Enablers and Barriers to Alternative Care

Perspectives of Community‐Dwelling Older Adults and Service Providers in Kerala

Bibliographic Data

ID19509067
AuthorsAnu Mohan (0009-0008-4764-7502, Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India), Teddy Andrews Jaihind Jothikaran (0000-0002-9995-1492, Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India, corresponding author), Lena Ashok (0000-0003-2441-3224, Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India)
Year2025
Volume28
Issue6
Pagese70507-e70507
Publication date2025-12-01
Open AccessYes
TypeARTICLE
VenueHealth Expectations (JOURNAL)
Journal identifiersISSN: 1369-6513 • E-ISSN: 1369-7625
PublisherWiley (PUBLISHER • GB)
DOI10.1111/hex.70507
PMID41319051
OpenAlexW4416825696
LanguageEN
Citations received2
References cited45

BACKGROUND: Decline of intergenerational co-residence, risk of functional and emotional deprivations in old age, and the diminishing capacity of families to care in-person for their older parents have intensified the demand for formal care provisions among left-behind older adults in migrant households of Kerala. While several attempts have been made to quantify the accessibility and utilisation of geriatric care, there is a dearth of evidence on the realities of alternative care in Kerala. The present study aims to explore the perception of older adults (65+) and service providers (government and non-governmental) on the systemic enablers and barriers of alternative care in migrant households of Kerala. MATERIALS AND METHODS: A qualitative approach using IDIs were employed among 20 left-behind older adults (65+) and 8 service providers across three districts of Kerala (Pathanamthitta, Thrissur and Kannur), using purpose sampling, and thematic analysis was followed using a deductive approach. RESULTS: Analysis using the Rainbow Model of Integrated Care revealed that the high cost of care at a micro level limits access and utilisation, while the inactivity of day care homes and their failure to upgrade as resource centres challenge the alternative care at a meso level of operation. The absence of need assessments, top-down implementation, inappropriate fund allocation, lack of measures to sustain the programme and rigid eligibility norms for inclusion pose challenges in the care avenues, while pain and palliative care community-based associations and doorstep delivery of essential services facilitate seamless delivery of alternative care. CONCLUSION: Alternative care efforts should integrate regional, state and central levels of planning, concrete implementation guidelines, participation of older adults in planning and implementation, and efforts to upgrade day care homes into regional resource centres, along with systematic monitoring and evaluation and multi-stakeholder governance to realise alternative care for older adults. PATIENT AND/OR PUBLIC CONTRIBUTION: Informal discussions with community-dwelling older adults and service providers helped in refining research questions and in-depth interview guides to explore their lived experiences. Participants shared insights on their care experiences, which informed data collection and interpretation. Research findings were reviewed within a subgroup of older adults and service providers to ensure contextual accuracy in reporting the practical enablers and barriers of alternative care as perceived by the stakeholders

Aged care · Data collection · MEDLINE · Patient participation · Primary care · Qualitative research · Service provider · Geriatric Care and Nursing Homes · Healthcare innovation and challenges · Intergenerational Family Dynamics and Caregiving

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