To analyze the current status and influencing factors of long-term care needs among middle-aged and older adults in China, and to provide a reference for optimizing long-term care services and formulating precise policy supply.

Using data from the 2020 China Health and Retirement Longitudinal Study（CHARLS）, this study focused on individuals aged 45 and above. Andersen’s Behavioral Model of Health Services Use was employed as the theoretical framework. Fisher’s exact test and multinomial logistic regression models were utilized for the analysis.

75.97% preferred home-based long-term care, 1.82% preferred long-term care in nursing homes, 1.05% chose hospital-based long-term care, and 21.16% selected other care options. In terms of predisposing characteristics, males were more likely to prefer nursing home care（OR=2.19, 95% CI=1.16-4.12）and other care options（OR=1.75, 95% CI=1.37-2.22）. Individuals aged 75 and above were more inclined toward hospital-based long-term care（OR=3.80, 95% CI=1.51-9.55）. Divorced（OR=23.62, 95% CI=3.69-151.30）, widowed（OR=43.70, 95% CI=12.88-148.27）, and other marital status groups（OR=26.45, 95% CI=7.50-93.35）were more likely to choose nursing home care. Regarding enabling resources, those with pensions or wages were less likely to choose nursing home care（OR=0.17, 95% CI=0.06-0.51）but more likely to select other care options（OR=3.74, 95% CI=2.93-4.77）. In terms of psychosocial factors, individuals who participated in social activities were less likely to prefer hospital care（OR=0.40, 95% CI=0.18-0.89）and other long-term care options（OR=0.54, 95% CI=0.43-0.67）. Those with depressive tendencies were more likely to prefer nursing home care（OR=0.40, 95% CI=0.14-0.91）.

The long-term care needs of middle-aged and older adults in China are influenced by factors such as gender, age, marital status, pensions or wages, participation in social activities, and depressive tendencies. There are still significant limitations in their autonomous choice of care options, with family-based care being the predominant preference. Therefore, the government should strengthen the top-level design of long-term care service systems, improve policy support, optimize the coordinated governance of multiple departments such as civil affairs, health, and medical insurance, increase support for home-based elderly care, and provide multi-level long-term care services.