Advancing people-centred community-based integrated care for frail older adults: A cross-national assessment using WHO's long-term care framework in Thailand, Germany, Japan, and the United States.

Background

Rapid demographic shifts necessitate resilient community-based integrated care systems (CBICS), particularly in resource-constrained nations. This study examines how social structures interact with policy mechanisms in diverse economic contexts to inform sustainable care models for emerging ageing societies.

Methods

We employed a qualitative comparative case study design using the World Health Organization (WHO) Country Assessment Framework for the Integrated Delivery of Long-Term Care. Data collection comprised semi-structured interviews with 47 key informants and a targeted documentary review of policy texts, statutes, and operational guidelines from Thailand, Germany, Japan, and the United States. Interview and documentary evidence were synthesised through a hybrid framework analysis combining deductive coding against the WHO domains with inductive thematic analysis.

Results

Findings reveal three integrative themes that cut across the WHO domains: (i) divergent service delivery configurations spanning informal networks and structured hubs; (ii) workforce sustainability tensions between professionalisation and volunteerism; and (iii) governance and financing patterns balancing stability and flexibility. Germany and Japan prioritise stability through statutory insurance; the United States emphasises technological innovation through programmes such as the Program of All-Inclusive Care for the Elderly (PACE); and Thailand leverages dense social capital to address infrastructure gaps.

Conclusions

Sustainable care in emerging economies requires a culturally adapted policy transfer approach that hybridises the financial resilience of statutory models with the community-driven ethos of local networks. For geriatric nursing practice, the findings highlight a leadership role in coordinating volunteer accreditation, embedding age-friendly digital tools, and brokering integration between health and social services across diverse welfare regimes.