Home-Based Care in Kenya: Building Safe and Sustainable Support Around Older People

For an older Kenyan whose mobility has deteriorated after a stroke, remaining at home may depend on a combination of people rather than a single formal service. A daughter may prepare meals before work. A neighbour may check in during the day. A Community Health Promoter may identify a health concern and link the household with primary healthcare. A privately paid helper may assist with personal care, while relatives living elsewhere contribute money. The arrangement can preserve independence and family connection, but it can also become fragile when needs increase or one person is no longer available.

Home-based care therefore sits at an important point in Kenya’s developing response to population ageing. As explored across the Kenya Ageing, Long-Term Care & Community Support Knowledge Hub, the country is not starting from a comprehensive publicly funded long-term-care system. Much continuing support is still organised within families and communities, alongside health services, social protection, charitable provision and a developing private care market.

The policy direction is nevertheless becoming clearer. Kenya’s National Policy on Older Persons and Ageing recognises care, dignity and participation in later life. More recent legislative proposals have explicitly described home-based and community-based programmes for older people, including physical and hygienic care, respite, professional and lay support, rehabilitation and assistance with daily living. These proposals should not be confused with an already implemented universal home-care entitlement, but they show how home support is entering the formal policy architecture.

The central challenge is to develop that architecture without destroying what is valuable about family and community care. Kenya needs neither to institutionalise every older person who develops dependency nor to assume that families can safely absorb unlimited responsibility. The stronger model is support built around the person at home, with formal capacity increasing as need, complexity and risk increase.

Home-based care is already happening, but it is not one service

Home-based care can sound like a defined programme. In practice, the term covers very different arrangements.

At one end is ordinary family support: shopping, cooking, accompanying somebody to a health facility or helping with household tasks. At the other are older people who need assistance several times a day with mobility, continence, medication, nutrition, personal hygiene or supervision because of dementia or neurological illness.

Between those positions sit informal paid helpers, domestic workers, community organisations, health professionals, rehabilitation services and emerging specialist home-care providers.

These arrangements should not automatically be treated as equivalent. An older person needing occasional help with food preparation presents different workforce, safeguarding and quality questions from somebody requiring transfers from bed, pressure-area care and complex medication support.

A developing Kenyan home-care system therefore needs to recognise intensity and complexity rather than defining everybody living at home as having the same form of need.

This is also why the wider principles of homecare service models and pathways are relevant. The strategic question is not merely whether support takes place at home, but how the pathway changes when needs increase, improve or become unsafe to manage through the existing arrangement.

The policy direction is towards community and home support

Kenya already has national standards addressing institutions for older persons, developed after concerns about variation in the quality of institutional provision. Home-based care has historically been less developed as a distinct formal service sector.

That distinction matters. Residential services operate from visible premises. Home care is dispersed across thousands of households, making it harder to understand who is providing care, what training they have received and when an arrangement has become unsafe.

Recent proposals concerning older persons have attempted to give community-based and home-based support greater definition. The Older Persons Bill, 2024, for example, proposed home-based programmes including hygienic, respite and physical care, professional and lay support, and assistance for older people who are isolated, lack available caregivers or require skilled services and help with activities of daily living. It also envisaged county involvement in establishing programmes and training requirements for caregivers.

Those provisions remain important as policy direction rather than evidence that every proposed service is already available nationally. Implementation would require legislation, regulations where applicable, financing, county capacity and an actual workforce.

The distinction protects against a common problem in long-term-care reform: announcing a right or programme is much easier than creating the local infrastructure through which somebody can receive it.

Home should be a care setting by choice, not by default

There are strong reasons to support ageing at home. Familiar environments can protect identity, relationships, routines and community participation. Remaining close to family, neighbours, faith communities and local networks can matter as much as the physical support being delivered.

Home care can also avoid unnecessary institutionalisation. An older person who needs help bathing and preparing meals does not necessarily require residential care simply because they cannot manage every activity independently.

Yet home should not be idealised.

A house can become isolating. It may contain steps, inaccessible sanitation or unsafe cooking arrangements. An older person may spend most of the day alone despite technically living “in the community”. Family members may be exhausted or unavailable. In some households, financial dependence or conflict may expose the person to coercion or neglect.

Person-centred home care therefore begins with the older person’s life rather than a policy preference for one setting. The principles of person-centred planning and strengths-based support are particularly relevant because remaining at home should support the outcomes that matter to the person rather than merely relocate responsibility away from formal services.

