Long-term care is an effective intervention that help older people cope with significant declines in capacity. The growing demand for long-term care signals a new social risk and has been given a higher political priority in China. In 2016, 15 local authorities have been selected to pilot the long-term care insurance programme. However, the current implementation of these programmes is fragmented, with a measure of uncertainty. This study aims to investigate the principles and characteristics of long-term care insurance policies across all pilot authorities. It seeks to examine the design of local long-term care insurance systems and their current status. Based on the 2016 guidance, a systematic search for local policy documents on long-term care insurance across the 15 authorities was undertaken, followed by critical analysis to extract policy value and distinctive features in the delivery of long-term care. The results found that there were many inconsistencies in long-term care policies across local areas, leading to substantial variations in services to the beneficiaries, funding sources, benefit package, supply options and partnership working. Policy fragmentation has brought the postcode lottery and continued inequity for long-term care. Moving forward, local authorities need to have a clear vision of inter-organisational collaboration from the macro to the micro levels in directional and functional dimensions. At the national level, vertical governance should be interacted to outline good practice guidelines and build right service infrastructure. At the local level, horizontal organizations can collaborate to achieve an effective and efficient delivery of long-term care.

Background: A consequence of demographic trends and economic prosperous is the increasing diversity in needs for care services. However, the traditional family support for older people has been largely supplanted by the wider provision of community care services. This study aims to investigate the current status of demand and supply in community care services across different villages of Zhejiang province and assess service effectiveness for healthy ageing.Methods: A questionnaire survey was carried out towards 207 rural villages across 9 cities in Zhejiang province. One hundred eighty-six valid responses were received, representing a response rate of around 89.9%. Descriptive statistics were employed to identify older villagers’ care needs and available community services. Comparative analysis examined the balance between the demand and supply of community care services. Correlation analysis were applied to determine key factors that impacted the supply of social services in rural communities.Results: The research found that rural older residents normally lived with their children or spouse with limited literacy and income. On average the categories of community care services is substantially small in comparison with the increasingly diverse demands of older people in rural areas. There was an obvious mismatch between service demand and service supply in rural communities, which often caused the waste of public resources. Moving forward, the uppermost priority is given to infrastructure construction service and daily life service, while little attention is paid to mental health service and specialized nursing service.Conclusion: There needs to be an improvement in the socio-economic capacity of rural communities and in the diversity of social care services. Policies and strategies are also needed to encourage private sectors’ involvement in providing care services for rural older people. Local government should have a clear vision of the potential demands for community care services, practical guidelines will be useful in guaranteeing better service quality.

In response to the impact of demographic change on the healthcare system, ‘ageing in place’ was introduced as a national policy to support elderly people living independently in their homes. Housing adaptation is essential for successful independent living and has been given increased political priority. However, adaptation policies and practice vary regionally, reflecting statutory limits, policy choices and local planning. This study investigated the current status of adaptation provision in different regions in the UK and assessed the effectiveness of local service planning and management. A mixed-methods sequential explanatory research strategy was employed. In the first quantitative phase, a questionnaire survey was carried out involving all 378 local authorities in England, Scotland and Wales. This was followed by a second qualitative phase involving individual interviews with five professionals and two clients and a focus group meeting with six key stakeholders. The study found that the current number of adaptations was relatively small compared with potential demands in most local areas, as was funding for adaptations. On the operational side, the adaptation process was fragmented, involving different service groups in many local authorities. There were disconnections between these groups, which often caused inefficiencies and poor effectiveness. Moving forward, local authorities need to have a clear vision of the overall need for adaptations and allocate sufficient resources. Practical guidelines are also needed for better integrated working and performance management.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Community participation is a key element of active aging that promotes a new paradigm to enhance health and well-being as people age. However, social isolation is often a concern for older migrants. In this study, we aimed to investigate the current status of older migrants’ community participation and assess the main influences on three forms of welfare, development, and organizational participation. We adopted a quantitative research design for this study. A questionnaire survey was completed by 1216 older migrants in 4 cities; 1105 valid responses were received, representing a response rate of around 91%. The research findings showed that the current participation of older migrants in community activities was limited. By comparison, full self-care capability and non-chronic illness positively affected general and welfare participation. Educated at primary school had a negative influence on general, development, and organizational participation, whereas knowledge of the local language was a significant predictor of general and development participation. Urban inclusion and resident friendship had positive effects on general, welfare, and development participation. The study also revealed direct influences of socioeconomic characteristics on different types of participation. Moving forward, actions are needed to maximize older migrants’ participation in public events and community life.

Housing adaptation is a rehabilitation intervention that removes environmental barriers to help older people accommodate changing needs and age in place. In the UK, funding application for home adaptations to local authorities is subject to several procedural steps, including referral, allocation, assessment, funding and installation. The five stages need to complete in a sequential manner, often cause long delays. This study aims to investigate the timelines across these key stages of the adaptation process and examine the main causes of delays in current practice. A mixed-methods research strategy was employed. A questionnaire survey was first undertaken with all 378 local authorities in England, Scotland and Wales; it was followed by 5 semi-structured interviews and 1 focus group meeting with selected service providers, and 2 case studies of service users. The results showed that the average length of time taken to complete the whole process is relatively long, with the longest waiting time being observed at the funding decision stage. Delays were found in each of the key stages. Main causes of delay include insufficient resources, lack of joint work, legal requirements, shortage of competent contractors and the client’s decisions. These issues need to be addressed in order to improve the efficiency and effectiveness of future housing adaptation practice.