Can Public Elderly Care Services Promote Social Participation Among Rural Older Adults?

Abstract

This study explores the impact of public elderly care services on social participation among rural older adults and examines the underlying mechanisms, providing empirical evidence for improving the rural elderly care system and promoting sustainable development in rural aging societies in China. Using four waves of panel data from the China Longitudinal Aging Social Survey (CLASS) (2014–2020), this research focuses on home- and community-based elderly care services. Employing a two-way fixed-effects model and an instrumental variable approach, the study finds that the accessibility of public elderly care services significantly promotes social participation among rural older adults. This result remains robust after conducting various checks, such as replacing outcome variables, altering measurement methods, and adjusting sample sizes. Heterogeneity analysis reveals that the positive effects are more pronounced among older adults with higher education, those co-residing with adult children, and those in more economically developed regions. The accessibility of public elderly care services primarily facilitates social participation by alleviating labor supply constraints, improving mental health, and strengthening the willingness to engage. The findings suggest that improving the accessibility of public elderly care services can significantly enhance social participation and recommend expanding service coverage as a core strategy to promote active aging in rural areas, with a focus on fostering localized models like rural mutual aid and neighborhood care. Additionally, addressing information asymmetry by establishing “village-level public elderly care information service stations” and creating time banks for mutual aid care at the township level could help foster a virtuous cycle of intergenerational support.

1. Introduction

Population ageing has emerged as one of the most formidable socioeconomic challenges of the twenty-first century. According to the latest United Nations projections, the share of adults aged 65 and over will surge from 6.8 per cent in 2000 to 14.3 per cent by 2040 and reach 16.3 per cent by 2050, with a potential ascent beyond 21 per cent by the end of the century. China, serving as a paradigmatic case, is confronting an unprecedented “silver tsunami.” The cohort born during the second baby boom (1962–1975) is now transitioning into old age, precipitating a rapid expansion of the elderly population. National Bureau of Statistics data indicate that individuals aged 60 and above accounted for 19.8 per cent of the total population in 2023—an increase of 2.3 percentage points over 2020. This demographic transition has eroded the traditional demographic dividend and escalated public pension expenditure from 5.1 per cent of GDP in 2010 to 8.7 per cent in 2023, exerting systemic pressure on sustainable socioeconomic development [1] (pp. 1–16). Against this backdrop, the Second World Assembly on Ageing in 2002 incorporated “active ageing” into its Political Declaration, establishing it as the guiding policy framework for addressing population ageing in the twenty-first century. Active ageing affirms the social value of older adults and underscores their right—contingent on personal preferences, capabilities, or interests—to engage in economic, political, cultural, and other social activities. By leveraging their accumulated skills, experience, and wisdom, older adults can transform ageing from a socioeconomic burden into a catalyst for sustainable development.

For a long time, the content of social old-age security has often focused on economic support and daily care, while neglecting the importance of spiritual elderly care. The rapid socioeconomic development of China has led to significant intergenerational differences among the older people population, and the demand structure of the older people is shifting from a “needs-based” to a “development-based” model. Compared with their predecessors, the older people in the new era exhibit new characteristics in terms of social experience, educational attainment, economic income, awareness of rights and interests, and initiative. Their needs have expanded from the traditional goals of “having adequate support in old age” and “having someone to rely on in old age” to “being able to contribute in old age” and “having the opportunity to achieve in old age”. The improvement in material living conditions and educational attainment has enhanced older people’s willingness and capacity for social participation, giving rise to the demand for active engagement in later life. With socioeconomic development, the living standards of rural residents, including older adults, have continuously improved. Many rural residents who experienced China’s three major literacy campaigns and universal education initiatives have now entered old age, increasing the average education level of the rural elderly population [2] (pp. 83–95). Statistics show that in 2000, 48% of older people had never attended school, whereas this figure has now declined to about 10%, and the average years of education among older adults has reached 6.05. This indicates a growing group of healthy, well-educated older individuals with valuable knowledge, experience, and human capital. According to role theory, social participation helps alleviate negative emotions caused by life transitions such as retirement or widowhood. Surveys also show that over 70% of older people are willing to engage in community volunteer activities, such as helping neighbors, mediating disputes, and maintaining community hygiene and safety.

At present, rural areas in China have entered the stage of moderate aging. Data from the Seventh National Population Census shows that in 2020, the proportion of rural older people population aged 60 and above in the total rural population reached 23.81%, which is 7.99 percentage points higher than that in urban areas. It is estimated that the aging degree of the rural population will reach as high as 45.16% by 2035, making rural areas enter the “super-aging society” ahead of schedule [3] (pp. 49–61). However, older people care resources in rural areas are relatively limited, and the development of public services is relatively lagging behind. How to fully tap into the older people’s human resources and realize the sustainable development of rural aging societies is of great significance for improving the construction of rural elderly care service system, implementing the national strategy of actively responding to population aging, and advancing the rural revitalization strategy.

Since 2016, China’s Ministry of Civil Affairs and Ministry of Finance have launched pilot reforms of home- and community-based elderly care services. The program aims to improve service quality through government coordination, social participation, and market-oriented operations to meet the needs of older people who prefer to age at home or within their communities. By 2020, a total of 203 pilot regions had been selected in five batches, covering all provinces in mainland China. As a care model relying on community organizations and support, delivered through public welfare and volunteer services, home-based and community-based elderly care services retain the advantages of traditional family-based and community-based care while offering professionalism, universality, and convenience. It is regarded as a significant institutional innovation that aligns with the residential preferences of China’s older people population and the national reality of “aging before getting rich” [4] (pp. 9–20). Data from the Fifth China Survey on the Living Conditions of Urban and Rural older people indicates that 91.7% of rural seniors prefer home-based care, a rate higher than that of urban areas (83.6%).

In rural China, home- and community-based elderly care services mainly rely on collaboration between grassroots organizations and local governments. However, significant structural limitations remain in service provision. On the one hand, national initiatives such as the Silver-Age Action encourage social organizations and volunteers to participate in elderly care, promoting the spread of public and mutual-aid models. On the other hand, rural areas generally suffer from weak infrastructure, shortages of professional care workers, and insufficient fiscal support, which constrain the real capacity of public services to support rural older populations. As family-based care continues to weaken, rural older adults face an increasingly pronounced care gap. According to the 2018 China Health and Retirement Longitudinal Study (CHARLS), the proportion of rural older adults with care needs is 8 percentage points higher than that of urban older adults. Yet, to date, few studies have examined how the accessibility of public elderly care services—represented by home- and community-based care—affects the sustainable development of rural aging communities.

