Multi-Dimensional Accessibility Framework for Nursing Home Planning: Insights from Kunming, China

Rapid population aging in developing countries has intensified demand for accessible nursing home services, yet spatial disparities in service distribution remain insufficiently examined in secondary cities. This study investigates spatial distribution and multi-dimensional accessibility of nursing homes in Kunming, China, using comprehensive spatial analytical methods to inform sustainable urban development. We analyzed 205 nursing homes with 47,600 beds, evaluating spatial distribution patterns, economic accessibility, and spatial accessibility across different transportation modes. Our analysis reveals a pronounced monocentric pattern with nursing resources concentrated within central urban districts, creating a “primary core-multiple satellite” structure and spatial mismatch between service supply and older adult population needs. A distinct institutional dichotomy exists between publicly and privately operated facilities, establishing a dual-track system with different accessibility implications for social equity. Economic accessibility analysis demonstrates significant barriers in central urban and tourism-oriented districts dominated by higher-priced private facilities, where minimum prices frequently exceed average monthly pension. Spatial accessibility remains inadequate across all transportation modes, with only 24.3% of communities achieving normal or higher accessibility via private car, 21.5% via public bus, and merely 13.9% via walking. These limitations primarily stem from insufficient service capacity (34 beds per 1000 older adults) relative to demographic needs rather than transportation constraints. We recommend three sustainable interventions: implementing demand-based planning mechanisms, establishing progressive pricing policies, and developing older adult-friendly transportation networks. This framework supports sustainable urbanization by promoting spatial equity and efficient resource allocation, providing valuable insights for secondary cities pursuing sustainable development goals.