted by various forms of care, such as community care, self-care, spousal care, and institutional care. Discussing these alternative forms of care in post-reform China, Keimig underscores the importance of gendered and unpaid spousal care that is usually neglected in elder care practices of filial piety. Chapter 5, “Care Work,” on the other hand, examines the complicated and intangible quality of care from the different perspectives of management personnel, elderly residents, and hugongs. Whereas management personnel value efficiency and profits, when talking about the quality of care, elderly residents see “attentional energy” as indicative of good care in institutional settings (125). Keimig also observes that elders deploy various tactics to maximize the level of “attentional energy” they can receive from care workers, including showing care and kindness to hugongs. However, hugongs are constantly balancing scarce time with an overwhelming demand for care, resulting in less attention to person-centered care. The flow of “attentional energy” in the nursing home is likely to be blocked or damaged by the precarity of nursing home business and complicated interpersonal relations. In the last chapter, “Chronic Living, Delayed Death,” Keimig discusses an unavoidable issue in elder care institutions—death. A good death in Chinese culture means balance, harmony, and reciprocity through continuing worship in kinship. Therefore, proper rites and ceremonies should be held to ensure the continuing bond in kinship and the exchange between the living and the dead, although funeral rituals and burials are replaced by cremation now. However, end-of-life interventions complicate how http://anthro-age.pitt.edu/ Book Review | Li | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2021.371 http://anthro-age.pitt.edu 182 institutionalized elders experience living and dying. Keimig highlights that many elders find themselves suspended in a state of “chronic living,” which “refers not simply to the undesirable state of living with a disease but also to what happens when living itself becomes undesirable.” (131-132) The elderly may appeal for the right to die under conditions of chronic living. Although this act conflicts with filial piety in Chinese tradition, palliative care and the right to die will become a controversial but important topic in the future. This book not only depicts the historical and social contexts in which Chinese adults age but also foregrounds voices of residents of elder care institutions in China. Keimig also provides readers with information on issues familiar to those working with elderly adults or vulnerable research subjects, such as applying for Institutional Review Board approval. The combination of surveys, interviews, and participant observation in her ethnography offers readers a wealth of diverse ethnographic data, while the methodology part is helpful for both undergraduate and graduate students seeking practical tips on doing ethnography. Moreover, Keimig’s ethnographic writing is a good example of engaging with audiences from different cultural backgrounds through empathetic storytelling. She weaves her family story of figuring out the care plan for her mother, who had suffered a hemorrhagic brainstem stroke, into stories of other Chinese families. To conclude, this book centers elders’ voices about their lives in the institutional setting of a transforming China, and it will be of interest to everyone working in the field of anthropology and aging, in terms of content, methodology, and writing style. http://anthro-age.pitt.edu/