Evaluating the impact of a pilot programme for home- and community-based services on long-term care needs among older adults in China.

China is facing escalating demand for long-term care (LTC), prompting the central government to launch a 5-year pilot programme to strengthen home- and community-based services (HCBS) from 2016 to 2020. However, the effects of this pilot programme on LTC needs remain unknown. This study aimed to evaluate the programme's impact on LTC needs of older adults. Using panel data from the China Health and Retirement Longitudinal Study (N = 3,327), we evaluated the effects of the programme using a combined approach of propensity score matching and difference-in-differences. We found that the implementation of the HCBS programme reduced the number of unmet needs for assistance with instrumental activities of daily living (IADL) and delayed the progression of IADL limitations among older adults. However, no significant impact was found on the number of unmet needs for assistance with activities of daily living (ADL) or the progression of ADL limitations. Heterogeneity analysis showed that the effects of the HCBS programme on ADL and IADL limitations were weaker among those living in the Eastern region, and the effects on ADL limitations were stronger among those living with other people in the same household. Our findings suggest that implementing the HCBS programme can effectively address unmet care needs and delay the decline in functional capability among older adults. However, special attention should be paid to older adults living alone to mitigate the inequalities in functional limitations.