Based on data from the China Longitudinal Aging Social Survey (CLASS), this study explores the impact of the accessibility of public elderly care services on the social participation of rural older people. The research focuses on the following questions: Can the accessibility of public elderly care services effectively promote the social participation of rural older people, integrate the goals of “having adequate support in old age” and “having the opportunity to achieve in old age,” and facilitate the realization of the strategic objectives of active aging? If it can promote such social participation, what are the specific manifestations of this promotional effect on the older people’s social participation? What is the underlying mechanism of this promotion? Does this impact exhibit heterogeneity?

2. Literature Review and Theoretical Analysis

2.1. Literature Review

2.1.1. Definition of the Accessibility of Public Elderly Care Services

The term “accessibility” is widely used in public health policy research, and it generally refers to the degree of matching between the supply and demand sides of services—i.e., whether services are accessible to target groups and whether they can meet their actual needs [5] (pp. 102–124). Early work conceptualized accessibility from the perspective of the “right to service use,” defining it as citizens’ equal entitlement to essential healthcare services. Subsequent studies advanced this notion by emphasizing the role of resource availability and spatial fit, thereby operationalizing accessibility as a measurable two-dimensional construct. Building on this foundation, the well-known “5A” framework—Availability, Accessibility, Affordability, Accommodation, and Acceptability—was proposed to capture the multidimensional and dynamic nature of accessibility. This framework underscored that accessibility is not a static threshold but a process shaped by population heterogeneity, resource distribution, and socio-cultural context [6] (pp. 53–77).

As research contexts diversified, the concept of accessibility was extended beyond healthcare to domains such as eldercare, nursing, mental health, and digital medicine. Empirical evidence from remote regions of Canada indicates that older adults’ perceptions of “acceptability” are strongly influenced by local culture and patient–provider relationships. In China, the evolution of health service accessibility has been characterized by a policy shift from basic medical security toward life-course health management [7] (pp. 56–69). In recent years, the analytical framework of accessibility has also been increasingly applied to eldercare research. One line of work integrates the “5A” framework with economic, service-content, and delivery dimensions to construct an indicator system for assessing the accessibility of basic rural eldercare services. Other studies show that spatial accessibility to community-based eldercare facilities generates the greatest marginal utility for urban older adults living alone. Community care accessibility has also been defined as the adequacy of opportunities and the service-supply fit for obtaining care resources within residential communities. Meanwhile, although telemedicine has substantially improved spatial accessibility for rural patients, it has simultaneously exacerbated inequalities in “acceptability” due to disparities in digital literacy.

Based on the evolutionary context of the aforementioned multi-dimensional framework, this study, building on the definition of community care accessibility proposed by Chen et al. [7] (pp. 56–69), defines the accessibility of public elderly care services as follows: For the two groups of older people—those receiving home-based care and those receiving centralized community-based care—this concept refers to the sufficiency of resources and suitability of needs achieved by communities in terms of the supply quantity, allocation structure, and service models of public elderly care service resources. Its core lies in measuring the dynamic matching level between service resources and the diverse needs of the older people.

2.1.2. Intrinsic Motivations for the Older People’s Social Participation

As the core of active aging, social participation of the older people is also a crucial indicator for measuring the older people’s well-being. As a behavioral choice of the older people, their demand for social participation serves as the internal motivation driving them to engage in social activities. According to Maslow’s Hierarchy of Needs, with the development of the economy and society as well as the gradual improvement of the social old-age security system, after the older people’s lower-level needs (such as physiological and safety needs) are met, they will pursue higher-level needs. For the older people, social or emotional needs are not only the dominant motivation for their social participation but also a way for them to realize their self-worth. The ultimate goal of the older people’s social participation is to satisfy the highest-level need of self-actualization [8] (pp. 591–619).

Drawing on the Social Exchange Theory, Dodd argued that the fundamental reason for the decline in the social status of the older people lies in their lack of power resources and values available for exchange. Therefore, the older people need to rely on social capital to maintain their living standards and improve their quality of life. Positive social participation, however, is an important way for the older people to maintain and expand their social networks as well as enhance their personal capital. Through social participation, the older people can increase their value capital, enabling them to maintain an advantageous position in social exchanges [9] (pp. 68–83).

In contrast, the Socioemotional Selectivity Theory holds that social participation requires the investment of certain costs. As the prospect of their remaining lifespan shortens, the older people will selectively narrow down their social interactions.

2.1.3. Public Policy and Older People Social Participation

In academic circles, there are two competing viewpoints regarding the impact of government public policies on social participation.

The Welfare Crowding-in Theory posits that the government, through fiscal transfer payment mechanisms, provides target beneficiary groups with diversified resource allocation, including cash subsidies, in-kind assistance, and service support. This not only creates the necessary material foundation and institutional guarantee for their social participation but also helps reconstruct the foundation of social trust by narrowing the income gap [10] (pp. 416–440). As a measure for the government to improve people’s well-being, public policies help cultivate citizens’ sense of social responsibility, stimulate enthusiasm for social participation, and form a positive cycle of social engagement [11] (pp. 5–26).

On the other hand, the Welfare Crowding-out Theory argues that the state provides citizens with institutionalized security through the social security system (such as endowment insurance and unemployment insurance). This replaces the mutual assistance behaviors based on consanguineous and geographical ties in traditional society, reduces the marginal utility of individuals in maintaining social networks, and ultimately leads to a decrease in investment in social interactions. For example, data from the German Socio-Economic Panel (SOEP) indicated that the participation rate of social welfare beneficiaries in community volunteer services is 18.7% lower than that of non-beneficiaries [12] (pp. 61–68).

