Do Home- and Community-Based Services Reduce Elderly Care Needs and Family Caregiving Burden? Evidence from China

• In Event: When Families Fill the Gaps: Intergenerational Support in Aging Societies

Abstract

Population aging has become a major socioeconomic challenge worldwide, with China undergoing this demographic transition at an exceptionally rapid pace and on an unprecedented scale. The accelerating pace of aging poses significant challenges to China’s social and economic systems, making long-term elder care needs increasingly urgent. In response, the Chinese government launched the Home- and Community-Based Services (HCBS) reform pilot in 2016, jointly initiated by the Ministry of Civil Affairs and the Ministry of Finance. This study examines the impact of China’s HCBS pilot program on elderly care needs and family caregiving burden. Using data from the 2008–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), we exploit the phased rollout of HCBS pilots since 2016 and identify causal effects using a difference-in-differences approach. Results show that HCBS implementation significantly reduces unmet care needs, caregiving hours, and the likelihood of intensive family caregiving. Specifically, the likelihood of unmet care needs declined by 10.1%, weekly caregiving hours fell by 34.3%, and the probability of high-intensity care decreased by 9.5%. These effects are robust to placebo tests (based on 1,000 random reassignments of treatment status), as well as alternative sample restrictions and control group specifications. We also find substantial heterogeneity by gender, age, location, cohabitation status, and pension receipt, reflecting differences in care needs and resource access. The HCBS pilot more strongly reduced unmet care needs among individuals aged over 75, women, rural residents, those living with others, and non-pension recipients. In contrast, reductions in caregiving hours were greater among those aged 75 or younger, men, urban residents, individuals living alone, and pension recipients. The decline in high-intensity caregiving was more pronounced among men and those living alone. A cost–benefit analysis indicates an economic return of approximately CNY 1.339 to CNY 1.488 for every CNY 1 invested, suggesting improved resource allocation and a more sustainable long-term care system. Overall, these findings highlight the role of HCBS in reducing disparities in elderly care access and alleviating family caregiving burden, offering valuable insights for policy development in China and other aging societies.

Author

• Lacey Chu, St. Catherine University
  Presenting Author