Institutional Design of Home-Based Elderly Care Services in China: Legal Norms, Organizational Dilemmas, and Governance Pathways

Abstract

China has established a multi-level legal framework for home-based elderly care services through local regulations and normative documents. However, quantitative legislative growth does not equate to effective institutional design. This paper identifies four fundamental design deficiencies that undermine the organizational performance of the service delivery system: (1) restrictive protection scope due to age thresholds and household registration barriers; (2) ineffective incentive norms for social forces; (3) fragmented entry standards coupled with a vacuum in exit mechanisms; and (4) over-reliance on fiscal funding without adequate supervision. These problems stem from four root causes: the absence of a rights-based legislative philosophy, structural imbalance in central-local legislative power allocation, hard constraints of service supply capacity, and institutional insufficiency of funding guarantees. To address these, this paper proposes systematic reforms: expand protection coverage through universal legislative philosophy and unified assessment procedures; institutionalize incentives for enterprises, social organizations, and volunteers via legally binding norms; establish unified, age-friendly entry standards and fill the institutional gap in exit mechanisms; diversify funding channels, elevate long-term care insurance to statutory social insurance, and institutionalize fund supervision. The core argument is that the legal-institutional framework must transition from management-oriented tools to rights-based protections, thereby achieving the shift from formal legislation to substantive governance.