With the accelerating process of global population aging, a growing body of literature has examined the relationship between social public policies and the social participation of older adults from multiple theoretical perspectives. Most existing studies have focused on the impact of social pension insurance on social participation, yet the empirical evidence remains inconclusive. (Comparative analyses across European countries reveal significant variations in older adults’ participation under different welfare regimes. Evidence from 13 European countries indicates that the level of social participation is significantly lower under social-democratic welfare systems than under Southern European regimes [13] (pp. 233–255). However, other studies suggest the opposite pattern—countries with social-democratic welfare systems exhibit the highest levels of active aging, while Southern European countries score the lowest [14] (pp. 541–567). Micro-level evidence from Colombia further suggests that participation in social pension schemes promotes social engagement among older adults [15] (pp. 968–973).

Evidence from China also supports a positive association between pension participation and social engagement. Using data from the China Health and Retirement Longitudinal Study, it has been found that enrollment in pension programs significantly increases the likelihood of social participation, with heterogeneous effects across different types of pensions—the urban employee pension showing the strongest impact [16] (pp. 1335–1359; p. 53). Moreover, pension income has been shown to promote social participation among rural older adults by alleviating income inequality and improving health conditions [17] (pp. 69–81). Nonetheless, some studies report insignificant effects of social pension insurance on social participation in rural China [18] (pp. 44–55). Overall, the relationship between social pension insurance and social participation among older adults appears to be contingent upon welfare regime types, socioeconomic contexts, and individual characteristics, warranting further investigation into the underlying mechanisms and heterogeneity.

By reviewing existing research literature, it can be found that most studies have focused on the policy impact of social endowment insurance, while paying insufficient attention to home- and community-based elderly care services as a crucial policy tool. Although some scholars have explored the health effects of such services [19] (pp. 163–185); and their spillover effects on the labor market [20] (pp. 186–202); research on their social participation effects remains scarce. This research gap urgently needs to be addressed.

2.2. Theoretical Analysis and Research Hypotheses

Originating from the concept of “community care” in the United Kingdom in the 1950s, home- and community-based elderly care services represent an elderly care model that integrates family and community support. In rural areas where public service development is relatively lagging, such services play a crucial role in promoting the social participation of rural older people [21] (pp. 154–168). This study constructs an analytical framework based on the Theory of Planned Behavior (TPB). The core proposition of this theory is that individual behavior is influenced by behavioral intention, which is jointly determined by three factors: attitude toward the behavior, subjective norms, and perceived behavioral control.

First, home and community-based elderly care services provide basic daily care services such as day care centers, older people’s meal programs, and meal delivery, offering tangible living security for the older people. By organizing in-home visits and launching mental health counseling and other spiritual care services, these services alleviate the older people’s sense of loneliness, strengthen their social connections, and boost their self-confidence. Furthermore, elderly people’s care service institutions organize a variety of cultural and recreational activities, which facilitate the role transition of the older people group from “passive recipients of assistance” to “active participants.” This practical experience of “being able to contribute in old age” significantly enhances their enthusiasm for social participation and improves their attitude toward engaging in social activities.

Secondly, the home and community-based elderly care service system effectively addresses the daily needs of rural seniors by providing life care services such as accompanying medical visits, errand running, and household chores. These services are primarily organized by village committees and older people’s associations, leveraging the traditional advantages of rural neighborhood mutual assistance and conducted through volunteer teams on a charitable basis. This service model rooted in local culture generates a demonstration effect, subtly shaping positive social participation norms: when older people witness their peers engaging in social activities and receiving recognition, their willingness to participate increases. Additionally, village committees and older people associations significantly reduce psychological barriers to public activity participation among seniors by organizing cultural and recreational events, festive gatherings, and other forms, utilizing the exemplary influence within neighborhoods. This social support system based on rural culture not only inherits traditional mutual aid ethics but also reinforces the older people’s value recognition of “productive aging” through modern service formats, ultimately forming a virtuous cycle between service provision and social participation.

Third, public elderly care service institutions enhance the perceived behavioral control of rural older people by providing systematic support. In terms of hardware support, the provision of infrastructure such as dedicated transportation for pick-up and drop-off and barrier-free activity venues effectively addresses the physical barriers that hinder the older people from participating in social activities, significantly reducing the time and economic costs incurred by rural older people during their social participation. In terms of capacity building, the delivery of age-appropriate training (e.g., smartphone operation courses) not only helps the older people bridge the digital divide but also strengthens their confidence in social connectivity through teaching practical functions such as instant messaging and medical appointment booking. Through the dual empowerment of hardware and software, this support not only eliminates the older people’s concerns about their ability to participate in activities but also reinforces their self-efficacy through practical successful experiences. This transforms the older people from a state of “daring not to participate” to “being able to participate,” driving a shift from passive observation to active engagement among the older people.

Finally, against the backdrop of a continuous increase in life expectancy, individuals face significant health risk shocks and external uncertainties, which may strengthen people’s motivation for precautionary savings. As a vital component of the social security system, home- and community-based older people care services receive government subsidies for service procurement. This not only alleviates the anticipated pressure of older people care to a certain extent but also enhances rural older people’s confidence in self-care during old age and boosts their sense of security. Older people often engage in employment primarily for subsistence or to support their retirement [22] (pp. 1511). When the expected liquidity constraints are alleviated, they can reduce their labor supply without compromising their living standards, thereby freeing up leisure time for participation in other activities. According to Maslow’s Hierarchy of Needs Theory, when basic needs (physiological and safety needs) are secured through public elderly care services, the older people will naturally develop higher-level needs—such as social interaction, respect from others, and self-actualization. Therefore, the “leisure crowding-in effect” generated by government subsidies encourages older people to reallocate their time resources, creating conditions for their social participation.

Based on the above analysis, the following hypotheses are proposed:

H1: 

Home- and community-based elderly care services contribute to promoting the social participation of rural older people.

H2: 

Home- and community-based elderly care services help older people enhance their willingness to participate in social activities, thereby facilitating their social participation behavior.

H3: 

Home- and community-based elderly care services can, through the leisure crowding-in effect, encourage the older people to reduce labor supply and increase leisure time, thereby promoting their social participation behavior.

