Can formal home and community-based long-term care replace informal care? Evidence from Chinese Longitudinal Healthy Longevity Survey

Abstract

Background Formal home and community-based long-term care (LTC) are often considered the preferable option for long-term care, offering older individuals the convenience of receiving care in their homes. Research indicates that these services may alleviate the burden on informal caregivers. However, there is a lack of clarity on which specific types of formal home and community-based LTC impact informal care provision. This study aims to address this research gap by exploring the unique effects that various formal home and community based LTC services have on reducing the burden of informal care. Methods This study draws upon data from the Chinese Longitudinal Healthy Longevity Survey 2005, 2008, 2011, 2014, and 2018. Employing fixed-effects and quantile regression models, this study investigates whether various forms of formal home and community-based care reduce care hours and associated costs of informal care for older individuals with functional limitations in China. Results Two specific types of formal care substantially influence the provision of informal care. The presence of daily living assistance services correlates with reduced informal caregiving hours, especially for those with extensive informal care needs. The availability of community-based health care services is linked to a decrease in the direct expenses incurred from informal caregiving, especially for those incurring greater direct caregiving costs. These negative effects are more prominent among urban residents. Other services, such as mental health support and legal advice services, do not demonstrate significant effects on alleviating informal care hours and costs. Conclusions Daily living assistance and community-based health care services in the community play a crucial role in benefiting the older individuals. It is important to prioritize the expansion of such services, while simultaneously addressing disparities in their distribution.