Supportive Policies and the Choice of Care by Relatives and Friends Among Disabled Older Adults in China: A National Population-Based Study

Abstract Background With rapid population ageing, informal care by relatives and friends has become a predominant model for disabled older adults in many countries, including China. Supportive LTCI policies provide support to both family caregivers and formal care facilities, but their association with care choices remains unclear. Methods We integrated policy documents from China's first 15 LTCI pilot cities with the 2018 Longitudinal Healthy Longevity Survey (CLHLS). Eight pilot cities (located across six provinces) implemented supportive policies for informal care. The sample included 3,745 disabled adults aged 65+. The outcome was caregiver type, the exposure was policy coverage. We tested the hypothesis that policy-covered provinces increase informal care. Covariates followed Andersen's Behavioural Model. Analyses used multiple imputation and weighted logistic regression. Results Among participants, 85.8% chose informal care, rising to 96.2% in policy-covered provinces. Policy coverage remained significantly associated with this choice after full adjustment (OR = 2.68, 95% CI: 1.02–7.03). Other significant factors included rural residence (OR = 2.92), intergenerational support hours (OR = 1.02), and preference for co-residence with children (OR = 3.11). Higher education (OR = 0.87) and community personal care services (OR = 0.09) were associated with formal care. Sensitivity analyses supported robustness. Policy exposure was measured at the provincial level (assuming provincial policy environment reflects pilot city policies) due to sample size constraints in individual pilot cities. Conclusion Supportive policy coverage is significantly associated with informal care choices among disabled older adults in China. Formal community services complement informal care. Future policies should develop integrated systems where formal care supplements informal care to ensure sustainable, quality care.