Building Quality into Home and Community Care for Older People in Viet Nam: From 2026 Guidance to Implementation

Building Quality into Home and Community Care for Older People in Viet Nam: From 2026 Guidance to Implementation

LONG-TERM CARE, HOME & COMMUNITY CARE

Last reviewed: October 2026

For many older people, the place where care matters most is not a hospital. It is home.

That care may involve help with medication, meals, mobility, bathing or other activities of daily living. It may involve a spouse or adult child, support from a commune health station, a community care club, volunteers or a community day-care point. As needs become more complex, rehabilitation, clinical assessment and other health services may also become necessary.

In Viet Nam, the policy and professional framework for this part of the care continuum changed substantially in 2026. The Law on Population No. 113/2025/QH15 and Decree No. 168/2026/NĐ-CP took effect on 1 July 2026, giving home and community care for older people a clearer legal structure. On the same day, the Ministry of Health issued Decision No. 1976/QĐ-BYT, providing detailed professional guidance for care at home and in the community. The Ministry subsequently issued Decision No. 2141/QĐ-BYT on 14 July to organize implementation of Decree 168, followed in September by Circular No. 34/2026/TT-BYT, which guides selected components of Phase I of the National Target Program on Health Care, Population and Development for 2026–2035 within the Ministry of Health’s remit.

This is an important shift. Viet Nam now has more than broad policy statements about caring for older people outside hospitals. It has defined care models, professional guidance, workforce roles and mechanisms for implementation. But written guidance does not automatically create reliable care. The next challenge is practical: how can Viet Nam turn this new framework into home and community care that is safe, person-centered, coordinated and consistently useful to older people and families?

Home and community care are not one single service

One of the first implementation challenges is recognizing that “community care” does not describe one uniform service.

Under Decree No. 168/2026/NĐ-CP, care at home includes guidance on care and prevention, early recognition of health risks, support for physical and mental well-being and social connection, and assistance with activities of daily living. People providing home care may include family members and domestic workers. Community-care personnel assigned by the commune health station may also provide home support in the circumstances defined by the decree, including for older people who are living alone and need care at home.

Community care includes different models with different purposes. Older-person care clubs may provide care and health education, physical activity, cultural and social activities and opportunities for older people to remain engaged in community life. Community day-care points provide daytime support, including care and prevention education, exercise and assistance with activities of daily living.

These models should not be treated as interchangeable. Their populations, functions, workforce and risks are different. An independent older person participating in a club for exercise and social connection has very different needs from someone with reduced self-care capacity who requires daytime assistance. Good implementation therefore begins with clarity about who each service is intended for, what it is expected to provide and where its responsibilities end.

Community care should complement clinical care, not blur the boundary

One of the most important legal and operational boundaries concerns community day-care points.

Decree No. 168 defines a community day-care point as a special model under the commune health station. It has no separate legal-person status and does not perform medical examination or treatment activities. Depending on local circumstances, it may operate at a commune health station, a health-station point, a cultural house or another appropriate site.

That does not make community care clinically irrelevant. People who spend time with older people at home or in the community may be the first to notice reduced mobility, confusion, weight loss, changes in mood or increasing difficulty with daily activities.

Decision No. 1976/QĐ-BYT creates an important link between recognition at community level and a more structured health response. Trained professionals at commune health stations, population collaborators, village health workers, social workers and volunteers can perform an initial assessment or screening of intrinsic capacity using the ICOPE tool. Screening results are sent to the commune health station, which assesses identified declines and care needs and advises on referral when appropriate.

In practical terms, the pathway is:

community-level recognition and screening → commune health-station assessment and care planning → appropriate care, support or referral

The value lies not in identifying more problems, but in connecting identified needs with an appropriate response. If reduced mobility is found, is there a realistic rehabilitation or exercise pathway? If cognitive decline is suspected, who performs further assessment? If weight loss is identified, who determines whether nutritional support is sufficient or a medical problem needs investigation? If a volunteer notices deterioration, whom do they contact and how quickly?

Quality depends on what happens after the need is identified.

