Prioritizing Long-Term Care Services for Disabled Older Adults: A Cross-Sectional Study Using the Kano Model and...

Understanding the hierarchical structure and supply priorities of long-term care (LTC) needs among disabled older adults is essential for responsive care systems. However, existing assessments fail to translate findings into actionable resource allocation strategies, leaving nursing managers without evidence-based guidance for prioritization.

To identify the hierarchical structure of LTC service demands among disabled older adults using the Kano model and to establish an evidence-based supply priority order through integrated entropy-weighted TOPSIS analysis, thereby providing nursing managers with a quantifiable sequence for phased resource allocation.

A cross-sectional survey was conducted from January to November 2024 among 585 disabled older adults recruited from six nursing institutions and six communities across three districts of Chengdu. Participants completed a self-designed Kano model questionnaire covering 52 service items. Kano analysis was used to classify service attributes into must-be, one-dimensional, attractive, and indifferent categories, and entropy-weighted TOPSIS was subsequently applied to determine supply priorities based on relative closeness (C_i) values.

Among the 52 items, Kano analysis identified 12 (23.1%) as must-be, 14 (26.9%) as one-dimensional, 10 (19.2%) as attractive, and 16 (30.8%) as indifferent. C_i values ranged from 0.007 to 0.905. Within one-dimensional attributes, vital signs monitoring (C_i = 0.905) and oral medication administration (C_i = 0.890) ranked highest. Among attractive attributes, cognitive training had the highest priority (C_i = 0.615). Notably, 11 of 15 traditional Chinese medicine (TCM) nursing services (73.3%) fell into attractive or one-dimensional categories.

The integrated Kano-TOPSIS framework identifies LTC need hierarchies and supply priorities among disabled older adults. Must-be services need basic guarantees; one-dimensional services drive quality; and attractive services, especially TCM nursing and cognitive training, boost satisfaction. This user-centered approach guides phased resource allocation and responsive LTC design.

The findings support a tiered resource allocation strategy based on the Kano-TOPSIS framework. Must-be services should be guaranteed as a basic care package. One-dimensional services should be prioritized for quality monitoring and performance evaluation. Attractive services can be developed as value-added modules to enhance cultural responsiveness. A phased approach is recommended: must-be first, then one-dimensional, and finally attractive according to local capacity. These measures enable nursing managers to translate needs assessment into actionable allocation decisions and bridge the supply-demand gap.