When ageing in place falls short: indicators of unmet care needs among older home care clients in Finland

Population ageing shifts long-term care policies towards supporting ageing in place. While most older adults prefer to remain at home, this preference depends on receiving sufficient support. Inadequate home care may contribute to unmet care needs, caregiver strain, and a desire to move to more intensive care settings. This study examines two potential indicators of unmet care needs among older adults in Finland: (1) a preference to move to 24‑hour care and (2) informal caregiver strain. Using nationwide Resident Assessment Instrument (RAI) home care data from 2023, we analysed clients aged ≥65. Preferences for 24‑hour care were analysed among clients whose assessments included input from the client and/or a family member (n = 39,652). Caregiver strain was examined among clients receiving both informal and formal home care (n = 35,833). Logistic regression models were used to estimate associations between client characteristics and both outcomes. Approximately 9% of clients preferred 24‑hour care, and 19.5% of caregivers experienced strain. Clients in these groups received more informal and formal care. Greater difficulties in health and functioning, and social factors that may indicate unmet care needs, were associated with both outcomes. The strong association between preference for 24-h care and caregiver strain suggests that these indicators are closely intertwined. Our findings, together with previous literature, suggest that caregiver strain and preferences for 24‑hour care may signal unmet care needs and potentially insufficient home care. Assessing both client needs and caregiver capacity is essential to ensure adequate support and sustain ageing in place.