Older adults receiving home and community-based services in South Korea showed a lower risk of moving into a long-term care facility when their service volume was higher — but only if their level of dependence was mild, according to an exploratory study published in BMC Geriatrics. Among older adults with severe dependence, the researchers found no statistically significant inverse association between service volume and institutionalization risk, a result the authors say challenges the assumption that simply expanding care hours protects everyone equally.
The study drew on the National Health Insurance ‘Elderly Cohort Database’ and included 10,296 home care service users aged 65 and older. Using survival analysis, the team tracked transitions to long-term care facilities between 2015 and 2019. The longitudinal associations between relevant factors — including home care service hours, demographics, and socioeconomic resources — and the risk of transition were evaluated using Kaplan-Meier estimates and a stratified Weibull regression model.
In general, the risk of transitioning to a long-term care facility tended to increase over time among home care service users. Against that baseline trend, the stratified analysis revealed a clear divergence by severity of dependence. For older adults with mild dependence, a higher volume of home and community-based services was inversely associated with the risk of entering institutional care. That pattern did not hold in the severe dependence group, where the association was not statistically significant.
The authors emphasize that the analysis was exploratory and that the severe-dependence subgroup was smaller, which may partly explain why no significant inverse association was detected there. Because the study is observational, the findings describe associations rather than demonstrated causal effects, and the results should be interpreted with those limitations in mind. The research was published as an open access article on 29 October 2026 and shared early as a citable, peer-reviewed accepted version subject to further edits before the final Version of Record.
The research team included Yumi Shin, Sejeong Yang, Chang-O Kim, Bokyoung Choi, Jihwan Lee, Eunhee Choi, Jihee Choi, Soong-Nang Jang and Hyejin Lee. The authors suggest that policymakers should move beyond blanket expansions of home and community-based services and instead develop severity-tailored resource allocation strategies, since a uniform protective effect of care hours across all dependence levels could not be assumed from their data.
Subject of Research: The association between home and community-based service volume and the risk of transitioning to long-term care facilities among older Korean adults, stratified by dependence severity.
Article Title: Home and community-based service volume and the risk of transitioning to long-term care facilities: an exploratory stratified analysis
Article References: Shin, Y., Yang, S., Kim, C.-O., Choi, B., Lee, J., Choi, E., Choi, J., Jang, S.-N., & Lee, H. (2026). Home and community-based service volume and the risk of transitioning to long-term care facilities: an exploratory stratified analysis. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08466-8
Image Credits: AI Generated
DOI: 10.1186/s12877-026-08466-8
Keywords: home and community-based services, long-term care, older adults, dependence severity, National Health Insurance, survival analysis, Kaplan-Meier, Weibull regression, institutionalization, South Korea, BMC Geriatrics, health policy
News Source: Ophelia Keating. (October 29, 2026). More Home Care Hours Linked to Lower Nursing Home Risk Only for Mildly Dependent Older Adults. Scienmag.
