Background Population aging and declining family caregiving capacity have increased unmet care needs among disabled older adults in China. In response, home- and community-based services have expanded to complement traditional family care. However, how unmet need and local service availability shape perceived need for social services remains unclear. Methods Using data from 6,672 older adults with activities of daily living (ADL) limitations from four waves of the Chinese Longitudinal Healthy Longevity Survey (2005–2014), we applied multilevel logistic regression models to examine perceived need for eight types of social service programs. Key predictors included unmet need for care and the self-reported availability of neighborhood social services. Results Among Chinese older adults with ADL disability, 58% reported unmet need for care and more than half of respondents reported perceived need for social connection and basic care services. At the same time, no more than 20% of respondents reported that social services were available in their neighborhoods. We found that both unmet need for care and available social services were positively associated with perceived need for social services. Furthermore, the availability of social services was associated with disabled older adults’ perceived need for a broader range of services, extending beyond those intended to address their specific unmet needs. Availability of basic care services was associated with decreased need for other services. These patterns did not substantially differ by unmet need for care or rural/urban residency. Conclusion Efforts to develop home- and community-based services for older adults should be driven by the gap between perceived need for services and availability of services. Services are needed in both rural and urban areas, for older adults whose needs are fully met by family and among those who have unmet need for care. Diverse service programs require financing, transportation, and outreach efforts to ensure equitable access.
Zhu et al. (Mon,) studied this question.