A meaningful assessment asks what the person can still do, what they want to continue doing, what support already exists and what additional help would make daily life sustainable.

A woman wants to remain in her rural home after a fall

An older woman living in rural Kenya fractures her hip and returns home after hospital treatment. Her adult children live in different towns and want her to move permanently to one of their homes. She wants to remain in the community where she has lived for decades.

The immediate question could be framed as a family disagreement. A stronger care pathway examines what is driving the concern. She is able to make decisions and can manage many daily activities, but bathing is difficult, the path to the latrine is unsafe and she is anxious about falling again. Her daughter can stay temporarily but cannot leave employment indefinitely.

A home-based response would combine rather than replace resources. Rehabilitation focuses on mobility and confidence. Simple environmental changes reduce obvious hazards. The family agrees who can provide temporary assistance and what cannot realistically be sustained. Community-level follow-up identifies whether recovery is continuing and whether further healthcare is needed.

If paid support is available locally, it may cover specific tasks rather than assuming somebody needs continuous supervision. The arrangement is reviewed as recovery progresses.

The important outcome is not simply that she remains at home. It is that she does so with a level of risk she understands, support that is realistic and a route to escalation if her condition changes.

Organisations examining similar decisions can use the Positive Risk-Taking Planner to structure thinking about autonomy, benefit, risk and safeguards. It is not a Kenyan assessment instrument, but its underlying discipline can help prevent safety concerns from automatically overriding an older person’s preferences.

Families remain central, but home care cannot mean unlimited family responsibility

Kenyan households already provide much of the practical support associated with long-term care. Families contribute accommodation, food, transport, money, supervision and direct personal assistance. This is a major source of resilience.

It is also a source of hidden system dependency.

A care arrangement may appear inexpensive because no formal service is being purchased, while a daughter has reduced her working hours, a spouse is providing physical assistance beyond their own capability or relatives are repeatedly travelling long distances.

The sustainability of home care therefore depends partly on whether systems can recognise family capacity honestly.

Assessment should not treat the existence of relatives as proof that care is available. The relevant questions include whether somebody is willing to provide support, whether they are physically capable of doing so, how much time they can offer and whether the arrangement can continue without serious consequences for their own health, income or family responsibilities.

This is especially important because unpaid care is gendered. Women frequently carry substantial household and caregiving responsibilities, and an expansion of home-based care that assumes women will absorb additional tasks could reproduce economic inequality even while reducing demand for institutional services.

The wider principles of family partnership and carer support therefore need to be embedded in service design. Family knowledge is valuable, but partnership is different from transferring professional responsibility to relatives without preparation or consent.

Community Health Promoters can connect households to care, but they are not a substitute for a home-care workforce

Kenya’s investment in Community Health Promoters creates an important foundation for household-level support. More than 100,000 CHPs operate within the community health system, and current health reforms have strengthened their role through training, equipment, digital tools and links with primary healthcare.

For older people, this infrastructure creates opportunities for earlier identification. A CHP visiting households may notice declining mobility, missed treatment, nutritional concerns or a caregiver struggling to cope. They can support health promotion, early detection and referral.

That does not mean CHPs should become an unpaid or overloaded long-term-care workforce.

Community health functions and sustained personal care are related but distinct. Helping an older person wash, dress or transfer several times each day requires time, continuity and sometimes specialist competence that cannot simply be added to an already broad community health role.

A sustainable model needs role clarity:

• Community Health Promoters can help identify concerns, provide preventive support and connect households with health services;
• health professionals retain responsibility for clinical assessment and interventions within their competence;
• rehabilitation professionals can support recovery, mobility and functional independence;
• trained care workers can provide recurring personal and practical assistance where such services exist; and
• families and community networks can contribute support without being assumed to replace professional input.

These boundaries do not require rigid silos. They protect people by ensuring that integration does not become uncontrolled task transfer.

Hospital discharge is where the weakness of home support becomes highly visible

A hospital can stabilise an older person medically without resolving how that person will live afterwards. This is particularly important following stroke, fracture, severe infection or deterioration associated with chronic illness.

Discharge home can create an abrupt transfer of responsibility. Families may receive instructions about medication, nutrition, mobility or wound care while also being expected to organise transport, equipment and daily supervision.

Where no formal home-care pathway exists, the difference between a safe and unsafe discharge may depend heavily on household resources.