Decision 1976 turns broad policy into practical care processes

Decision No. 1976/QĐ-BYT is important because it goes considerably further than general statements about healthy aging.

The guidance covers care at home, older-person care clubs and community day-care points. It addresses age-related physiological and psychological changes, nutrition, common health conditions, physical activity, activities of daily living, medication support according to prescriptions, communication and counseling, intrinsic-capacity screening and implementation responsibilities. It also includes a detailed appendix on using the ICOPE application.

For community day-care points, the guidance includes basic measurements such as blood pressure, temperature, pulse, respiratory rate, height and weight, along with self-care counseling, support with daily activities and appropriate physical activity. This provides local services with a much clearer operational starting point than broad policy alone.

But guidance still has to be translated into workflows, competencies, supervision, documentation, referral criteria and escalation pathways. The same national guidance will inevitably look somewhat different across localities because geography, workforce, transport, service availability and community resources differ. Local variation is not necessarily a quality problem. Variation caused by unclear responsibilities or unreliable implementation is.

Training is necessary, but competency matters more

Circular No. 34/2026/TT-BYT moves implementation further by defining responsibilities for older-person health care within Phase I of the National Target Program.

The Population Department is responsible for developing training and guidance materials and building capacity. Provincial health departments can adapt materials to local languages, customs and conditions and organize training for population collaborators, village health workers and others involved in community care. Commune health stations are responsible for training volunteers and providing older people and family caregivers with guidance on self-care and care at home and community day-care points, using Decision No. 1976/QĐ-BYT as the professional basis.

That is a strong foundation, but completing training does not by itself demonstrate competency in practice.

A volunteer may learn how to conduct an ICOPE screening but still be uncertain when a finding requires urgent escalation. A family caregiver may receive general medication guidance but struggle when the regimen changes after hospitalization. Someone may understand the principles of safe mobility but be unsure how to help when an older person’s function suddenly deteriorates.

For tasks with meaningful safety implications, implementation therefore needs to ask whether people can perform the relevant activity safely, understand the limits of their role, know when to seek help and have access to supervision when they are uncertain.

Workforce development needs to move beyond training delivered toward competency supported in practice.

Identification capacity and response capacity need to grow together

Viet Nam’s new guidance creates the opportunity to identify changes in intrinsic capacity closer to where older people live. That is potentially valuable, but it also creates one of the most important quality risks in implementation: assessment capacity can expand faster than the services available to respond.

Suppose community workers identify many older people with reduced mobility. What happens if rehabilitation access is limited? If cognitive concerns are identified, is there a realistic pathway for further evaluation? If nutritional problems are found, who follows up? If social-care needs become visible, what support actually exists?

A program can achieve impressive assessment coverage and still produce little improvement if identified needs are not acted upon. That is why two capacities need to grow together:

the capacity to identify need and the capacity to respond to need

Decision No. 1976 already contains this logic. Community-level workers can perform initial ICOPE screening, while the commune health station assesses identified declines, determines care needs and advises referral where appropriate.

This distinction should also be visible in measurement. The number of older people screened is a coverage measure. The proportion of identified needs that received appropriate further assessment, intervention or referral is a quality and implementation measure.

Both matter, but they answer different questions.

Family caregivers are part of the care system

The 2026 framework formally recognizes something that has long been true in everyday life: much older-person care is delivered by families.

Decree No. 168 identifies relatives as one of the groups that may provide care at home. Circular No. 34 explicitly includes older people and family members providing care among the groups who should receive guidance and support through community older-person health-care activities.

That recognition matters, but it also raises a quality issue. A family member may be available without being ready.

They may live with the older person but not understand the medication regimen. They may not be physically able to assist safely with transfers. They may not recognize delirium or clinical deterioration. They may have work, childcare or their own health needs that make the level of care assumed by the plan impossible to sustain.

If a care plan depends on a family caregiver, quality therefore depends partly on the caregiver’s knowledge, skills, physical capacity, available time and access to professional advice. Education can help, but it should not become a mechanism for transferring unlimited responsibility from formal services to families.

