Date of Award

1-29-2026

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Discipline

Social Sciences

Department

Sociology and Social Policy

First Advisor

Prof. CHAN Chak Kwan Dickson

Second Advisor

Dr FONG Meng Soi Florence

Abstract

China is experiencing a profound demographic transformation as its population ages rapidly, driven by declining fertility, increased longevity, and long-term effects of the One- Child policy. Traditional family-based elderly care has become increasingly unsustainable due to the pressures of the “4-2-1” family structure and the rising prevalence of empty-nest households. In this context, there is an increasing trend in institutionalized elderly care, accompanied by a growing demand for Nursing Home Care Workers (NHCWs). In spite of their vital importance, NHCWs often face heavy workloads, poor compensation, low recognition, and limited professional autonomy. This study explores the work environment and structural empowerment of NHCWs in Chinese nursing homes through the lens of Structural Empowerment Theory (SET), focusing on five dimensions: resources, support, opportunities, formal power, and informal power.

This research employed a qualitative research method based on 32 in-depth, semi-structured interviews with NHCWs across four nursing homes in Jiangmen City, Guangdong Province. Participants were selected through convenience sampling to ensure variation in different ages, different local or migrant cultural background, and work experience. Interviews were conducted in Mandarin or Cantonese, transcribed verbatim, and thematically analysed using NVivo software. The coding process followed a hybrid deductive and inductive strategy: while initial codes were developed based on SET, the inductive analysis allowed new themes to emerge. Ethical approval was obtained, and all interviews followed standard protocols of informed consent, confidentiality, and voluntary participation.

The findings reveal that NHCWs often work 10 to 12 hours per shift, engaging in physically and emotionally demanding care tasks such as feeding, bathing, and cleaning. Many participants said that chronic fatigue and limited recovery time, while shift systems and understaffing further intensify their burdens. Peer support is inconsistent and often dependent on personal relationships, with little formal coordination. Institutional support from supervisors is perceived as superficial, with few mechanisms for feedback or expressing concerns. Social exclusion and unequal treatment are reported by migrant NHCWs especially.

Opportunities for professional development are uneven. Some nursing homes offer periodic training, but most lack clear pathways for skill upgrading or certification. Career advancement is rare, and formal decision-making power remains minimal. Informal power dynamics such as group affiliation, tenure, and regional identity are usually to the disadvantage of newer and non-local NHCWs.

This study contributes to the growing literature on eldercare labour in aging societies by offering an empirically grounded account of how structural empowerment is unevenly realized in Chinese nursing homes. It highlights the urgent need to improve institutional practices, develop inclusive support systems, and expand training and advancement opportunities for NHCWs. At the same time, this study enhances the SET to localize it, adapting it to China's unique sociocultural and organizational context, such as language and culture, gender, emotional individualization, and social biases profoundly shape NHCWs' work experiences. Based on the research findings, recommendations are proposed at both the organizational and policy levels to improve work environment and empowerment for NHCWs.

Language

English

Recommended Citation

Ou, Y. (2026). Structural empowerment and the work environment of nursing home care workers in China (Doctoral thesis, Lingnan University, Hong Kong). Retrieved from https://commons.ln.edu.hk/otd/273/

Download

Share

COinS