The principles behind homecare transitions and hospital interfaces are therefore highly relevant to Kenya. A discharge process should consider not only whether hospital treatment is complete but whether the next setting can realistically support the person.

This does not require every older patient to undergo an elaborate long-term-care assessment. It requires proportionate attention to function and support where dependency is evident.

Useful questions include whether the person can move safely, eat and drink, manage essential medication, access sanitation and obtain help when required. Where family support is central, staff need to understand what relatives can actually provide rather than assuming that somebody described as a caregiver is available continuously.

A stroke survivor is medically ready to leave hospital

An older man has a stroke and receives acute treatment in a county hospital. His condition stabilises and there is no longer a clinical reason for him to occupy an acute bed. Before the stroke he lived with his wife, who is herself in her late seventies.

He can now eat with assistance but requires help transferring, dressing and using the toilet. His wife expects him home but has not been shown how to assist safely. Their son works in Nairobi and assumes his mother will manage because she has always run the household.

A discharge based only on medical stability transfers a substantial care problem into the home. A stronger pathway identifies functional dependency before discharge. Rehabilitation staff determine what he can do and what assistance is required. His wife is included in planning but is not automatically designated as capable of physical transfers. Equipment and follow-up needs are identified, and the household receives a clear route back to health services if his condition deteriorates.

Where a formal home-support service exists, short-term assistance could help stabilise the transition. Where it does not, the gap itself becomes important county-level evidence rather than remaining an invisible family problem.

If similar discharges repeatedly generate readmissions, falls or caregiver breakdown, governance should move beyond reviewing individual cases. The recurring pattern indicates a pathway problem requiring service redesign.

Home-care workers need an occupational identity, not just goodwill

As demand grows, Kenya is likely to see further expansion of paid care delivered in people’s homes. Some support will be organised through companies or organisations; some will continue through individually hired caregivers or domestic workers.

This developing workforce needs greater visibility.

Personal care requires relational skill, judgement and practical competence. Workers may need to understand mobility assistance, hygiene, nutrition, dementia, communication, infection prevention, safeguarding and when a health concern needs escalation. More complex services can require additional competencies and professional oversight.

Training should therefore correspond to the work being performed rather than treating every caregiver as interchangeable.

The policy direction in proposals for older-person home care has recognised caregiver training. Turning that principle into practice would require decisions about minimum competence, training providers, supervision and how expectations apply across organised services and individually employed workers.

The challenge is proportionality. Regulation that is too weak can leave older people exposed to poorly trained workers. Requirements that are expensive or administratively inaccessible can push care further into an informal market where oversight is even more limited.

Workforce policy also needs to address employment quality. Sustainable home care depends on recruitment, continuity and retention, not simply creating a supply of low-paid labour. The wider principles of staff training and practice competence are relevant, but training alone cannot compensate for excessive workloads, unpredictable income or unsafe working conditions.

Care work needs credible progression as well. Entry-level support roles could provide routes into more advanced care, rehabilitation support or health-related occupations where training frameworks permit. This would make workforce development part of Kenya’s broader care economy rather than treating home support as a temporary or invisible occupation.

Quality assurance has to work inside private homes

Quality oversight is harder when services are delivered behind thousands of individual front doors.

A residential institution can be visited and its staffing, environment and records reviewed in one place. Home-care quality is distributed across relationships between individual workers and people receiving support. Supervisors cannot observe every interaction, nor should intrusive monitoring turn a person’s home into an institutional environment.

Quality therefore has to be built into the operating model.

For organised providers, this includes recruitment, identity checks, training, supervision, reliable scheduling, clear care information, incident reporting and mechanisms through which older people and families can raise concerns. Records should show whether planned support occurred and whether changing needs were acted upon, without creating documentation so burdensome that workers spend the visit completing forms rather than supporting the person.

Continuity matters particularly in intimate personal care. A technically completed visit may still feel poor if an older person repeatedly receives unfamiliar workers who do not understand their communication, routines or preferences.

Outcome measurement should consequently look beyond completed visits. The Quality Dashboard Builder provides a generic framework for structuring quality and outcome information. In a Kenyan context, any measures would need to reflect local policy and service arrangements, but the underlying principle is transferable: activity, safety, continuity and human outcomes need to be visible together.

A developing home-care evidence set might examine whether visits occur as planned, whether serious incidents are identified, whether workers remain consistent, whether functional outcomes are changing and whether the person feels respected and secure.

