The impact of China’s home and community-based older adult care reform policies on the mental health of older adults: a nationwide quasi-experimental study

Objective: The study aims to examine the effects of pilot reform policies related to home- and community-based care services on the mental health of older adults in China. This research carries significant practical implications for achieving the goal of "aging well" and unleashing the potential of the "silver economy." Methods: Using data from the China Family Panel Studies (CFPS) spanning 2010-2022, this study treats the pilot reform of home- and community-based older adult care services as a quasi-experiment and applies the difference-in-differences (DID) method for causal identification. It quantitatively evaluates the impact of integrated home- and community-based care on the mental health of older adults. Results: The findings indicate that: (1) The pilot reform of home- and community-based older adult care services significantly reduced depressive symptoms and improved mental health among older adults. (2) Better physical health and enhanced perception of filial support represent key mechanisms through which the pilot policy exerts positive effects on older adults' mental health. (3) Heterogeneity analysis shows that the policy effects are particularly pronounced among females, individuals with lower education levels, and those with disabilities. Conclusion: The reform of home- and community-based older adult care services has the potential to significantly improve the mental health of older adults. These findings are not only important for the understanding of the integration of home-based and community-based older adult care services, but also provide valuable insights for the development of older adult care service systems in developing countries.