Abstract

Background and objectives: China’s national ageing policy has set up a goal to develop a long-term care system with home-based care as the “basis,” community-based services as “backing,” and institutional care as “support.” Whether the ageing-in-place preference of Chinese older adults echoes with this policy initiative remains unclear. This study aims to investigate the reported intention for nursing home placement and its associated factors among older adults living in urban areas.

Methods: The GALLUP-Tsinghua University China Elderly Service Study (CESS) was designed to investigate the recent development of elderly care services in major Chinese cities. Between March and November 2016, the CESS team reached 68,000 people through randomly dialling 270,000 phone numbers in 16 cities. A total of 2202 respondents who were 60 years old or older completed the twenty minutes computer-assisted telephone interview. Using data from CESS, we applied multilevel logistic regression models to examine the relationship between reported intention for nursing home placement and levels of satisfaction regarding the neighbourhood support, controlling for personal characteristics (age, gender, education, subjective well-being, self-reported health and household size). Measures of neighbourhood support included participants’ satisfaction of food quality, transportation, financial services, medical services, community service and environment.

Results: When asked about the plan for living arrangements in the later years, 57.5% of the participants indicated a preference of ageing-in-place, 5.8% planned to move in with their adult children, 13.0% intended to move to nursing homes and 22.7% indicated no plan. The regression result showed that dissatisfaction with medical services [odds ratio (OR) = 1.5, p = 0.019], community service and environment (OR = 1.5, p = 0.020), and food quality (OR = 1.4, p = 0.040) were significantly associated with reported intention for nursing home placement. Apart from these community-level characteristics, household size (OR = 0.8, p = 0.000), being female (OR = 1.5, p = 0.008), and higher level of education (OR = 1.2, p = 0.002) were also significantly associated with nursing home replacement intention.

Conclusions: Despite the government’s policy effort for promoting ageing-in-place and the widespread belief of the deep root of family values and filial piety in China’s cultural tradition, the percentage of people who reported an intention of nursing home placement among Chinese urban elderly was unexpectedly high. However, improving medical services and community services may play a substantial role in changing the intention.