Safeguarding at home requires sensitivity as well as escalation

Most care delivered by relatives and workers is supportive. However, dependence can create opportunities for neglect, financial exploitation, coercion or abuse.

The home environment can make those concerns difficult to identify. An older person may depend financially and physically on the same person whose behaviour concerns them. A worker may notice unexplained injuries but be uncertain where to report them. A family may interpret severe neglect as an unavoidable consequence of poverty or caregiver exhaustion.

Safeguarding systems therefore need to distinguish deliberate abuse from situations in which families are overwhelmed while still protecting the older person from harm.

The wider principles of safeguarding incident response and escalation can help frame this distinction. Concerns require a route to action, but intervention should remain proportionate and centred on the older person’s circumstances and wishes wherever possible.

Financial safeguarding is particularly important as pensions, cash transfers and mobile money become part of household finances. Assistance with digital transactions can be entirely legitimate, yet dependence on another person to access money can also reduce privacy and control.

Home-care workers and community health personnel should not be expected to investigate complex allegations themselves. They do need enough awareness to recognise concerns, respond to immediate danger and know where information should go.

A paid caregiver becomes the older person’s financial intermediary

An older woman living alone in an urban area employs a caregiver privately for several hours each day. Over time, the worker begins helping her purchase food and withdraw money because walking to local services has become difficult.

The arrangement initially makes life easier. Several months later, a niece notices that household spending appears much higher and that her aunt cannot explain some transactions. The older woman is reluctant to complain because she depends on the caregiver and worries that she will be left without help.

The situation cannot be resolved safely by assuming either guilt or innocence. The older woman needs an opportunity to speak privately and explain what assistance she agreed to. Financial records may clarify transactions, while immediate care continuity needs consideration if the caregiver is suspended or leaves.

If the worker is employed through an organisation, there should be a clear internal escalation and safeguarding process. Where employment is purely private, routes are less straightforward, demonstrating why an expanding informal home-care market creates governance questions beyond workforce supply.

The strongest response protects the older woman without removing her control unnecessarily. A safeguarding concern should not automatically result in relatives taking over all financial decisions if she remains capable of making them.

Home environments can either enable independence or manufacture dependency

Care needs are shaped partly by the physical environment.

An older person who cannot safely use steps may appear to require constant assistance in one home while functioning with much greater independence in a more accessible setting. Poor lighting, uneven surfaces, inaccessible washing facilities and unsuitable beds can increase falls and make care physically harder.

Kenya’s housing conditions vary widely, and expensive adaptations will not be realistic for every household. Yet environmental assessment can still identify practical improvements.

Simple changes to furniture layout, handholds, lighting or access routes can sometimes reduce dependence. Other people may need mobility equipment or more substantial adaptations. Rehabilitation professionals can help distinguish what improves function from changes that merely appear helpful.

Assistive technology may also contribute. Mobile communication, medication reminders, remote consultation and selected monitoring technologies could support some people, particularly where relatives live at a distance.

Technology should remain a supplement rather than a presumption. Connectivity, affordability, electricity, digital literacy and cognitive or sensory impairment all affect usability. A sensor cannot provide personal care, and a smartphone does not solve the absence of somebody able to respond when assistance is needed.

For organisations considering technology within home support, the Digital Transformation Readiness Assessment can help structure questions about capability, information governance, workforce adoption and implementation. It should be used as a general analytical framework rather than as a Kenyan regulatory standard.

Rural home care requires a different operating model from dense urban provision

Geography changes the economics of care.

In Nairobi or another densely populated area, a worker may be able to support several people without travelling extreme distances. In sparsely populated rural areas, conventional short visits can become inefficient because travel consumes a substantial part of the working day.

This matters if counties, community organisations or private providers expand organised home support. A service designed around urban assumptions may become unaffordable or unreliable in remote communities.

Rural models may require more locally recruited workers, longer but less frequent visits, stronger links with Community Health Promoters, flexible use of community facilities and remote professional support where clinically appropriate.

Local recruitment can strengthen continuity and reduce travel, but it raises its own questions. Workers may be supporting neighbours or relatives, making confidentiality and professional boundaries important in small communities.

Remote communities also need escalation arrangements. A home-care worker identifying sudden deterioration cannot be treated as the endpoint of the pathway. Transport, referral and communication with health services determine whether recognising risk actually changes the outcome.

