Perceived quality of home- and community-based services and urban-rural disparities in aging-in-place intentions: evidence from Chinese older adults

BACKGROUND: With approximately 90% of older adults globally preferring to age in place, this study examines how perceived Home- and Community-Based Services (HCBS) quality shapes older adults' intentions within China's urban-rural context. While existing research emphasizes perceptions of internal factors and service utilization, significant gaps remain regarding perceived HCBS quality's role across different environmental contexts. METHODS: Using data from 11,601 older adults in Sichuan, China, we analyzed perceived HCBS quality across four dimensions (service quantity, service quality, provider sufficiency, and distance) through an ecological framework integrating service quality models and the Ecology Model of Aging. Stratified urban-rural differences and moderation effects of unmet care needs were tested. RESULTS: Perceived HCBS quality significantly predicted aging-in-place intentions, with notable urban-rural variations. Rural older adults showed resilience to service quantity limitations but sensitivity to quality deficits, provider shortages, distance, and service unavailability, while urban respondents were more affected by provider shortages and distance barriers. The negative impact of service unavailability was exacerbated when care needs were unmet among urban but not rural older adults, while rural older adults who perceived both distance barriers and unmet needs were most likely to age in place, reflecting either greater adaptation to systemic constraints or fewer alternative options in rural areas. CONCLUSIONS: Findings underscore the need to improve HCBS accessibility and provider availability to support aging-in-place preferences. Urban areas require strategies addressing service proximity and workforce capacity, while rural regions benefit from enhanced service quantity and quality. These results highlight the importance of context-specific policies that account for both service quality perceptions and urban-rural disparities in China's aging population.