Paying for Parents: Filial Values and Elder Care Decisions in Henan

China’s demographic transition has placed new pressures on families to reconcile traditional filial obligations with modern caregiving realities. This study investigates how filial piety values, economic capacity, and evolving cultural attitudes shape adult children’s willingness to financially support institutional elder care in Henan Province. Adopting a mixed-methods design, the research combines survey data from 820 respondents with a discrete choice experiment (DCE) and 40 in-depth interviews. Measurement validation confirmed strong reliability (? > 0.80, AVE > 0.50), and structural equation modeling explained 42% of variance in willingness to pay (WTP). Results indicate that filial piety (? = 0.18, p < .001), economic capacity (? = 0.24, p < .001), and institutional acceptance (? = 0.22, p < .001) positively predict WTP, whereas stigma exerts a significant negative effect (? = ?0.17, p < .001). Interaction effects show that financial security amplifies the influence of filial values on care preferences. The DCE further revealed that families value higher-quality care (+RMB 1,200/month), frequent visitation opportunities, and culturally relevant activities. Qualitative narratives highlighted a reframing of institutional placement as “pragmatic filiality,” where financial support and emotional involvement coexist. These findings suggest that elder care decisions in central China reflect a dynamic negotiation between moral obligation and material feasibility. Policy implications emphasize the need for subsidies, tiered pricing, and community campaigns that normalize institutional care as compatible with filial duty, ensuring both cultural continuity and sustainable elder care provision.