Community-Based Long-Term Care for Older Adults

Community-based long-term care encompasses an array of health, social and supportive services delivered outside institutional settings to enable older adults to maintain independence, dignity and quality of life in familiar environments. Driven by demographic shifts and policy priorities, this model emphasises person-centred care, multidisciplinary collaboration and integration of health and social support. Services commonly include personal care, nursing, rehabilitation, meals, transportation and respite for informal carers. Funding mechanisms vary internationally, encompassing public insurance schemes, targeted waiver programmes and out-of-pocket contributions. Innovations in care coordination, digital health platforms and risk stratification are enhancing the ability to tailor interventions to individual needs and to monitor outcomes in real time. At the same time, challenges persist in workforce training, equitable access, affordability and the sustainability of community infrastructure. Research highlights the critical role of early assessment, comprehensive discharge planning and seamless transitions between hospital, community and residential care. In this context, ageing in place is not only a preference expressed by many older adults but also a strategic imperative to contain costs and improve wellbeing. Regional collaborations between primary care, social services and community organisations further underpin efforts to bridge gaps, reduce emergency admissions and support informal carers. The global significance of community-based long-term care is underscored by population ageing trends in both high- and low-income settings, where tailored, culturally sensitive models are emerging to address local resource constraints and social expectations.

Research from Nature Portfolio

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Community-Based Long-Term Care for Older Adults publication trend

The graph below shows the total number of articles in community-based long-term care for older adults across all publications each year (not limited to Nature Index journals).

Technical terms

Community-Based Long-Term Care: A system of health and support services delivered in non-institutional settings to enable older adults to maintain independence and quality of life at home or within community environments.

Aging in Place: The principle and practice whereby older individuals remain living in their own homes or familiar communities safely, affordably and with access to necessary services as their care needs evolve.

Instrumental Activities of Daily Living (IADLs): A set of complex tasks—such as managing finances, shopping and using transportation—that are essential for independent community living.

Home and Community-Based Services (HCBS): A broad category of publicly or privately funded programmes offering personal care, nursing, meal delivery and other supportive services to older adults in their homes or community settings.

Waiver Programme: A state-option under Medicaid that allows federal funds to cover home and community-based services as an alternative to institutional care.

References

1. Evaluating the health outcomes of aging in place: the role of medicaid aging waiver program on U.S. older adults. BMC Public Health (2024).
2. Program of All-Inclusive Care for the Elderly (PACE) versus Other Programs: A Scoping Review of Health Outcomes. Geriatrics (2022).
3. The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents. Health Services Research (2022).