{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:33:04Z","timestamp":1787581984708,"version":"build-2736575974"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Decline of intergenerational co\u2010residence, risk of functional and emotional deprivations in old age, and the diminishing capacity of families to care in\u2010person for their older parents have intensified the demand for formal care provisions among left\u2010behind older adults in migrant households of Kerala. While several attempts have been made to quantify the accessibility and utilisation of geriatric care, there is a dearth of evidence on the realities of alternative care in Kerala. The present study aims to explore the perception of older adults (65+) and service providers (government and non\u2010governmental) on the systemic enablers and barriers of alternative care in migrant households of Kerala.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A qualitative approach using IDIs were employed among 20 left\u2010behind older adults (65+) and 8 service providers across three districts of Kerala (Pathanamthitta, Thrissur and Kannur), using purpose sampling, and thematic analysis was followed using a deductive approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis using the Rainbow Model of Integrated Care revealed that the high cost of care at a micro level limits access and utilisation, while the inactivity of day care homes and their failure to upgrade as resource centres challenge the alternative care at a meso level of operation. The absence of need assessments, top\u2010down implementation, inappropriate fund allocation, lack of measures to sustain the programme and rigid eligibility norms for inclusion pose challenges in the care avenues, while pain and palliative care community\u2010based associations and doorstep delivery of essential services facilitate seamless delivery of alternative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alternative care efforts should integrate regional, state and central levels of planning, concrete implementation guidelines, participation of older adults in planning and implementation, and efforts to upgrade day care homes into regional resource centres, along with systematic monitoring and evaluation and multi\u2010stakeholder governance to realise alternative care for older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and\/or Public Contribution<\/jats:title>\n                    <jats:p>Informal discussions with community\u2010dwelling older adults and service providers helped in refining research questions and in\u2010depth interview guides to explore their lived experiences. Participants shared insights on their care experiences, which informed data collection and interpretation. Research findings were reviewed within a subgroup of older adults and service providers to ensure contextual accuracy in reporting the practical enablers and barriers of alternative care as perceived by the stakeholders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70507","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T08:39:41Z","timestamp":1764491981000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Enablers and Barriers to Alternative Care: Perspectives of Community\u2010Dwelling Older Adults and Service Providers in Kerala"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4764-7502","authenticated-orcid":false,"given":"Anu","family":"Mohan","sequence":"first","affiliation":[{"name":"Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9995-1492","authenticated-orcid":false,"given":"Teddy Andrews Jaihind","family":"Jothikaran","sequence":"additional","affiliation":[{"name":"Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2441-3224","authenticated-orcid":false,"given":"Lena","family":"Ashok","sequence":"additional","affiliation":[{"name":"Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education Manipal India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"e_1_2_21_2_1","doi-asserted-by":"crossref","unstructured":"A.Agarwal A.Lubet E.Mitgang S.Mohanty andD. 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