Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City

Abstract

Background: Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly's demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote utilization of community-based care services in the AHCs of China. Methods: Guided by previous studies, a conceptual framework was developed. Then, a questionnaire was designed and a community based survey was conducted from May 10-20, 2018 in Daishan AHC of Nanjing City, China. Four hundred eight participants from 25,650 elderly people were selected by systematic random sampling technique. Binary logistic regression was applied to the data about the elderly' primary demands for community-based care services in the AHC, to quantify the elderly's demands and explore related individual-level factors. Results: The finding indicates that more than 50% of respondents had the demand for an elderly care hotline, building health archives, on-call nursing and doctor visits, medical lectures, regular medical examinations and sporting fitness. The binary logistic regression models revealed that the primary demands of the elderly for community-based care services were influenced by distinct factors. Conclusions: Our findings help clarify different types of community-based care services and provide fresh information about the demand for community-based care among the elderly in AHCs. Several policy implications are discussed to enhance the efficiency of community-based care service provision.

The Elderly’s Demand for Community-Based Care Services and Its Determinants: A Comparison of the Elderly in the Affordable Housing Community and Commercial Housing Community of China

“…The response variable was measured as a dichotomous variable with possible values 0, if the respondent needed this type of community-based care services and 1 otherwise. It is known from the findings of our literature review that the elderly generally have higher demand for the MAS, the CAS, the BAS, the RTS, the FAS, and the DMCS [ 2 , 3 , 22 , 30 ]. Thus, these six types of community-based care services were selected as outcome variables and they were measured, respectively, by responses to the question above.…”

“…According to the prior work, individual characteristics have been reported to be correlated with determining the elderly's demand for different types of community-based care service, such as sociodemographic characteristics, family structure, economic characteristics, and elderly care intention. Considering the second aim of this study and the feasibility of large sample data collection, the potential influencing factors include gender (1 = “male”; 2 = “female”), age (classified into 5 groups: 1 = “60–64”; 2 = “65–69”; 3 = “70–74”; 4 = “75–79”; 5 = “ ≥80”), living alone or not (0 = “no”; 1 = “yes”), monthly income(classified into 3 groups: 1 = “<1000”; 2 = “1000–3000”; 3 = “ >3000”), and elderly care intention (1 = “private home”; 2 = “institution”; 3 = “community facilities”) [ 22 ].…”

“…With the help of the Nanjing Civil Affairs Bureau, more than 11,724 questionnaires were distributed to the elderly people over 60 years old by many volunteers in the vast majority of the CHCs of Nanjing and 8422 valid data were received (the rate of effective recovery was 71.84%). Meanwhile, to achieve the statistical theoretical sample size and decrease multiple deviations in the survey of the Daishan AHC, fourteen trained postgraduates from our research group of Southeast University participated in the interview with 420 elderly people living in the Daishan AHC [ 22 ]. 408 valid data were collected after the face-to-face interview (the rate of effective recovery was 97.14%).…”

“…It is generally recognized that community-based care services cover a variety of social and health services and it is ambiguous in that the development of such services is adapted to the particular national and cultural conditions [ 28 , 29 ]. Thus, guided by existing literature, community-based care services for the elderly can be divided into four categories (i.e., assistance with activities of daily life service, medical care service, cultural and entertainment service, and psychological and legal service), and each category of these services includes different types of services [ 22 ]. Previous literature also suggests that six types of services, namely, meal-aid service (MAS), cleaning-aid service (CAS), bath-aid service (BAS), rehabilitation therapy service (RTS), first-aid service (FAS), and daily mental care service (DMCS), were predominantly far from meeting the elderly's demand [ 2 , 3 , 22 , 30 – 34 ].…”

“…Much of the literature on aging issues in urban communities is extensive and focuses particularly on indoor facilities management [ 17 ], assessing elderly adaptability [ 18 ], use of formal and informal sources of mental health care [ 19 ], the allocation of elderly healthcare facilities [ 11 , 20 ], demand for public space in elderly housings [ 21 ], the elderly's demand for community-based care services in the AHC [ 22 ], etc. In particular, the demands for the elderly care hotline, building health archives, on-call nursing and doctor visits, regular medical examinations, and sporting fitness among the elderly in the AHC have been adequately explored.…”