Behind the High Scores: Adaptive Compliance and the Evaluation of Care Among Dependent Older Adults in Chinese Long-Term Care.

This convergent mixed-methods study examines how institutional dependency shapes older adults' evaluations of long-term care in China. A SERVQUAL-based survey of 154 residents across three Chongqing facilities was integrated with 35 audio-recorded cases of score-narrative inconsistency. Despite high survey reliability, qualitative findings revealed lowered expectations, strategic face-work, and mismatches between abstract quality concepts and lived care experiences. High satisfaction scores may thus reflect adaptive compliance shaped by structural dependency and cultural norms. The findings highlight gerontological social workers' roles in psychosocial support, independent quality observation, and advocacy to strengthen care evaluation. .