County-level service design is therefore critical. The objective should be equitable access rather than identical delivery. A rural service can look operationally different from an urban one while still working towards common expectations around dignity, competence, safety and outcomes.

Home-based care needs a clearer relationship with health financing

Kenya’s current health reforms are strengthening primary healthcare, the Social Health Authority and household-level health services. These developments can improve access to clinical care for older people, but healthcare financing and long-term personal support should not be treated as interchangeable.

An older person may have access to treatment for hypertension or diabetes while still needing daily help to bathe, dress or prepare food. Conversely, somebody receiving home support may need clinical intervention that a care worker is neither trained nor authorised to provide.

The distinction becomes particularly important as policymakers consider financing.

Some home-based interventions can appropriately sit within healthcare: clinical review, rehabilitation, treatment, professional nursing interventions and preventive health activity. Sustained assistance with everyday living may require different funding arrangements.

If those boundaries remain unclear, costs can be shifted rather than managed. Health services may discharge people whose continuing needs are treated as entirely familial, while families may expect clinical systems to provide indefinite personal assistance.

A stronger future model would define interfaces rather than attempting to make one financing mechanism cover every form of support.

This also allows policymakers to examine where public investment has the greatest preventative value. A relatively small amount of temporary home support after illness may prevent loss of independence. For somebody with progressive dementia or severe disability, however, the need may be long-term and require a sustainable funding decision rather than a short intervention.

Formal home care will need proportionate regulation

As organised home-care services grow, Kenya will need to decide what should be regulated, by whom and to what degree.

The answer cannot simply replicate regulation designed for institutions. A provider coordinating workers across hundreds of private homes creates different risks from a residential facility.

Regulatory development should focus on the functions that materially protect people: provider accountability, worker suitability, competence, safeguarding, complaints, continuity, accurate information and appropriate management of health-related tasks.

It should also distinguish organised commercial or charitable provision from ordinary unpaid family support. Attempting to regulate routine family caregiving as though it were a formal provider service would be intrusive and largely unenforceable.

Informally hired paid caregivers create a more difficult boundary. Completely excluding them from future quality frameworks could leave a significant part of the market invisible, while imposing complex registration on every household employing assistance could discourage formalisation.

Kenya’s future approach may therefore need graduated oversight according to the scale, intensity and organisational nature of provision.

The broader principles of regulation and oversight are relevant here. Effective regulation should make accountability clearer without creating administrative requirements that bear little relationship to actual risk.

Any new framework will also need to align with constitutional functions and existing health, professional and social-protection responsibilities rather than establishing parallel oversight without clear authority.

Information should follow the person without turning the home into a surveillance environment

Home-based care depends heavily on information. Workers need to know what support has been agreed. Families need to understand significant changes. Health professionals may need information about deterioration. Providers need enough evidence to supervise services.

Poor information creates obvious risks: missed medication, duplicated tasks, inconsistent instructions and delayed escalation.

Yet more data is not automatically better care.

Digital systems can make home support more visible through scheduling, electronic records and alerts. They can also create intrusive monitoring if location tracking, cameras or sensors are introduced without clear purpose and consent.

Kenya’s wider digital health development creates opportunities for better coordination, but long-term-care information will extend beyond clinical records. Functional ability, personal preferences, family involvement and practical support arrangements may all matter.

A proportionate record should answer the questions required for safe continuity while protecting privacy.

Where several organisations are involved, governance should establish who needs access to which information and why. The objective is not a universal file visible to everybody but reliable information exchange at relevant points in the pathway.

This becomes particularly important during transitions between hospital, primary healthcare and home support. Digital infrastructure can reduce repetition, but only if systems and organisations are capable of acting on the information they receive.

A family uses technology to support a father living alone

An older man in Mombasa remains largely independent but has become forgetful about medication. His children live elsewhere and begin calling several times each day to remind him. He finds the calls intrusive and resents the assumption that he can no longer manage his life.

The family considers installing extensive monitoring technology. A person-centred discussion reveals that the main problem is much narrower: he occasionally misses an evening dose and sometimes forgets whether he has already taken it.

A simpler reminder system, combined with medication review and agreed family check-ins, may address the actual risk without creating continuous surveillance. If his memory deteriorates further, the arrangement can be reviewed.

The scenario illustrates a wider principle for Kenyan home care. Technology should respond to a defined need rather than being introduced because it is available. The least intrusive effective option is often more sustainable because the older person is more likely to accept and use it.

