Aging in institutions in East Asia: Care poverty pathways among older adults with intellectual disabilities

Despite policy commitments to aging in place and deinstitutionalization, little research has examined older adults with intellectual disabilities who continue to age in long-stay institutions, particularly in East Asian and other non-Western contexts. Using Taiwan as an East Asian case, this study explores how place-specific care arrangements, unmet support needs, and welfare infrastructures shape pathways into institutional care and experiences of institutional aging. We conducted in-depth life-history interviews with 13 residents aged 56-74 in four long-stay institutions in Taiwan. Drawing on a care poverty framework, we analyzed how unmet personal, practical, and socio-emotional support needs are embedded in broader cultural and welfare contexts. Entry into institutions commonly followed the breakdown of unpaid family care alongside limited access to home- and community-based services and supported housing. Gendered pathways were evident: men often entered after the death of a mother or other natal caregiver, whereas women more often entered after widowhood, following marriages to older military veterans or other socially disadvantaged partners. In five cases, a mother and her adult child with intellectual disabilities lived in the same institution, pointing to intergenerational institutionalization. Participants described institutional life as providing basic personal care while also involving isolation and limited control over daily life, relationships, and living arrangements. We propose poverty in choice and control to capture structurally constrained autonomy over where and with whom to live. The findings show how institutional settings reproduce lifelong disadvantage and offer broader insight into aging, care, and institutionalization in East Asia.