Abstract

Background
The accelerated global aging trend has led to an expanding population of individuals with dementia, imposing a substantial disease burden. While home-based care remains the predominant model for dementia patients, its overall quality remains suboptimal. This inadequacy stems from unmet home care demands, with the root cause lying in the lack of leadership from community healthcare institutions in coordinating and delivering integrated support services.
Methods
A qualitative research design was adopted. Using purposive and convenience sampling methods, data were collected from April 2024 to February 2025 through semi-structured interviews and memo writing. The participants included 38 primary family caregivers of older adults with dementia and 14 community healthcare providers and administrators. Nvivo12 software was used in combination with the framework analysis method to code and analyze the collected data. This approach was employed to examine the needs of family caregivers for home-based dementia care support services, as well as the service provision challenges faced by healthcare providers and administrators in community medical institutions.
Results
1. By analyzing the evolving patterns of illness management in families of community-dwelling older adults with dementia, the underlying psychological and behavioral logic behind delayed help-seeking is identified. Two distinct phases and two key turning points are observed.
2. Guided by the socio-ecological model and informed by the trajectory of illness coping, this study examined and clarified the home care needs of primary caregivers throughout the entire course of dementia home-based care support. This course was divided into three phases: the latent demand phase, the healthcare-seeking phase, and the service utilization phase. 
3. This study describes the content and operational models of home-based care support services for dementia patients implemented by existing community medical institutions. These services include health promotion activities, medical record keeping and health monitoring, early dementia screening, discharge preparation, home-based continuity of care, online appointment scheduling, outpatient consultations, community volunteers, home care for family beds, health education, emotional support, non-pharmacological management, community subsidies, and collaborative care support services provided in partnership with the community and senior care institutions.
4. The community faces significant challenges in providing home-based care support services for dementia patients: caregiver skill gaps and staff shortages (individual); communication barriers (interpersonal); fragmented resources (organizational); inadequate facilities (community); unclear policies and funding gaps (policy). 
5. The community faces a mismatch between the supply and demand for home-based care support services for elderly dementia patients throughout the entire process. During the stage of perceiving healthcare needs, there is a contradiction between the low health literacy of those seeking care and the insufficient promotion and health education provided by service providers. In the stage of seeking healthcare services, a gap exists between individuals' knowledge and ability to seek care and the accessibility of available services. The stage of receiving healthcare services is characterized by a mismatch between the content, quantity, and timing of supply and demand, as well as a discrepancy between the payer's ability to pay and the affordability of service provision.
Conclusion
There is a common delay in seeking medical care among families of elderly individuals with dementia. The need for home-based care among older adults with dementia is consistently observed across the latent demand phase, the healthcare-seeking phase, and the service utilization phase. Multiple challenges are identified in the provision of home-based supportive services for individuals with dementia, with supply-demand mismatches occurring throughout the entire caregiving process. As a result, the home care needs of dementia patients are often inadequately met.