Good home care supports both the older person and the caregiver.

Volunteers can extend reach, but their role needs clear boundaries

Decree No. 168 gives volunteers a formal place in community older-person care. Volunteers may assist older people with activities of daily living at home and at community day-care points. They do not receive remuneration for this volunteer role, work according to assignment from the commune health station and are to receive training and guidance from that health station.

This can extend community reach, particularly where formal workforce capacity is limited. But volunteer participation is safe only when responsibilities are clear.

Volunteers need to know what they are expected to do, what they should not do, which findings require escalation and whom they can contact when uncertain. The formal system also needs to be able to respond when a volunteer raises a concern.

A model that expands community involvement without clear boundaries risks creating informal clinical responsibility that the model was never intended to carry. The quality question is therefore not simply how many volunteers were trained, but whether they can perform their assigned role safely and whether the formal health system responds when they identify a problem.

Information continuity is part of care quality

Home and community care will remain fragmented if important information stays inside separate programs.

If an ICOPE screening identifies reduced cognition or mobility, the commune health station needs that information. If the person is referred for clinical assessment, the result should ideally inform ongoing care. If an older person is hospitalized and returns home with changed medication or reduced function, relevant primary and community services need to understand what changed.

Decision No. 1976 creates one basic information pathway by requiring screening results to be sent to the commune health station. The wider National Target Program is also developing digital and health-information infrastructure, including investments related to commune health-station platforms.

But technology cannot replace governance. Local services still need to know who records information, who receives it, who is responsible for acting on it, how referral completion is confirmed and who updates the care plan when circumstances change.

An elegant digital platform cannot compensate for unclear ownership of care.

Community day care should remain community care

Community day-care points are potentially important because they create a layer of support between independent living at home and more intensive formal services.

Their value may lie precisely in the fact that they are not miniature hospitals and not miniature residential facilities.

Under Decree No. 168, they are daytime community-care models. Their functions include care and prevention education, physical activity and support with activities of daily living, while medical examination and treatment remain outside their functions.

Quality implementation should preserve the strengths of the model: proximity to home, social connection, support for daily function, early recognition of changing needs and some relief for families during the day.

When a clinical need arises, the day-care model should connect the older person with the appropriate service rather than gradually absorb functions it was not designed or legally authorized to provide.

Integration does not mean making every setting capable of doing everything. It means making different settings work together.

Local adaptation is necessary, but basic quality expectations should remain consistent

Circular No. 34 explicitly allows training and implementation materials to be adapted to local customs, languages and conditions. That flexibility is important in a country where health-service capacity, geography, culture and community resources differ substantially between localities.

A model designed for a major urban area cannot simply be copied into a remote rural community. But adaptation should not mean that basic expectations of quality disappear.

Whatever the local model, older people should be treated with dignity and respect. Responsibilities should be clear. People delivering care should have competencies appropriate to their roles. Changes in health or function should have an escalation pathway. Families should receive appropriate information and support. Abuse, neglect and inappropriate restriction should not be normalized. Documentation and communication should be reliable enough to support continuity.

A 2025 technical brief from the WHO Regional Office for Europe highlights a similar implementation challenge: home- and community-based long-term care has expanded faster than quality-management frameworks in many European settings, creating a need for stronger standards, measurement, quality assurance and continuous improvement. The brief was developed for the European context and is not a regulatory framework for Viet Nam, but its quality-management principles are relevant to the problem Viet Nam now faces.

The service model can vary. The expectation of safe, person-centered and accountable care should not.

Coverage is not the same as quality

The new policy environment naturally creates implementation indicators: how many people were trained, how many clubs operate, how many day-care points were established and how many older people received an assessment or service.

Those measures describe capacity and coverage. They do not tell us, by themselves, whether the care was good.

A local pilot might also examine whether identified needs received an appropriate response, whether referrals were completed, whether family caregivers felt prepared, whether medication or mobility problems were addressed, whether community workers could obtain help when a situation exceeded their role and whether older people experienced care as respectful and useful.