Digital innovation can extend independence, but it should not redefine independence as being constantly observed.

Home-care governance needs to see patterns, not only individual problems

Many weaknesses in home support first appear as isolated events. One family cannot manage a discharge. One caregiver leaves without notice. One older person falls repeatedly. One rural household cannot access rehabilitation.

Governance becomes valuable when those events are aggregated.

If the same type of problem recurs, the issue may no longer be individual. Repeated missed visits can indicate workforce instability. Frequent readmission after discharge can reveal an inadequate transition pathway. Similar safeguarding concerns across several workers can point to weak recruitment or supervision.

Providers need mechanisms for identifying these patterns within their own services. Counties need visibility of recurring pathway and access problems. National institutions need enough information to recognise whether broader standards, workforce policy or financing arrangements require change.

The Governance Maturity Assessment offers organisations a generic way to test whether responsibility, assurance and escalation are sufficiently developed. In Kenya, the relevant governance structures will differ, but the core question remains useful: does information about what is happening in people’s homes reach somebody capable of changing the system?

Older people and families are themselves essential sources of evidence. Complaints, compliments, service withdrawals and informal feedback can reveal issues that activity data misses. Home-care quality cannot be understood solely from provider records.

Kenya can build a home-care system without replacing community life

Formalisation is sometimes presented as a choice between professional services and traditional family or community support. Kenya does not need to make that choice.

A stronger system can preserve reciprocal family relationships while adding formal support where needs exceed what households can safely or sustainably provide.

The key is to avoid two extremes.

One is to treat every difficulty as requiring a paid service, potentially weakening community resources and creating unaffordable public expectations. The other is to romanticise family care and leave households managing complex dependency without training, respite or alternatives.

Home-based care can instead operate as a continuum. People with relatively low needs may rely mainly on their own strengths and informal networks. As dependency increases, targeted professional or paid support can supplement those arrangements. Complex or unstable needs trigger greater clinical involvement and oversight. Residential care remains an option where it genuinely offers the more appropriate environment rather than becoming the automatic destination for everybody needing assistance.

This approach also respects cultural diversity. Family relationships, household structures and expectations differ across Kenyan communities and within individual families. Public policy should enable support rather than prescribe one supposedly ideal family model.

International learning lies in building infrastructure around the home

Many countries have sought to shift long-term care away from institutional provision towards support in ordinary homes and communities. Their experiences offer useful principles but not a ready-made Kenyan model.

Countries with mature home-care systems often have established public entitlements, municipal purchasing structures, regulated provider markets and large formal care workforces. Kenya’s financing arrangements, labour market, family structures and devolved institutions are different.

The transferable lesson lies less in importing those mechanisms than in recognising what makes care at home dependable.

Successful home support requires more than workers making visits. It depends on assessment, referral, continuity, workforce competence, rehabilitation, equipment, information, safeguarding and routes to healthcare when needs change. It also depends on recognising what families can and cannot sustainably provide.

Kenya can develop these components incrementally. Counties can test models appropriate to local geography. National policy can strengthen common expectations. Workforce frameworks can become clearer as the market develops. Evidence can show which interventions maintain independence rather than merely increasing service activity.

That progression allows formal home care to grow around existing community strengths rather than attempting to replace them.

Conclusion

Home-based care has the potential to become one of the most important components of Kenya’s future long-term-care system because it begins where many older people already want to remain: within familiar homes, families and communities. But living at home and being adequately supported at home are not the same thing.

Kenya’s strategic challenge is to turn a largely informal and uneven collection of arrangements into a stronger continuum without assuming that every household needs a formal service. Community Health Promoters and primary healthcare can support prevention and early identification. Rehabilitation can protect function. Families can remain central partners. A developing paid care workforce can provide additional capacity where daily assistance is required. Counties can shape delivery around local geography, while national policy can progressively establish clearer expectations for quality, workforce competence and protection.

The decisive issue will be implementation. Home care cannot become sustainable if its apparent affordability depends on invisible unpaid labour, poorly trained workers or families accepting risks they cannot manage. Nor will excessive regulation help if it drives emerging services further into informality.

The stronger direction is proportionate formalisation: more support as need increases, clearer accountability as provision becomes organised, and greater integration when health and long-term-care needs overlap. If Kenya can build that infrastructure while preserving autonomy, family relationships and community participation, home-based care can become more than the absence of institutional care. It can become a credible, safe and person-centred part of the country’s evolving care system.