Facing changing needs? A study of older adults experiences of requiring home care for the first time

Abstract Introduction Many older adults, in Sweden and elsewhere, begin formal home care only after significant functional decline. Gaining insight into this initial transition is essential for understanding and responding to their needs and expectations during a period of major life changes. This study explores how older people describe their life situation and evolving needs leading up to their first application for home help services. Methods Fourteen adults (65+) with a first-time home care grant in Region Stockholm (2024) were purposively recruited via care providers, associations, and personal contacts. Participants had up to four months’ experience and varying care needs (I-ADL and P-ADL). Those with severe cognitive impairment were excluded. Interviews (mean 74 min) has beed transcribed and coded iteratively. Data is analysed using reflexive thematic analysis. Preliminary results Three preliminary themes have been created: 1) Living in a shrinking life space - about perceived isolation and feelings of being limited, being afraid of accidents and of losing control. 2) Ambivalence when reassessing the capacity for independence - about the gap between intellectual understanding the need for help, but having difficulties emotionally accepting it as well as the differences between your own and others’ analysis of the situation. 3) Becoming street smart to find a personalized solution for support - about getting new knowledge and strategies needed to apply for and adjust support services. Relevance Understanding the circumstances and underlying reasons why people decide to apply for home care for the first time can help to tailor application procedures and service provision in a timely manner in relation to older people's functional decline. This can alleviate individual suffering, enable secondary and tertiary prevention, and optimize the management of welfare resources in a long-term perspective.