The development of China’s community care services and its impact on older adults' health and subjective wellbeing: 1998 -2018

As China has experienced rapid population aging, the demand for elder care services has increased dramatically. The gap in service demand has become concerning because the traditional provision of eldercare heavily relies on informal care provided by the family. Social and demographic transformations have made the family-reliant care model unsustainable. Community care has become a reasonable and practical option to balance the care demand. Despite the crucial role of community care in elder care provision, the focus of many scholars has predominantly been on state, market, or family-provided care, with less attention given to community-based services.This dissertation examines the evolution and impact of community care services on the health and subjective well-being (SWB) of older adults in China. Utilizing data from four waves of the Chinese Longitudinal Healthy Longevity Study, the study employs person fixed-effect regression analysis to assess community care influence on the broader population of older adults, including subpopulations such as the childless and disabled.Key findings indicate a significant disparity between the provision and needs of community care, with unmet needs having a notable negative impact on both health and SWB,especially pronounced in urban areas. The research reveals that while community care services significantly enhance SWB and health, the impact varies depending on the type of service, place of residency, disability status, and financial sufficiency. Specifically, cultural and social services were found to have a more significant effect on health outcomes, whereas medical care services notably influenced SWB. Importantly, the study also found that community care services might more directly influence older adults' subjective well-being than their objective health outcomes.The dissertation highlights the critical need for policies that foster an integrated care model combining community and family care to effectively support aging in place. This approach not only leverages the strengths of both care systems but also addresses the unique needs of the aging population, thereby enhancing their quality of life and well-being. The study advocates for future research to incorporate more objective health measures and to examine the influence of degree of urbanicity on the effectiveness of community care services.