3. Research Design

3.1. Data Source

The data used in this study are from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS). As a nationwide and continuous large-scale social survey project, CLASS covers 30 provinces (autonomous regions and municipalities directly under the Central Government) across China, encompassing a total of 476 villages (neighborhood committees). The survey content includes the older people’s health status and care needs, economic conditions and social security, community services, and attitudes toward aging. This provides nationwide micro-level survey data for exploring the impact of home- and community-based elderly care services on the social participation of rural older people. The project launched its first nationwide baseline survey in 2014, followed by follow-up surveys every two years in 2016, 2018, and 2020. Since the 2014 and 2016 survey questionnaires did not include questions related to the older people’s social participation, this study uses data from the 2018 and 2020 waves. The sample is restricted to individuals aged 60 and above who reside in rural areas, resulting in a total of 9956 observations.

3.2. Variables and Descriptive Statistics

3.2.1. Dependent Variable

The dependent variable in this study is the social participation behavior of the older people. In its 2002 report Active Ageing: A Policy Framework, the World Health Organization (WHO) proposed the concept of active aging, defining “active” as the older people not only maintaining good health and the ability to engage in physical activities and work but also actively participating in social, economic, cultural, spiritual, and public welfare affairs. In line with this definition of active aging, this study examines the impact of home- and community-based elderly care services on the social participation behavior of rural older people from two dimensions: volunteer service activities and leisure and cultural activities. In the 2018 and 2020 CLASS survey questionnaires, respondents were asked about their participation in two categories of activities over the past year:

Volunteer activities: These include community security patrols, caring for other older people (e.g., assisting with shopping, daily living care), environmental protection, mediating neighborhood disputes, accompanying others for conversations, professional skill-based volunteer services (e.g., free medical consultations, cultural and technological promotion), and helping take care of others’ children.

Cultural and recreational activities: These cover participation in religious activities, attending older people universities or training courses, watching TV/listening to radio/reading books/newspapers/listening to operas, singing/playing musical instruments, playing mahjong/chess/cards, and square dancing.

For each of these activities, respondents were given five response options to indicate their participation frequency: Never participated, Several times a year, At least once a month, At least once a week, and Almost every day. These options were assigned scores from 0 to 4, respectively, with higher scores representing higher participation frequency. By summing the scores of the aforementioned 13 activities for each respondent over the past year, a continuous variable was constructed to measure the level of social participation among rural older people.

3.2.2. Independent Variable

The core independent variable of this study is the accessibility of home- and community-based elderly care services. Drawing on the methodology of Chen et al. [7] (pp. 56–69), this variable is constructed based on the number of home- and community-based elderly care services provided in the community where the older people reside. The CLASS questionnaire includes questions about whether the respondent’s community provides the following services for the older people, with each service assigned a value based on the respondent’s answer: home visits, hotline for elderly services, accompanying medical visits, assistance with daily shopping, legal aid, in-home housekeeping services, older people meal programs or meal delivery, day care centers or older people care centers, and psychological counseling services. The accessibility of home- and community-based elderly care services is measured by summing the number of services that respondents reported being available in their communities.

3.2.3. Control Variables

In line with existing research, differences in individual characteristics and family characteristics influence older people’s choice of social participation behavior. Gender: Influenced by the traditional gender norm of “men working outside the home and women managing household affairs,” older men in rural areas have a higher level of participation in economic, political, and cultural activities than older women. Age: The Socioemotional Selectivity Theory suggests that as the prospect of remaining lifespan shortens, the older people will selectively narrow their social interactions. With increasing age, older people experience a decline in physical functions and activity capacity, leading to a reduction in their social participation. Marital status: The social participation behavior of widowed older people is affected to varying degrees. Health and income: The older people’s social participation is also constrained by their health status and influenced by income stability [23] (pp. 17–30). Endowment insurance: Participation in the New Rural Social Endowment Insurance (NRSPI) increases the probability of social participation among rural older people. Education level: Older people with higher education levels are more likely to participate in social activities. Family characteristics: Additionally, family size and living arrangements have a significant impact on the social participation of rural older people [24] (pp. 112518). Intergenerational support from children serves as a strong backup for the older people’s lives, ensuring they have sufficient energy to participate in social activities. [25] (pp. 85–97). Compared with older people living alone, those living with their children can obtain more intergenerational support and are more likely to participate in social activities [26] (pp. 179–205).

Based on the above, this study controls for individual characteristic variables (gender, age, education level, marital status, activity capacity, endowment insurance, and income) and family characteristic variables (family size).

3.2.4. Instrumental Variable

To address potential endogeneity issues, this study draws on the selection of instrumental variables in existing relevant research [27] (pp. 112–128) and introduces the regional average number of home- and community-based elderly care services to correct for potential endogeneity. On the one hand, this variable is calculated by excluding the village where the sample is located to obtain the average level of home- and community-based elderly care services in the region. To a certain extent, it reflects the common conditions faced by rural older people in the region regarding the accessibility of public elderly care services, and has a strong correlation with the quantity of home- and community-based elderly care service supply in the respondent’s community. This satisfies the condition that the instrumental variable is correlated with the endogenous variable. On the other hand, the regional average accessibility of home- and community-based elderly care services does not directly affect the social participation behavior of rural older people, thus meeting the requirement of exogeneity for instrumental variables.

3.2.5. Mechanism Variables

1.

Willingness to Participate in Society

The CLASS survey questionnaire asked respondents to describe their current willingness to participate in society, specifically including: If given the opportunity, I would be willing to participate in certain village/neighborhood committee work; I often think about doing more for society; I currently enjoy learning; I feel I am still a useful member of society. Each question offered five response options: Strongly disagree, Somewhat disagree, Neutral, Somewhat agree, Strongly agree. Responses were assigned scores from 1 to 5, with higher scores indicating greater willingness to participate. The scores for these four questions were summed to derive a composite score for willingness to participate in social activities.

2.

Labor Supply Behavior

The 2018 and 2020 CLASS surveys inquired about respondents’ current engagement in income-generating work (including agricultural labor). The question offered five response options: not participating, several times a year, at least once a month, at least once a week, and almost daily. Based on respondents’ answers to these questions, scores ranging from 0 to 4 were assigned, with higher scores indicating greater participation frequency.

3.

