Regional Home-Care Service Availability and Formal and Informal Care Use Among Older Adults with Care Needs In South Korea

Background and Purpose

As population aging and changing family structures increase care needs among older adults, an important policy question is whether greater availability of home- and community-based care services expands formal care use and alters reliance on informal care. Existing research has largely focused on individual-level need factors, while paying less attention to the role of regional service availability in shaping care arrangements. To address this gap, this study examines how variation in home-care service availability across regions is associated with informal and formal care use among older adults with care needs in South Korea.

Method

This study used data from the 2023 National Survey of Older Koreans and focused on 1,648 older adults with care needs. Two binary outcomes were examined: informal care use (from kin or non-kin) and formal care use(publicly funded care services). Multilevel logistic regression models were estimated to account for individuals nested within 17 Metropolitan Cities and Provinces in South Korea. The key independent variable was regional home-care service availability, measured as the number of home care agencies per 1,000 older adults. Individual-level covariates included predisposing factors (age, gender, marital status, and education), enabling factors (household composition, number of close social ties, household income, and net wealth), and need factors (ADL limitations, IADL limitations, chronic conditions, and cognitive decline). Additional regional controls included the long-term care recipient rate and the proportion of older adults in the region.

Results

At the regional level, greater home-care service availability was associated with higher odds of formal care use (OR = 2.11, 95% CI [1.21, 3.68]), but not with informal care use (OR = 1.48, 95% CI [0.87, 2.50]). The regional proportion of older adults was also positively associated with formal care use (OR = 1.15, 95% CI [1.07, 1.23]), but not with informal care use. At the individual level, need factors—including ADL/IADL limitations, chronic conditions, and cognitive decline—were broadly associated with care use, highlighting the importance of functional need in shaping care arrangements. Beyond need, enabling factors further differentiated care arrangements: informal care use was more likely among those living with a spouse or others and those with more close social ties, whereas formal care use was more likely among older adults in elderly-only households (OR = 3.21, 95% CI [2.22, 4.64]) and less likely among those with higher net wealth (OR = 0.94, 95% CI [0.91, 0.98]).

Conclusions and Implications

These findings suggest that regional home-care infrastructure is associated with greater formal care use among older adults with care needs, but not with informal care use. Rather than displacing informal care, greater service availability may broaden access to formal care, particularly for those with greater functional limitations. Policy efforts should therefore focus not only on expanding home-care infrastructure, but also on reducing regional disparities in service availability and strengthening outreach to those most likely to be underserved — including older adults living alone or in elderly-only households and those with limited financial resources.