An Embedded Model of Care to Address Depression in the In-Home Aged Care Setting

Depression is increasingly common among older Australians receiving home care, yet symptoms are often under-recognised and access to evidence-based psychological treatment remains limited. This paper introduces EMBED, a new model of care designed to improve detection, escalation and management of depression within routine home care service delivery.

We describe the development of an evidence-informed model of care for the Australian home care setting. The model draws on clinical guidelines, published evidence on late-life depression and psychological treatment, implementation evidence from aged care and consultation with frontline staff, managers, senior leaders and consumer representatives.

The EMBED model comprises four integrated components: (i) workforce training to improve the knowledge, attitudes and self-efficacy of home care workers; (ii) routine screening to support early identification of symptoms and deterioration; (iii) structured clinical assessment to guide escalation and treatment planning; and (iv) tailored psychological intervention using lifestyle therapy and behavioural activation. The intervention was designed to be stratified according to symptom severity, responsive to older people's preferences and feasible for delivery within aged care services and through health service collaboration.

The EMBED model offers a practical approach to addressing a major gap in current home care practice by embedding mental health capability into usual aged care service delivery. Further research is required to determine its effectiveness and cost-effectiveness, as well as implementation requirements in the Australian home care context to enable providers to better support the growing population of older people with symptoms of depression.