Mental Health Status

This study employs relevant variables from the Center for Epidemiologic Studies Depression Scale (CESD) within the CLASS survey questionnaire to assess the mental health status of rural older people. The CESD scale in the CLASS survey comprises nine questions, three of which measure positive emotional experiences (e.g., “In the past week, have you felt cheerful?” Do you feel your life is going well? Do you find your life enjoyable (interesting)?), while 6 questions assess negative emotional experiences (During the past week, did you feel lonely? Did you feel sad? Did you have no appetite? Did you have trouble sleeping? Did you feel you couldn’t sleep well? Did you feel useless? Did you feel you had nothing to do?). To facilitate interpretation of regression results, this study adjusted the traditional CESD scoring method to construct a positive-scoring scale for mental health among rural older people, ranging from 9 to 27 points, where higher scores indicate better mental health. Considering that some respondents in the sample may have high CESD scores but exhibit severe negative emotions in specific areas, a binary mental health indicator was constructed following the methodology by referring to the practices in existing literature [19,20] (pp. 163–185; pp. 186–202). Specifically, if an older people respondent’s CESD score exceeds the sample mean and each individual item score is above 2 (i.e., no item shows the highest negative emotion or lowest positive emotion), the variable is assigned a value of 1; otherwise, it is assigned a value of 0.

Table 1. Variable definitions and descriptive statistics.

Variable	Definition	Mean
Social participation	Sum of 13 participation items (0–45)	5.59
HCBC accessibility (village)	Count of available services (0–9)	0.38
HCBC accessibility (prefecture IV)	Leave-village-out mean of services in prefecture (0–2.34)	0.22
Female	1 = female, 0 = male	0.47
Age	Years	71.77
Education	Years of schooling	2.39
Married & co-residing	1 = married and living with spouse	0.71
ADL independent	1= independent in all six ADL items	0.90
Pension	1 = receiving pension benefits	0.68
Income	Log annual personal income (CNY)	8.29
Children	Number of living children	2.90
Co-residence	1= living with at least one adult child	0.39
Willingness to Participate in Society	Composite Score for Social Participation Willingness	11.38
Labor Participation Behavior	Did not participate = 0; Several times a year = 1; At least once a month = 2; At least once a week = 3; Almost every day = 4	1.30
Mental Health Status	Mental Health Status	0.38

presents the variable definitions and descriptive statistics results. Overall, rural older people participate in an average of 1 or more social activities. The average number of public elderly care services provided in the communities where respondents reside is 0.38, while the regional average number of home- and community-based elderly care services is 0.22. These figures indicate that public elderly care service resources in rural areas are relatively limited.

Among the rural older people sample, the gender ratio is relatively balanced; the average age of the older people is relatively high, and their educational level is generally low. The vast majority of the older people have basic activity capacity and are entitled to endowment insurance benefits.

3.3. Empirical Strategy

This study employs a two-way fixed effects model to estimate the impact of the accessibility of home and community-based elderly care services on the social participation of rural older people. The baseline regression model is specified as follows:

$${\mathrm{SP}}_{\mathrm{ict}}={\mathrm{\alpha }}_0+{\mathrm{Access}\text{\_}\mathrm{care}}_{\mathrm{ict}} +{ \mathrm{X}}_{\mathrm{it}} +{\mathrm{\delta }}_{\mathrm{i}}+{\mathrm{\lambda }}_{\mathrm{t}}+{{\mathrm{\mu }}_{\mathrm{c}}+\mathrm{\epsilon }}_{\mathrm{it}}$$

(1)

where i indexes individuals, c prefectures, and t survey years; SP_ict denotes social participation; Access_care_ict is the count of HCBC services; X_it is a vector of controls; δ_i, λ_t, and μ_c are individual-, year-, and prefecture-fixed effects, respectively; ε_it is the idiosyncratic error.

This study focuses on analyzing the impact of the accessibility of home- and community-based elderly care services on the social participation of rural older people. However, addressing this research question may be challenged by two endogeneity issues: reverse causality and omitted variable bias. On the one hand, the social participation behavior of rural older people may conversely affect the supply of home- and community-based elderly care services (reverse causality). On the other hand, although this study controls for key factors that may influence the social participation of rural older people (such as individual characteristics and family characteristics) and employs a two-way fixed effects model to control for individual and time fixed effects, there may still be unobservable factors that are correlated with both the accessibility of public elderly care services (the core variable of interest) and the social participation behavior of rural older people. This gives rise to endogeneity issues caused by omitted variables. To mitigate the aforementioned endogeneity issues, this study introduces an instrumental variable to correct for potential endogeneity. The two-stage least squares (2SLS) model for the instrumental variable is specified as follows:

Stage 1:

$${\mathrm{Access}\text{\_}\mathrm{care}}_{\mathrm{ict}}={\mathrm{\beta }}_0+{\mathrm{\beta }}_1{\mathrm{I}\mathrm{V}}_{\mathrm{i}\mathrm{c}\mathrm{t}}+{\mathrm{\beta }}_2{\mathrm{X}}_{\mathrm{it}}+{\mathrm{\theta }}_{\mathrm{i}}+{\mathrm{\vartheta }}_{\mathrm{t}}+{\mathrm{\mu }}_{\mathrm{it}}$$

(2)

Stage 2:

$${\mathrm{SP}}_{\mathrm{ict}}={\mathrm{\gamma }}_0+{\mathrm{\gamma }}_1{\mathit{Acce}\hat{\mathit{s}}\text{\_}\mathit{care}}_{\mathit{ict}}+{\mathrm{\gamma }}_1{\mathrm{X}}_{\mathrm{it}}+{\mathrm{\rho }}_{\mathrm{i}}+{\mathrm{\sigma }}_{\mathrm{t}}+{\mathrm{\tau }}_{\mathrm{it}}$$

(3)

where IV_ict is the instrumental variable and is the predicted value from (2). Standard errors are clustered at the village level.

4. Empirical Results

4.1. Baseline Regression Results

This study estimates the impact of the accessibility of home- and community-based elderly care services on the social participation of rural older people. The baseline regression results are presented in

Table 2. Public long-term-care accessibility and rural elders’ social participation.

