Monitoring utilisation patterns of home- and community-based services for healthy ageing: a cross-sectional study

The home- and community-based care model has been developed to enable older people healthy ageing in place. However, few studies have investigated how well particular home- and community-based services (HCBS) have reached older people. This is crucial to address the issue of inequity in healthcare for seniors living independently. This study aims to examine the utilisation of the overall HCBS as well as its three main categories: life care services (LCS), medical health services (MHS) and spiritual comfort services (SCS). It will compare various predictors influencing the uptake of these services and highlight broader policy implications for building an integrated care system that promotes ageing within communities.

The research adopted a cross-sectional research design with a comparative analysis approach. A questionnaire survey was carried out with 1246 older adults in Zhejiang province, yielding 1171 valid responses and an overall response rate of 93.98%. Descriptive statistics and binary logistic regression analyses were applied to identify differences in service utilisation and key determinants.

The research findings showed that overall HCBS utilisation was relatively low, influenced by factors such as age, family support, self-assessed economic status, community type, type of social security benefits, awareness of regular HCBS, self-care capability and self-rated health. Substantial variations were observed in the utilisation rates of LCS, MHS and SCS. The young-old population was less likely to use LCS and MHS, whereas individuals with family support and chronic diseases were more inclined to utilise MHS and SCS. Economic condition and community type emerged as key determinants affecting the use of all three services.

This study highlights that HCBS have not been fully utilised and are influenced by various factors. Moving forward, it is crucial to address the care needs of different income groups, with particular attention to the unique challenges faced by rural older adults. Targeted policies and interventions are necessary to enhance accessibility for those with chronic illnesses and limited family support. Local governments should work in partnership with families to develop higher-quality, place-based integrated care services, ensuring that both medical care and spiritual well-being services are effectively delivered to meet the evovling needs of an ageing population.