Structure and Organization of Home-Based Care for Older Adults in Different Countries: A Scoping Review

Abstract

Background: Home care (HC) for older people is important due to population aging, chronic diseases, and cost-effectiveness. Sharing experiences of leading countries in home-based long term care (LTC) is needed. Objectives: This review describes the structure of HC for older adults in different countries. Methods: A scoping review was done on HC published in English, using databases and grey literature. The search was from January 2022 to June 2023. The main keywords were 'home care', 'old', 'Funding', 'organization', 'training', 'policy', 'formal care', and 'home-based services'. Data are categorized into 7 domains, including (1) governing, (2) long-term care insurance (LTCI), eligibility for HC services and financing, (3) benefits, (4) marketization and free choice system, (5) workforce training, (6) quality assurance of care, and (7) supporting caregivers. Results: Out of 4072 studies, 50 documents from 23 countries were analyzed. Each study covers some HC domains, and some compare domains in some Asian and European countries. The regulation enables authorities to organize quality care. Ministries provide legal frameworks, and municipalities are autonomous in determining principles and financing. Older adults receive cash and in-kind benefits based on their needs or assets. Financing is done by insurance, taxes, or privately. Some countries have mandatory quality assessment of services. Conclusions: This review can generate novel insights into designing HC systems according to different contexts. However, comprehensive information on HC organizations for older adults was only available in some countries. Therefore, further in-depth studies are needed to assess each component of the HC system separately. For developing countries, some recommendations are to define legal rights and responsibilities for caregivers and older individuals, to provide universal coverage of LTCI for all older adults, to offer financial and care options to help pay for HC, and to train family caregivers.