Abstract:

Objective: To provide empirical evidence for optimizing meal assistance policies and strengthening their role in supporting the health of older adults, this study took Shandong Province as a case to examine the policy logic and practical challenges of meal assistance services for older adults. Methods: A combination of policy tool text analysis and qualitative interviews was employed. For the policy tool analysis, 59 policy documents related to meal assistance for older adults at the central and Shandong provincial levels from 2013 to 2024 were selected and categorized using a three-part framework, with policy provisions coded and analyzed as units. Qualitative interviews were conducted in two rounds, from August to October 2023 and again in January 2026, across eight urban and rural sample sites within Shandong' s three major economic circles, involving 17 providers of meal assistance services for older adults; the interview data were coded and analyzed using thematic analysis. Finally, the two sets of data, including policy tools and implementation themes, were integrated through a comparative approach. Results: The development of meal assistance policies for older adults in Shandong Province can be broadly divided into three stages: The initial stage, the growth stage, and the deepening stage. Overall, policy tools exhibited a balanced emphasis on supply-oriented and environment-oriented instruments, while demand-oriented instruments remained relatively insufficient. Interview findings indicated that urban areas had primarily adopted a "government subsidy + market operation" model, while rural areas mainly relied on happiness homes, village collective resources, and public welfare positions to deliver meal assistance services. However, both urban and rural areas faced common challenges, including a mismatch between financial subsidies and operational costs, a shortage of professional staff, weak motivation for social participation, insufficient expression of demand and sustained spending by older adults, and limited implementation capacity at the grassroots level. Meanwhile, some meal assistance sites showed early signs of health-oriented meal assistance practices, such as adjusting menus according to older adults 'dietary preferences, chewing ability, and chronic disease conditions, reducing oil and salt in meal preparation, and exploring meal delivery and health education activities. Nevertheless, these efforts remained largely experience-based and fragmented, and had not yet developed into a standardised model. Conclusion: Meal assistance services for older adults are not only a livelihood initiative to ensure access to warm meals for older adults, but also a crucial entry point for promoting balanced diets, maintaining functional capacity, and achieving healthy aging. Future efforts should focus on refining a tiered and categorized subsidy mechanism, optimizing the differentiated supply structure between urban and rural areas, enhancing demand-side mobilization and social collaboration, strengthening grassroots governance and quality supervision, and facilitating the transition of meal assistance services from project-based provision to an institutionalized and sustainable model.

Key words: Meal assistance for older adults, Public policy, Healthy aging, Home- and community-based care