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Background <p>Publicly funded home care is pivotal in supporting ageing in place across high-income health systems. Home care delivery models vary in funding, governance, and service delivery. The scope, distribution, and comparability of evaluation evidence is limited.</p> Objective <p>To map and characterise models of publicly funded home care for community-dwelling older adults across six high-income countries: Canada, England, Denmark, Sweden, Australia, and New Zealand, and to synthesise available evaluation evidence related to model characteristics, quality, patient and family satisfaction, integration with health and social care, and equity-relevant considerations.</p> Methods <p>A scoping review was conducted in accordance with JBI methodology and reported following PRISMA-ScR guidelines. MEDLINE, Embase, and CINAHL were searched from 2005 onwards, alongside targeted grey literature searches. Data meeting the inclusion criteria were extracted and synthesised using qualitative content analysis. An equity lens was applied using the PROGRESS-Plus framework, and SAGER guidelines.</p> Results <p>Nineteen sources were included, comprising 14 peer-reviewed studies and five grey literature documents. Five models of publicly funded home care were identified<b>:</b> (1) provincially/territorially organized home care in Canada, where models vary by jurisdiction and level of integration; (2) the National Home Care Packages Program in Australia organized around consumer directed care; (3) the Universal Welfare Model managed municipally in Denmark and Sweden; (4) Cash for Care/Direct Payments in England; and (5) nationally framed Home and Community Support Services in New Zealand. Characteristics most common across models were public funding and professional as well as support services. Across models, evaluation evidence was unevenly distributed and largely descriptive, with relational aspects of care and workforce conditions prominent in reported experiences, and equity-relevant characteristics inconsistently reported.</p> Conclusions <p>This scoping review charts the models of publicly funded home care across six high-income countries and identifies gaps in the evidence. The findings underscore the need for consistent and comparative evaluation of home care models as population ageing and policy attention to integrated people-centred care intensifies.</p>

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Models of publicly funded home care for community-dwelling older adults across six high-income health systems: a scoping review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Marilyn Macdonald,
  • David Litvack,
  • Rochelle Litvack,
  • Paulina Carrasco,
  • Nadia Stec,
  • Kristy Hancock,
  • Alyssa Barker,
  • Ali Hammoud,
  • Grace Magro,
  • Andrea Tricco,
  • Sharon Strauss

摘要

Background

Publicly funded home care is pivotal in supporting ageing in place across high-income health systems. Home care delivery models vary in funding, governance, and service delivery. The scope, distribution, and comparability of evaluation evidence is limited.

Objective

To map and characterise models of publicly funded home care for community-dwelling older adults across six high-income countries: Canada, England, Denmark, Sweden, Australia, and New Zealand, and to synthesise available evaluation evidence related to model characteristics, quality, patient and family satisfaction, integration with health and social care, and equity-relevant considerations.

Methods

A scoping review was conducted in accordance with JBI methodology and reported following PRISMA-ScR guidelines. MEDLINE, Embase, and CINAHL were searched from 2005 onwards, alongside targeted grey literature searches. Data meeting the inclusion criteria were extracted and synthesised using qualitative content analysis. An equity lens was applied using the PROGRESS-Plus framework, and SAGER guidelines.

Results

Nineteen sources were included, comprising 14 peer-reviewed studies and five grey literature documents. Five models of publicly funded home care were identified: (1) provincially/territorially organized home care in Canada, where models vary by jurisdiction and level of integration; (2) the National Home Care Packages Program in Australia organized around consumer directed care; (3) the Universal Welfare Model managed municipally in Denmark and Sweden; (4) Cash for Care/Direct Payments in England; and (5) nationally framed Home and Community Support Services in New Zealand. Characteristics most common across models were public funding and professional as well as support services. Across models, evaluation evidence was unevenly distributed and largely descriptive, with relational aspects of care and workforce conditions prominent in reported experiences, and equity-relevant characteristics inconsistently reported.

Conclusions

This scoping review charts the models of publicly funded home care across six high-income countries and identifies gaps in the evidence. The findings underscore the need for consistent and comparative evaluation of home care models as population ageing and policy attention to integrated people-centred care intensifies.