Older adults prefer to age in place in homes and communities, where they have a sense of attachment and familiarity.1 Aging in place is considered a way to facilitate independent living and high quality of life for older populations.2 To support aging in place, policymakers globally have developed strategies to expand community-based care services to prevent or delay admissions into long-term care (LTC) facilities,3,4 and reduce the cost of health care in the aging population.5

In South Korea, the proportion of adults aged 65 years and older is expected to reach 20% by 2025.6 In response to growing care needs, the Korean government established national LTC insurance for older adults in 2008. In 2018, a community-based integrative care policy was also adopted to develop comprehensive medical, LTC, and housing service models in local communities to support aging in place.7 Despite the positive impact of LTC insurance on older adults through facility and in-home benefits,8 there have been limitations in care delivery for community-dwelling older adults. Along with a concern about the quality of LTC services, the lack of coordination between healthcare and LTC services has led older adults to prefer hospitalization over receiving care in the community.9

Older adults need diverse types of assistance depending on their health conditions and individual needs. The World Health Organization (WHO) has defined community-based care services and programs as a blend of health and social services provided to an individual or family in their place of residence to promote health or minimize the effects of illness and disability.10 Community-based services have been shown to be effective in preventing institutionalization and enhancing the physical function and well-being of older adults.11 In this regard, the length of hospital stay has been reported to be minimized to facilitate early discharge, with health and social care services provided in an integrated way in countries experiencing population aging.12,13 The places of residence and care for older adults have also diversified. In addition to conventional homes, older adults with care needs may reside in care institutions, including nursing homes. A growing number of older adults also reside in senior housing, which has been developed in an effort to link housing and community-based LTC services.14

Previous studies have reported that old age, functional disabilities, and marital status are key determinants of the need for formal care services.15,16 A study conducted in Taiwan showed that institution-based service users were less likely to be married and to co-reside with family members than community service users.16 However, previous research on determinants of older adults’ formal care use have tended to focus on institution-based services, including nursing home or hospitals.17, 18, 19 Despite the diversity in care services that support older adults’ daily living (e.g., visiting services, senior center, transportation, adult day care),10 factors associated with the need for community services are unclear. Moreover, a recent review of studies reported that there is a lack of research on LTC services that address social care needs and enhance social participation.20 Understanding older adults’ needs for health and social care services is important to develop effective and comprehensive policies and services. However, the diverse needs of community-dwelling older adults are less well known, especially in the LTC context.

This study aimed to explore the patterns and factors associated with a need for community- and institution-based care services among community-dwelling older adults. We focused on both healthcare services and social care services. We applied Andersen's behavioral model of health services use, which posits that the use of healthcare services is determined by predisposing, enabling, and need factors.21 Older adults’ care needs have been found to be associated with an individual's predispositions, such as age, gender, educational level, and need factors (health conditions).22, 23, 24 Further, factors that enable the use of care services, such as income level and marital status, have also been found to be associated with care needs.25

In this study, we hypothesized that predisposing, enabling, and need factors would be associated with needs for each service. We expected that need factors and enabling factors would mainly be associated with a need for community- and institution-based care services among older adults in South Korea. Given the importance of family care, we also expected that those who are married or co-reside with children would have higher needs for community services and lower needs for institution services. The study is intended to provide insights for policy developments to help meet older adults’ individual needs and reduce inequalities in care utilization in community and institution settings.