	Modal 1	Modal 2	Modal 3	Modal 4
	FE	FE	Reduced-form	2SLS 1st stage	2SLS 2nd stage
HCBC accessibility	0.272 ***	0.262 **			0.416 **
	(0.067)	(3.91)			(3.02)
Prefecture mean HCBC (IV)			0.487 **	1.170 **
			(3.06)	(20.09)
Female		0.149	0.352 **	0.047 **	0.332 **
		(1.33)	(3.33)	(2.06)	(3.15)
Age		−0.030 **	−0.050 **	0.001	−0.051 **
		(−3.44)	(−5.97)	(0.64)	(−6.04)
Education		0.046 **	0.077 **	0.008 **	0.074 **
		(2.90)	(5.18)	(2.52)	(4.97)
Married & co-residing		0.266 **	0.573 **	0.043	0.555 **
		(2.11)	(4.79)	(1.79)	(4.65)
ADL independent		0.902 **	0.534 **	−0.055	0.557 **
		(4.61)	(3.07)	(−1.28)	(3.22)
Pension		0.361 **	−0.628 **	0.118 **	−0.677 **
		(2.07)	(−5.86)	(6.02)	(−6.15)
Income		0.035	0.163 **	−0.049 **	0.184 **
		(0.66)	(2.98)	(−3.87)	(3.34)
Children		−0.163 **	−0.370 **	−0.002	−0.369 **
		(−3.65)	(−9.53)	(−0.24)	(−9.62)
Co-residence		0.081	−0.087	−0.052 **	−0.065
		(0.67)	(−0.80)	(−2.32)	(−0.61)
Year fixed effects	YES	YES	YES	YES	YES
Prefecture fixed effects	YES	YES	YES	YES	YES
Observations	9956	9956	9956	9956	9956
R2	0.248	0.261	0.042	0.122	0.047
First-stage F-statistic				403.414
KP rk LM					258.309
p-value					0.000

Notes: Robust standard errors clustered at the individual level are reported in parentheses. *** p < 0.01, ** p < 0.05, * p < 0.10.

. Among them, Models 1 and 2 report the estimation results of the two-way fixed effects model, Model 3 shows the reduced-form estimation results of the instrumental variable, and Model 4 presents the estimation results of the two-stage least squares (2SLS) method.

The results of Models 1 and 2 indicate that the accessibility of home- and community-based elderly care services has a significantly positive impact on the social participation of rural older people. After incorporating control variables at the individual and family levels, the result remains robust. The result of Model 3 shows that the regional average accessibility of public elderly care services has a significantly positive impact on the social participation of rural older people, which is consistent with the estimation results of Models 1 and 2.

The first-stage regression result of Model 4 reveals a significantly positive correlation between the regional average accessibility of home- and community-based elderly care services (instrumental variable) and the accessibility of home- and community-based elderly care services in the respondent’s community (endogenous variable), satisfying the requirement that the instrumental variable is correlated with the endogenous variable. The second-stage regression result shows that home- and community-based elderly care services have a positive impact on the social participation of rural older people, which passes the significance test at the 5% level, verifying Hypothesis 1 (H1).

In addition, the results of the weak instrumental variable test show that the Kleibergen–Paap Wald rk F statistic is 403.414, which is greater than the critical value (16.38) for a 10% bias in the Stock-Yogo weak instrumental variable test, rejecting the null hypothesis of “weak instrumental variable”. The statistic of the underidentification test (Kleibergen–Paap rk LM) is 208.309, which significantly rejects the null hypothesis of “instrumental variable underidentification” at the 1% significance level. The above results confirm the validity of the selected instrumental variable. After addressing potential endogeneity issues using the instrumental variable method, the promoting effect of public elderly care services on the social participation behavior of rural older people is more pronounced compared with the estimation results of the fixed effects model.

4.2. Robustness Check

This paper uses three methods, namely, substituting the explained variable and the explanatory variable, and adjusting the sample size, to test the robustness of the benchmark regression results.

4.2.1. Substitution of the Explained Variable

To alleviate the impact of potential measurement errors on the benchmark regression results, this paper successively substitutes the explained variable with a binary variable indicating whether the older people participate in social activities, the participation in volunteer service activities, and the participation in leisure and cultural activities to test the robustness of the model. Specifically, if the respondent answers “no” to all social activity participation situations, it is considered that the respondent has not participated in any social activities and is assigned a value of “0”; otherwise, the value is “1”. The respondents are assigned values according to their answers regarding their participation in volunteer service activities and leisure and cultural activities, and the scores of the respondents’ participation in these two types of activities are summed up to measure the respondents’ participation in volunteer service activities and leisure and cultural activities. The results in

Table 3. Robustness Test Results on the Impact of Public Elderly Care Service Accessibility on Social Participation Among Rural Seniors.

	Alternative Dependent Variable			Alternative Explanatory Variable	Restricted Sample
	Binary Participation Indicator	Volunteering Engagement	Leisure/Cultural Activity Engagement	Community Provision of Public Long-Term-Care Services	Rural Sample Aged 60–69	Exclude the 2020 Sample
	(1)	(2)	(3)	(4)	(5)	(6)
HCBC accessibility	0.006 **	0.023***	0.008 **		0.239 **	0.461 ***
	(0.003)	(0.005)	(0.003)		(0.094)	(0.096)
HCBC offered (dummy)				0.417 **
				(0.166)
Controls	YES	YES	YES	YES	YES	YES
Year fixed effects	YES	YES	YES	YES	YES	YES
Prefecture fixed effects	YES	YES	YES	YES	YES	YES
Observations	9956	9956	9956	9956	4410	4831
R2	0.235	0.268	0.232	0.259	0.268	0.0616

Notes: Robust standard errors clustered at the individual level are reported in parentheses. *** p < 0.01, ** p < 0.05, * p < 0.10.

(1)–(3) show that after substituting the explained variable, the accessibility of home and community-based elderly care services still significantly increases the probability of rural older people’s social participation, and the conclusion remains robust.

4.2.2. Substitution of the Independent Variable

This study replaces the independent variable with a binary variable indicating whether the respondent’s community provides home- and community-based elderly care services. If a respondent reports that none of the services are provided in their community, the variable is assigned a value of “0”; otherwise, it is assigned a value of “1”. The regression results in Column (4) of Table 3 show that the provision of public elderly care services significantly promotes the social participation behavior of rural older people. This indicates that the result remains robust after substituting the independent variable.

