Determining the spatial distribution of nursing homes in China: a spatial heterogeneity analysis

The number of people in China aged 60 and older has risen from 10.0% in 1999 to 17.9% in 2018, signaling that Chinese society is facing an unprecedented challenge to care for their ageing population. With the decline of traditional family support for elderly relatives and subsequent development of social provisions for them, nursing homes are expected to increasingly take on a caregiving role in the coming years. Therefore, this paper first ascertains the spatial distribution of nursing homes in China. Based on a global ordinary least squares (OLS) model and geographically weighted regression model, it then investigates which socio-economic factors affect the spatial distribution of nursing homes and the degree of their influence. Study results show that, (1) nursing homes are mainly located in the Bohai Bay Economic Zone and the Yangtze River Delta region, with fewer in western cities, except Chongqing; (2) urbanisation and fiscal expenditures are the main drivers for promoting nursing homes in the Yangtze River Delta region and southwest China; (3) the increase of nursing homes in the Pearl River Delta and Northeast China may largely rely on the level of social welfare, social welfare services, and higher number of elderly people; (4) outward migration poses a major challenge to the development of nursing home services in southwest China, and North and Central China Plain, given that population size is positively associated with the number of nursing homes, and (5) population migration from west to east is continuing, so regional collaboration between east and west is urgently needed to cope with the ageing issues. This research advocates for more detailed and region- and city-targeted elderly care policies on the basis of actual situations in cities and regions.