Demand-Choice-Dilemma-Decision: Exploring the realities of paid care for community-dwelling older adults in Kerala

The deterioration of family-based care and rising functional impairment among older adults have led to greater reliance on paid care, which remains sparse in low- and middle-income care economies. The present study aims to explore the demands and dilemmas in paid care as perceived by caregivers, receivers, and service providers. A qualitative exploratory design grounded in an interpretivist approach is used to explore demands and dilemmas in paid care. Twenty older adults (65+), seven caregivers, and eight service providers were selected through purposive sampling and interviewed until data saturation, followed by an inductive thematic analysis. The analysis illuminated the care demand‒choice‒dilemma‒decision framework, which depicts the realities of the care paradox and the pathways to care decisions in migrant households. However, suitability, reliability, risk of discontinuity, unaffordability, and limited person-centered care in paid care are reported as dilemmas in paid care, which is critical in deciding the places where people choose to age in their later years.