**1. Introduction**

Life satisfaction, an overall assessment of an individual's quality of life based on predefined criteria [1], is a subjective cognitive process of comparing the current situation with pre-defined criteria [2]. A specific heterogeneity in the criteria of life satisfaction exists for people in different life cycles [3]. Under the trend of accelerated population aging, on the one hand, the transformation of social roles and the decline of physical functions of the elderly enable them to begin to reassess their own values. Psychological problems such as low self-esteem, loneliness, loss, depression, and paranoia gradually emerge and bring about a reduction in mobility and the deterioration of the physical health of the elderly [4,5]. On the other hand, with the change in social structure and the weakening of family functions, it is increasingly difficult to satisfy the physical and mental needs of the elderly by depending solely on care provided by children and relatives. The intergenerational support from children to parents in a family with fewer children may also increase the psychological burden of the elderly on hampering their children's work [6,7]. A deterioration of physiological functions and an increase in psychological burdens negatively affect the daily lives of the elderly and reduce their life satisfaction. In this context, numerous researchers have explored the influencing factors for the life satisfaction of the elderly and investigated effective ways to improve their quality of life from different perspectives [8,9].

The seventh census indicates that 13.5% of China's population is over 65 years old, and the country has fully entered an aging society [10]. Therefore, it is urgen<sup>t</sup> to promote a senior care service system in line with China's national conditions. From the perspective of the existing elderly care model in China, the family elderly care model is still the main

**Citation:** Zhang, Z.; Mao, Y.; Shui, Y.; Deng, R.; Hu, Y. Do Community Home-Based Elderly Care Services Improve Life Satisfaction of Chinese Older Adults? An Empirical Analysis Based on the 2018 CLHLS Dataset. *IJERPH* **2022**, *19*, 15462. https://doi.org/10.3390/ ijerph192315462

Academic Editors: V. K. Kumar, Jasmin Tahmaseb-McConatha and Antonio G. Oliveira

Received: 18 October 2022 Accepted: 21 November 2022 Published: 22 November 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

<sup>1</sup> College of Civil Engineering & Architecture, Zhejiang University, Hangzhou 310027, China

<sup>3</sup> Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin 300301, China

**<sup>\*</sup>** Correspondence: 12012142@zju.edu.cn

one, and the institutional elderly care model is supplementary. However, these two models are gradually showing shortages and weaknesses, and the community home-based elderly care model has been put forward. The differences and connections between three kinds of elderly care models are summarized in Table 1.

**Table 1.** Differences and connections between three kinds of elderly care models.


From the perspective of the institutional model, unlike the elderly in developed countries and regions, the Chinese elderly generally have a strong affection for family retirement. Moreover, because economic development and social welfare are still at a preliminary stage, the limited development and managemen<sup>t</sup> capacity of institutional elderly care has led to various problems of "bullying the elderly" [11]. This has caused the public to question the institutional elderly care model. From the perspective of the family elderly care model, although this type of model can meet the home sentiment of Chinese older people, the "4-2-1" or "4-2-2" family form has led to the need for children to balance family elderly care, child-rearing, and work. Therefore, their children are under too much pressure from elderly care, and the weakness of the family elderly care model has gradually emerged [12].

Combined with the experience of mature elderly care models in developed countries, community home-based elderly care can meet the psychology of the elderly aging at home, relieve the pressure on their children, and allow the elderly to receive medical and elderly care services provided by relevant service institutions and professionals. This can combine the advantages of family and institutional elderly care to the greatest extent and become a novel idea for the development of the elderly care model integrated with Chinese characteristics [13]. Therefore, it is important to investigate the effectiveness of community home-based elderly care services (CHECS) and analyze the impact of CHECS on their life satisfaction to promote their healthy aging and improve the "home-based, community-depended, institutional-supplemented, medical combined elderly care service system" [14].

Previous studies have investigated the effects of CHECS on the quality of life of the elderly from different aspects [15,16]. At least three aspects need improvement. The first is in terms of research methods. Most prior studies employed traditional linear regression methods such as Logit, Probit, and Tobit and investigated whether they received CHECS as a dummy variable in the regression equation. This allowed for the comparison of the differences in quality of life between older adults who received CHECS and those who did not [17,18]. However, such methods overlook the heterogeneity of the two types of older adults and cannot overcome the biased estimation and sample selectivity deviation caused by sample "self-selection", thus resulting in invalid results. The second aspect is in terms of research content. The majority of studies examined the impact of CHECS on the quality of life of older adults from the perspective of both physical and mental health [19,20]. However, only a few studies explored the impact on life satisfaction. The third aspect is in terms of the selection of control variables. Most studies only selected the individual characteristics and living habits of the elderly as control variables [21,22]. However, in China, which is still dominated by family retirement, financial, health, and emotional support from family has a significant impact on the elderly [23]. Only a few studies include these as relevant control variables, such as Chen and Hao's study on the mental health of the elderly [24] and Yao et al.'s study on the physical and mental health of the elderly [25]. In addition, based on Maslow's needs theory, human life needs five

levels, namely, physiological, security, love/belonging, respect, and self-actualization [26]. Among them, physiological and safety are primary needs, love/belonging and respect are intermediate needs, and self-actualization is a high need. When the lower-level needs are satisfied, the higher-level needs will subsequently be created [27]. Compared with physiological and psychological health, life satisfaction is a higher-level need. Therefore, the level of physiological and psychological health of the elderly affects their life satisfaction. However, only a few relevant studies include them as control variables.

In order to investigate the effect of different kinds of CHECS on the life satisfaction of Chinese older adults, this work employs propensity score matching (PSM), a quasi-natural experimental research method, to establish a counterfactual research framework based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. We also empirically analyzed the effect of CHECS on their life satisfaction in different groups, with different activities of daily living (ADL), depression levels, and living conditions. The findings obtained are useful for broadening the research scope of CHECS on the quality of life of Chinese older adults. We aim to provide an important practical reference to further optimize CHECS supply, promote the development of a senior care service system in line with China's national conditions, and contribute to active and healthy aging.

#### **2. Materials and Methods**
