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

Population aging, the burden of chronic diseases, and the cost-effectiveness of home care (HC), compared to hospitalization and institutionalization, have increased the importance of HC. Therefore, there is a need to share the experiences of leading countries in home-based long-term care (LTC) for older individuals.

This review aimed to explain the structure of HC for older adults in different countries.

A scoping review was performed on HC published in English using PubMed, Embase, Scopus, Web of Science, CINAHL, Google Scholar, and grey literature. The search began in January 2022, and the latest search was conducted in June 2023. The main keywords ‘home care’, ‘old*’, ‘Funding’, ’organization’ and ‘training’ and ‘policy’ and ‘formal care’ and ‘home-based services’ were used for searching. The data were classified 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.

Overall, 44 documents out of 4072 studies were included in the final analysis, containing data from 23 countries. Each study covers some domains of HC, and some other studies compare domains in some Asian and European countries. The regulation makes authorities organize high-quality care. Ministries set legal frameworks, and municipalities are autonomous in determining principles and financing of services. Older adults are eligible to receive cash and in-kind benefits based on their needs or assets. Financing is done using insurance, taxes, or privately. Some countries have made the quality assessment of services mandatory.

This review can generate novel insights into designing HC systems according to different contexts. 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. Defining legal rights and responsibilities for caregivers and older individuals, universal coverage of LTCI for all older adults, financial and care options to help pay for HC, and training family caregivers are recommended for developing countries.