Disparities in Integrated Care Needs Across Three Types of Long-Term Care Facilities in China: A Multi- Centre Comparative Analysis

Background Integrated care is a pivotal strategy for addressing global population aging, with its core tenet being “person-centered and demand-driven”. The Chinese government’s “14th Five-Year Plan for National Aging Development” explicitly advocates for the classified development of three types of long-term care facilities (LTCFs): subsistence security-oriented, inclusive support-oriented, and fully market-oriented. However, evidence regarding the integrated care needs of older adults across these distinct institutional models remains scarce, particularly concerning activities of daily living (ADL)-impaired older people. Objectives To investigate the integrated care needs of older people in the above three types of LTCFs and explore the influencing factors of such needs. Methods This multi-centre, cross-sectional,study included 1300 older people from LTCFs. Participants were surveyed using a general information questionnaire and an integrated care needs questionnaire. Multiple linear regression analysis was conducted to identify the factors influencing their integrated care needs. Results Older adults in LTCFs reported moderate-to-high integrated care needs (overall mean ± SD: 3.42 ± 0.62 on a 5-point scale), with the highest demand for basic nursing (3.65 ± 0.72), followed by health guidance (3.58 ± 0.76). Multiple linear regression analysis (adjusted R²=0.512, F = 70.258, p < 0.001) identified ten independent determinants:facility type (public welfare vs. private: β = 0.236, p < 0.001), primary income source,family visit frequency, ADL impairment severity (severe vs. mild: β = 0.332, p < 0.001), chronic disease burden, hospitalization frequency, polypharmacy status, sensory impairment (β = 0.275, p < 0.001), psychological state (poor vs. Good: β = 0.228, p < 0.001), and length of stay. Notably, 89.30% of residents expressed desire for facility-community collaborative care windows. Conclusion Older people in Chinese LTCFs present substantial, multidimensional integrated care needs that vary inversely with facility service capacity. ADL impairment severity, sensory deficits, and psychological distress emerged as the strongest determinants. These findings inform targeted resource allocation and the development of tiered, facility-type-specific integrated care protocols to address the “high age, disability, and chronicity” challenges in institutional aging.