Home- and community-based services, informal support networks, and life satisfaction among older adults in China: moving beyond filial support

BACKGROUND: With rapid population ageing and shrinking household sizes in China, Home- and Community-Based Services (HCBS) have become a critical component of elderly care. However, the interplay between formal services and informal support networks-such as intergenerational family support and horizontal social ties-remains insufficiently explored. This study examines the impact of HCBS utilization on life satisfaction among older Chinese adults and analyzes how these effects are moderated by different types of support networks. METHODS: This study utilized data from the 2023 China Longitudinal Aging Social Survey (CLASS). Ordinary Least Squares (OLS) regression was employed to estimate the baseline association between HCBS utilization and older adults' life satisfaction. To address potential selection bias and endogeneity, propensity score matching (PSM), inverse probability weighted regression adjustment (IPWRA), and an instrumental variable (IV) approach were applied. Furthermore, we examined the moderating effects of informal support (filial support networks and social support networks). Heterogeneity analyses were conducted across urban-rural residency, income levels, activities of daily living (ADL), and age cohorts. RESULTS: After rigorously addressing selection bias, we found no significant main effect of HCBS utilization on life satisfaction within the full sample. However,HCBS utilization significantly improves life satisfaction exclusively among rural older residents. Moderation analyses identified distinct mechanisms: the emotional network synergistically enhanced the HCBS effect (β = 0.101∼0.136, p < 0.01), whereas the instrumental network exhibited a substitution effect, attenuating the HCBS impact (β = - 0.084∼ - 0.055, p < 0.05). Independently, the instrumental network served as the strongest protective factor for ADL-impaired (β = 0.158, p < 0.05) and low-income (β = 0.137, p < 0.01) elders. A striking geographic divergence emerged: emotional networks benefited urban residents (β = 0.037, p < 0.05) but harmed rural ones (β = - 0.046, p < 0.01), while contact networks uniquely benefited rural areas (β = 0.041, p < 0.01). CONCLUSION: Aging policies must move beyond traditional assumptions of filial support, as empirical evidence uncovers that broader informal ties-particularly instrumental networks-now exert a stronger relative impact on well-being than traditional family care. Furthermore, HCBS is not a one-size-fits-all solution; its benefits are geographically masked, primarily accruing to rural and functionally capable elders. The interplay between formal and informal care features emotional synergy and instrumental substitution. Policymakers must favor precision-tailored interventions that integrate formal HCBS with robust community networks.