4.2.3. Sample Size Adjustment: Focusing Only on the 60–69 Age Group

Considering that the social participation behavior of older people is constrained by their physical conditions—with the gradual decline of various physical functions as age increases, their ability and willingness to participate in social activities may decrease accordingly. Younger seniors (aged 60–69) are the main participants in social activities; therefore, this study only examines the impact of the accessibility of home- and community-based elderly care services on rural older people aged 60–69. The regression results in Table 3 column (5) show that the impact of public elderly care service accessibility on older people’s social participation remains robust.

4.2.4. Excluding the 2020 Sample

Although the 2020 wave of the CLASS survey was conducted during 2020–2021, a relatively stable period of the pandemic, COVID-19 might still have influenced older adults’ willingness and behavior regarding social participation. Therefore, year fixed effects were included in the model to account for the specific shock in 2020, and robustness tests were performed by excluding the 2020 sample. As shown in Column (6) of Table 3, the results remain robust after removing the 2020 data, indicating that the pandemic did not alter the main conclusions of this study.

4.3. Heterogeneity Analysis

The social participation behavior of rural older people is significantly influenced by both regional economic development disparities and the heterogeneous resource endowments of this demographic group. On one hand, the willingness and ability of the older people to participate in social activities are influenced by the quality of their human capital and social network resources. Generally, older people with higher education levels and richer social network resources exhibit stronger awareness of social participation. On the other hand, the improvement and functional implementation of the public elderly care service system require local governments to provide corresponding policy and financial support. Due to unequal distribution of public resources across regions, there are distinct disparities in the public elderly care service resource system, leading to significant differences in the support provided for the older people’s social participation behavior. Therefore, this study explores the heterogeneous effects of the accessibility of home- and community-based elderly care services on the social participation behavior of rural older people from the individual, family, and regional levels. Based on the 2018–2020 survey questionnaires, dummy variables are constructed to measure differences in individual, family, and regional characteristics from three dimensions: whether the individual has a higher education level, whether the individual lives with their children, and whether the individual resides in an economically developed region.

This paper introduces interaction terms between elderly care services and these individual variables and regional variables.

Table 4. Heterogeneity Analysis of the Impact of Public Elderly Care Service Accessibility on Social Participation Among Rural Seniors.

Variable	(1)	(2)	(3)
	Education	Co-Residence	Regional GDP
HCBC × High education	0.4196 **
	(0.203)
HCBC × Co-residence		0.3446 **
		(2.3219)
HCBC × Developed region			−0.4215 ***
			(−2.9381)
HCBC accessibility (main)	0.2533 ***	0.2352 ***	0.4498 ***
	(0.059)	(3.5043)	(6.1160)
Education attainment of junior high school or above	1.1194 **
	(0.446)
Cohabitation with adult children		−0.1895
		(−1.3840)
Economically more developed regions			−1.1002 ***
			(−6.8481)
Controls	YES	YES	YES
Year fixed effects	YES	YES	YES
Prefecture fixed effects	YES	YES	NO
Observations	9956	9956	9956
R2	0.0504	0.0489	0.0575

Notes: Robust standard errors clustered at the individual level are reported in parentheses. *** p < 0.01, ** p < 0.05, * p < 0.10.

reports the impact of the accessibility of home-based and community elderly care services on the social participation of the older people with different educational levels. Due to the generally low educational level of the older people in rural areas, the average educational level of the sample older people is about 2 years. Therefore, this paper classifies the samples with a junior high school education or above as the group with a higher educational level. The regression results show that, compared with the group with a lower educational level, the increase in elderly care service projects significantly improves the social participation behavior of the rural older people group with a higher educational level. The possible reason is that in rural areas of China, the older people with a higher educational level are often more popular, have more social resources, the cost of social participation is relatively low, and the demand for social participation is relatively stronger. The improvement of the accessibility of home-based and community elderly care services may be more able to stimulate the demand for self-value realization of the rural older people with a higher educational level, thus having a more obvious promoting effect on their social participation behavior.

Column (2) of Table 4 introduces the interaction term between elderly care services and living arrangements. The regression results show that, compared with rural people not living with their children, the accessibility of public elderly care services has a more pronounced impact on the social participation behavior of rural older people living with their children. The underlying reason is that intergenerational support from children serves as a strong backup for the elderly’s older people’s social participation [21] (pp. 154–168). Rural older people living with their children can obtain more daily care and emotional comfort, which ensures they have sufficient energy to participate in social activities. With the improvement of public elderly care service accessibility, the caregiving burden on children can be alleviated to a certain extent, allowing children to better focus on their work and lives. This, in turn, provides more family support for the older people’s social participation behavior.

Finally, this study conducts a heterogeneity analysis based on regional economic development status. Regions with a gross domestic product (GDP) higher than the sample average in the corresponding year are classified as economically developed regions. The results in Column (3) of Table 4 indicate that, compared with less economically developed regions, home- and community-based elderly care services significantly promote the social participation of rural older people in economically developed regions. A possible explanation is that economically developed regions have advantages in the quality of public elderly care service supply, which helps improve the older people’s health literacy and enhance their ability to participate in social activities. Meanwhile, the national strategy of active aging emphasizes encouraging the older people to participate in social activities. Economically developed regions may have more comprehensive policies and supporting facilities for promoting the older people’s social participation, and offer richer content and forms of activities for the older people’s social engagement. Therefore, the accessibility of home- and community-based elderly care services plays a more prominent role in promoting the older people’s social participation in economically developed regions.

4.4. Mechanism Analysis

4.4.1. Willingness

As shown in Column 1 of

Table 5. Regression Results Examining the Mechanism of Public Elderly Care Service Accessibility on Social Participation Among Rural Seniors.

	(1)	(2)	(3)	(4)
	Willingness	Labour Supply	MH Score	Good MH
HCBC accessibility	0.212 ***	−0.008 ***	0.115 ***	0.017 ***
	(0.039)	(0.002)	(0.031)	(0.005)
Controls & FE	yes	yes	yes	yes
Observations	9956	9956	9956	9956
R2	0.234	0.290	0.223	0.173

Notes: Robust standard errors clustered at the individual level are reported in parentheses. *** p < 0.01, ** p < 0.05, * p < 0.10.

