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Impact of Home-Based Care Services on Healthcare Utilization among Older Adults in Nigeria

Abstract

The ageing population is increasing in many countries, including Nigeria, creating a growing need for accessible and appropriate healthcare services for older adults. Older adults may experience multiple chronic conditions, reduced mobility, functional limitations, and difficulties accessing conventional facility-based healthcare. Home-based care services provide an alternative approach to healthcare delivery by bringing appropriate health and supportive services directly to older adults within their homes. These services may include home visits by healthcare professionals, medication support, health monitoring, basic nursing care, health education, rehabilitation, assistance with activities of daily living, referral, and follow-up care. Healthcare utilization refers to the extent to which individuals access and use available healthcare services, including primary healthcare visits, hospital services, diagnostic services, medication-related services, and emergency care when required. In Nigeria, older adults may face barriers to healthcare utilization such as geographical distance, transportation difficulties, financial constraints, physical limitations, long waiting times, inadequate geriatric services, and limited family or caregiver support. Home-based care services may reduce some of these barriers by providing healthcare closer to older adults and facilitating timely contact with healthcare professionals. Against this background, this study investigates the impact of home-based care services on healthcare utilization among older adults in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Systems Framework, and the Continuity of Care Model. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how home-based services may influence older adults' access to healthcare. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential medicines, financing, and access to healthcare as important components of an effective health system. The Continuity of Care Model emphasizes coordinated, consistent, and accessible healthcare across different stages and settings of care and provides a suitable basis for examining the role of home-based services in supporting continued healthcare utilization. Collectively, these theoretical perspectives provide a suitable framework for explaining how home-based care services may influence healthcare utilization among older adults in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from adults aged 60 years and above receiving or eligible for home-based care services across selected locations in Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, home-based care programmes, and eligible older adults. Home-based care services will be assessed using indicators such as frequency of home visits, availability of trained healthcare personnel, nursing care, medication support, health monitoring, rehabilitation services, health education, assistance with activities of daily living, referral services, follow-up care, accessibility, affordability, and continuity of service. Healthcare utilization will be assessed using indicators such as frequency of primary healthcare visits, hospital attendance, outpatient visits, diagnostic service use, medication-related healthcare visits, emergency healthcare utilization, and follow-up appointments within a defined reference period. Structured questionnaires, service records, healthcare utilization records, and relevant caregiver information will be used for data collection where appropriate. Descriptive statistics will be used to summarize participants' characteristics, home-based care utilization, and healthcare utilization patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the impact of home-based care services on healthcare utilization. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that access to effective home-based care services has a significant positive impact on healthcare utilization among older adults in Nigeria. Older adults who receive regular and appropriate home-based care are expected to have greater access to necessary healthcare services and better continuity of care than older adults without access to such services. Home visits may facilitate early identification of health problems, medication monitoring, routine health assessments, and timely referrals to healthcare facilities when specialized care is required. By reducing the need for frequent travel, home-based care may also overcome mobility and transportation barriers that discourage some older adults from seeking healthcare. Regular follow-up may further encourage adherence to scheduled appointments and improve continuity of treatment. Conversely, limited availability of home-based care services, inadequate staffing, high service costs, and weak referral systems may restrict their potential benefits. However, home-based care services alone may not fully determine healthcare utilization because household income, health insurance coverage, family support, severity of illness, transportation infrastructure, availability of healthcare facilities, and individual health-seeking behaviour may also influence utilization. The study is expected to contribute to the literature on home-based care, healthcare utilization, geriatric health, ageing, community health, primary healthcare, nursing, chronic disease management, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, community health programmes, home-care providers, geriatric healthcare professionals, development partners, and policymakers regarding strategies for improving healthcare access among older adults. The study will also provide evidence-based recommendations for expanding home-based care programmes, increasing the availability of trained home-care personnel, strengthening referral and follow-up systems, integrating home-based services into primary healthcare, improving access to essential medicines and health monitoring, reducing financial and transportation barriers, and developing age-responsive healthcare services for older adults across Nigeria.

Keywords: Home-based care services, healthcare utilization, older adults, Nigeria, geriatric health, ageing, community health, primary healthcare, home healthcare, healthcare access, chronic disease management, public health.