Community environment moderates the relationship between older adults’ need for and utilisation of home- and community-based care services: The case of China

This study explores the moderating influence of perceived and objective community environments on the relationship between older adults’ home- and community-based care (HCBC) needs and their actual utilisation of such care. We selected 5,668 older adults in two cities in China and adopted latent class analysis to descriptively explore the patterns of their HCBC need and utilisation. Structural equation modelling was used to determine factors related to the patterns of need and utilisation of HCBC services, and to explore the moderating roles that the perceived and objective community environments had on the effect of long-term care need on its utilisation. The results descriptively showed that older adults’ patterns of HCBC need and utilisation appear to be embedded within two broader latent categories: a high-need/use group and a low-need/use group. Among participants who were satisfied with their community or who lived in areas with high accessibility to HCBC services, HCBC need could predict HCBC use. Our integrated conceptual framework proved to be applicable, thus enriching the theoretical models in explaining HCBC-related behaviours. The results have strong implications for urban planners, policymakers, and programme managers who seek to support older people and provide elderly care services in communities.