, the accessibility of public elderly care services exhibited a significantly positive effect on rural old people’s social participation willingness (p < 0.01), suggesting that home- and community-based elderly care services enhance their engagement propensity. According to the Theory of Planned Behavior, individual actions are influenced by behavioral intentions. Therefore, the accessibility of public elderly care services may promote rural old people’s social participation by increasing their willingness to engage, thereby validating Hypothesis 2 (H2).

4.4.2. Leisure Crowding-In Effect

Column (1) of Table 5 reveals that public elderly care service accessibility significantly reduces rural old people labor supply (p < 0.01). Existing research demonstrates that under time endowment constraints, greater discretionary time allocation increases social participation likelihood [17] (pp. 69–81). Consequently, home- and community-based elderly care services may facilitate rural old people’s social engagement through two mechanisms: (1) by reducing labor supply demands, and (2) by creating additional leisure time, thereby validating Hypothesis 3 (H3). This leisure substitution effect aligns with the theoretical prediction that expanded time availability for non-compulsory activities enhances social interaction opportunities among older populations.

5. Mental Health Status

This study further examines the impact of public elderly care service accessibility on rural old people’s mental health, operationalized through both continuous mental health scores and a binary classification of mental health status. As shown in Columns (2)-(3) of Table 5, public elderly care accessibility significantly improved Mental health self-assessment scores and probability of positive mental health classification. Existing research demonstrates that old people’s social participation is contingent upon mental health conditions and cognitive functions. Therefore, mental health enhancement constitutes an additional mediating mechanism through which home- and community-based elderly care services facilitate rural old people’s social engagement.

6. Conclusions and Discussion, Recommendations, Limitations, and Future Studies

6.1. Conclusions and Discussion

This study utilizes data from the 2018 and 2020 waves of the CLASS survey, employing a two-way fixed effects model and instrumental variables approach to examine the impact of home-based and community-based elderly care services on social participation among rural seniors.

(1)

Findings indicate that accessibility to public elderly care services significantly promotes social participation among rural seniors, with results remaining robust after controlling for instrumental variables and sample adjustments. Unlike studies by Lin [28] (pp. 186–202) and Kong et al. [1] (p. 2023) that focus on the impact of social pension insurance—centered on fiscal subsidies—on rural seniors’ social participation, this research examines the influence of public policies on old people’s social engagement from a multifaceted perspective beyond mere economic support. This study shifts focus to home-based and community-based elderly care services—a composite policy offering both daily care and emotional support—systematically examining its impact mechanisms on social participation. This expands theoretical understanding of multidimensional intervention pathways in public policy.

(2)

This study examines the differential effects of public eldercare service accessibility on social participation among rural seniors across three levels: individual, household, and regional. Heterogeneity tests reveal that public eldercare service accessibility more significantly promotes social participation among rural seniors with higher educational attainment, those cohabiting with children, and those residing in economically developed regions. This finding aligns with Lu et al. [29] (pp. 18–24), who examined home-based and community-based elderly care services’ impact on older adults’ well-being by treating social participation as a mechanism variable. Their research revealed that the effectiveness of such service policies is closely linked to household resource endowments and regional economic development levels. Lu et al. [21] (pp. 154–168) examined how living arrangements influence older adults’ social participation. Their findings indicate that older adults living with their children and those with higher educational attainment are more likely to engage in social activities.

(3)

Mechanism analysis reveals that public elderly care services enhance social participation among rural seniors primarily by reducing their labor supply, improving mental health, and increasing willingness to engage in social activities. Unlike studies such as Li et al. [20] (pp. 186–202) on the relationship between public elderly care services and labor supply, and Jia et al. [19] (pp. 163–185) analyzing the impact of community-based elderly care services on mental health, previous research has primarily focused on the spillover effects of public elderly care services on the health or labor market of the old people. However, in the context of China’s accelerating aging process, whether and how public elderly care services can promote active aging remains an unexplored area. Given that rural areas represent both a priority and a challenge for active aging policies, this study constructs an analytical framework specific to rural contexts. It provides the first empirical examination of how the accessibility of public eldercare services influences social participation behaviors among old people. The findings reveal the potential role of public eldercare services in activating old people’s resources and reshaping social roles, thereby filling a gap in contextualized research on this topic.

6.2. Recommendations

Based on the research conclusions above, this study puts forward the following recommendations:

First, identify expanding the coverage of public elderly care services as a core measure to advance active aging in rural areas. Establish a collaborative mechanism featuring “government policy guidance, village-level organization implementation, and social force supplementation” to focus on fostering localized models such as rural mutual assistance elderly care and neighborhood care. Leverage policy tools including financial subsidies and venue support to guide elderly care service institutions to extend their services to rural areas, while simultaneously constructing village-level elderly care service centers. This will shorten the distance to elderly care services and enhance their accessibility.

Second, address the bottleneck of information asymmetry. It is recommended to establish “village-level public elderly care information service stations,” led by village committees and old people’s associations. Utilize down-to-earth communication methods such as loudspeaker broadcasts and door-to-door explanations to help the old people fully understand various elderly care services. Meanwhile, develop a voice interaction platform integrating service reservations, policy consultation, and health management, and assign village-level information specialists to provide operational guidance. It is also suggested to organize “Elderly Care Service Open Days” quarterly, where on-site experiences can improve old people’s acceptance of such services.

Third, we suggest establishing mutual-aid time banks for elderly care at the township level to create an efficient matching platform for volunteers and care recipients. Considering the close-knit nature of rural communities, younger and healthier older people can be encouraged to provide volunteer services and accumulate time credits, which can later be exchanged for equivalent services. This approach helps alleviate the current mismatch between the supply and demand of elderly care services and promotes the sustainable development of elderly care through intergenerational mutual assistance and intertemporal value exchange.

6.3. Limitations and Future Studies

This study has two limitations. First, the influence of potential confounding factors may still exist. Although the study employs the regional average number of services as an instrumental variable to mitigate endogeneity concerns and controls for year and regional fixed effects as well as socioeconomic variables, unobserved factors such as cultural and political influences may still affect the results. Future research could adopt multiple-instrument strategies or apply geographic regression discontinuity designs to further reduce potential biases arising from these contextual factors.

Second, the analysis lacks heterogeneity by service type. Due to data limitations, this study is unable to separately estimate the independent effects of home- and community-based services. We have added a note in the discussion section and suggested that future research employs more detailed data to further explore their differentiated impacts.