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The Transformation of Older Adults' Perceptions of Government's Responsibility for Elderly Care under the Vision of “Ageing in Place”: Evidence from the Pilot Reform of Home and Community-Based Elderly Care Services
Li Long, Ma Qifeng, Sun Kexin
Population Research    2026, 50 (1): 20-35.  
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With the rapid ageing of the population and the trend toward smaller family sizes in China, the demand for community-based home elderly care services increasingly outstrips supply. Developing community-supported home care has become a critical measure to fulfill the vision of “ageing in place” for the vast elderly population. To this end, China launched a pilot reform of Home and Community-Based Elderly Care Services (HCECS) in 2016. This government-led reform aims to enhance the accessibility and perceived availability of services, directly addressing the urgent need for ageing in place while continuously signaling a shared responsibility for elderly care. This may subtly influence older adults' perceptions of government responsibility for elderly care.

Using five waves of unbalanced panel data from the China Longitudinal Aging Social Survey (CLASS) spanning 2014 to 2023, this study focuses on individuals aged 60 and above and employs a staggered difference-in-differences approach. It investigates the baseline impact of the HCECS pilot on older adults' perceptions of government responsibility for elderly care, explores underlying mechanisms, and examines heterogeneous effects. The research not only helps reveal how changes in the elderly care service delivery model reshape individual perceptions of responsibility attribution and the boundaries of public welfare provision, thereby deepening our understanding of how perceptions of government responsibility are formed, but also directly relates to whether policies can effectively shape social expectations, clarify government functions, and enhance the overall effectiveness of the elderly care service system. Thus, it holds significant theoretical and practical implications.

The findings indicate that the HCECS pilot significantly strengthens older adults' perceptions of government responsibility for elderly care, and the results remain robust after a series of sensitivity tests. Mechanism analysis reveals that the HCECS pilot reinforces the tendency to attribute responsibility to the government by reducing financial support from adult children, while simultaneously generating a masking effect through increased instrumental and emotional support from children. Heterogeneity analysis shows that the policy impact is particularly pronounced among older adults with lower education levels, poorer family economic status, and better health conditions. Based on these findings, the study proposes recommendations in three areas: first, optimizing institutional design to guide older adults toward rational expectations of shared responsibility for elderly care; second, improving family-community collaboration mechanisms to achieve complementary integration between formal and informal support; and third, identifying policy-sensitive groups to implement targeted service delivery and perception guidance strategies.

This study extends beyond prior policy evaluations that often focus on objective outcomes such as health and economic status. By adopting a cultural perspective, it explores how the HCECS pilot reshapes older adults' perceptions of government responsibility, thereby broadening the scope of policy assessment research. Additionally, the quasi-experimental design helps identify causal policy effects, addressing previous limitations in establishing robust causal inference regarding the relationship between elderly care security policies and individual perceptions of government responsibility. Furthermore, this study thoroughly analyzes and verifies the mechanisms and heterogeneity of the policy effects, providing new empirical evidence for understanding how policies reshape older adults' perceptions of government responsibility for elderly care.
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