Assessing Spatial Distribution of Home- and Community-Based Services for Older Adults in Shanghai, China

Background and Purpose: Since the early 2000s, the Shanghai government has initiated home- and community-based services (HCBS) for older adults to face this rapidly increasing population. This trend has led to concerns about social justice and service disparity. However, there is a lack of empirical scientific analysis to examine this issue. The purpose of this study is to examine the spatial variation in distributing HCBS for older adults in Shanghai, in order to explore the (in)equity in long-term care resource allocation.

Methods: This study focused on one HCBS program in central Shanghai, which delivers elderly long-term care through 37 service centers across 73 neighborhoods. Data are drawn from the 2015 service centers’ data and the 2015 and 2007 neighborhood data in Shanghai. The service centers’ data included addresses of each service center and the neighborhoods they served. The neighborhood data included the neighborhoods’ geographic boundaries, the housing stock, the number of households, the number of older population, and the number of older adults who lived alone. The spatial analyses were performed by ArcGIS and GWR4.

Results: Spatial analyses demonstrate that service centers of this HCBS program are likely to be located in neighborhoods where the population of older adults is dense and the housing stock is old. Furthermore, our analyses reveal that although service centers are designed for easy access for elderly clients, within 500 meters from their homes, their assigned service center may not be the geographically closest one.  

Conclusions and Implications: This spatial analysis is the first study to specifically examine the distribution of HCBS for older adults in Shanghai. We revealed spatial strategies of allocating HCBS elderly long-term care resources of local governments in Shanghai. The discrepancy in distance that older adults accessed designated service center and the closest one indicates inequity in allocating financial and administrative resources among different local governments. This study underscores the importance of spatial analysis to enhance HCBS delivery and location choice to maximize HCBS benefits for older adults. The government should integrate neighborhood characteristics and service center locations to optimize equal accesses to HCBS for older adults.