Specialized Home Care Needs and Models for Disabled Older Adults by Disability Level: A Cross‐Sectional Study

Background Home care systems face critical challenges: severe staff shortages, ill‐defined service content, and ineffective care needs communication, all contributing to suboptimal service delivery. Developing a severity‐stratified priority model for functionally impaired older adults enables precise resource allocation, improving both care quality and quality of life in this high‐risk population. Objective To identify the specialized home care service needs of older adults with physical disabilities across varying disability levels and to propose strategies to optimize specialized home care services. Design A cross‐sectional study. Setting and Participants From October 2023 to January 2024, 550 older adults with physical disabilities participated in a disability assessment in Shanghai, China. Methods Using the Kano model as the analytical framework, item attributes were determined through the maximum‐frequency method. Better–Worse analysis calculated the satisfaction and dissatisfaction indices for each service, and an importance matrix analysis was subsequently plotted to prioritize demand items. Results A total of 534 complete datasets were obtained, with disability levels distributed as follows: complete self‐care (318 cases, 59.6%), mild disability (68, 12.7%), moderate disability (45, 8.4%), and severe disability (103, 19.3%). Better–Worse matrix analysis revealed distinct demand item distributions across disability levels. Overall, 3 items fell into the critical improvement zone, 2 in the advantage zone, and 12 in the maintenance zone. Specifically, complete self‐care participants showed 3 critical improvement, 1 advantage, and 10 maintenance items; mild disability had 3 critical improvement, 1 advantage, and 14 maintenance items; moderate disability demonstrated 6 critical improvement, 3 advantage, and 6 maintenance items; while severe disability exhibited 4 critical improvement, 6 advantage, and 8 maintenance items. Conclusions Disabled older adults exhibit differentiated needs for specialized home care services based on disability severity. Effective care requires accurate disability identification and tailored prioritization of care programs aligned with impairment levels, ultimately enhancing service quality for this population. Relevance to Clinical Practice This study analyzes differing specialized home care needs among older adults with different levels of disability in order to provide precise care and help reduce the burden of care. Patient or Public Contribution Patients contributed through filling out questionnaires.