Not every locality needs the same dashboard, and the initial measurement set should remain small. The essential distinction is:

Coverage tells us whether the service reached people. Quality tells us what happened when it did.

A service can achieve impressive coverage while still producing unreliable care. Conversely, a small pilot can generate important quality learning before reaching large numbers of people.

A pilot should test the whole pathway

A useful implementation pilot does not need to begin across an entire province.

One commune or a small group of communities could first map the existing system: the older-person population, commune health-station capacity, available rehabilitation and clinical services, community organizations, volunteers, family-caregiver needs and realistic referral options.

A local pathway might then look something like:

older person or caregiver → community assessment or concern → commune health-station review where needed → care or support plan → community or clinical response → follow-up → reassessment

This is not a proposed national pathway. Its purpose would be to test how the new framework works under real conditions.

Which referrals cannot be completed? Which roles remain unclear? Where do volunteers need more supervision? Do family caregivers understand what they are being asked to do? Which needs can genuinely be addressed in the community, and which require clinical care? How much workforce time is required? What information is lost when care crosses settings?

These are implementation questions, but they are also quality questions.

Governance should be designed before scale-up

As community services expand, quality needs clear ownership.

At commune level, who reviews incidents or complaints? Who checks whether training translates into safe practice? Who knows whether referrals are being completed? Who supports volunteers when concerns arise? Who recognizes when a family caregiver is struggling? Who reviews whether a community day-care point is functioning as intended?

At provincial level, what information is needed to understand differences between localities? Which problems can be solved locally and which require technical support? Which measures should be comparable? How should effective approaches be spread?

Circular No. 34 assigns implementation responsibilities across the Population Department, provincial health departments and commune health stations. The quality challenge is to make sure those responsibilities support learning and improvement, not only administrative reporting.

A program can comply with an implementation plan and still deliver inconsistent care. Governance needs to be able to see that difference and respond.

Viet Nam has an opportunity to build quality early

Many health and care systems expand capacity first and build quality systems later. Viet Nam is still at a stage where important components of home and community care are being defined, staffed and connected to national programs. That creates uncertainty, but it also creates an opportunity.

Quality can be built into the system while the system itself is developing.

Competency can be incorporated into workforce development. Referral and escalation pathways can be designed as services expand. Caregiver readiness can become visible in care planning. Coverage measures can be distinguished from quality measures from the beginning. Community roles can be connected deliberately with commune health stations and clinical services. Information systems can be designed around the older person’s care journey rather than around individual programs.

WHO’s Global Standards for Long-Term Care are currently under public consultation. WHO describes the consultation draft as the first global framework of standards for planning, delivering, monitoring and improving long-term care for older people. It covers home- and community-based care alongside facility care, unpaid caregivers, workforce, financing, governance and quality monitoring. Consultation remains open until 30 October 2026, so the document is not yet a finalized WHO standard.

Viet Nam should not simply import that framework. But the broader direction is relevant: service expansion, workforce development, governance and quality management need to evolve together.

From guidance to reliable care

The developments of 2026 matter because they give home and community care for older people more structure than before.

The Population Law provides a stronger statutory basis. Decree No. 168 defines care models and roles. Decision No. 1976 translates many of those concepts into practical professional guidance, including ICOPE-based intrinsic-capacity screening and a link back to commune health stations. Decision No. 2141 establishes a Ministry-level implementation plan for Decree 168, while Circular No. 34 connects workforce development and community older-person health activities with the National Target Program.

The next stage is harder. It requires turning written guidance into pathways that still work when an older person’s condition changes, when a caregiver is overwhelmed, when a volunteer identifies deterioration, when a referral is unavailable or when information needs to move between home, community and clinical services.

That is where quality becomes visible.

For Viet Nam, the useful question is no longer simply “Do we have guidance for home and community care?” It is “Can we turn that guidance into care that older people and families can rely on, safely, consistently and across the boundaries between home, community and the health system?”

That is the implementation challenge now in front of Viet Nam.

References

1. National Assembly of Viet Nam. Law on Population No. 113/2025/QH15. 10 December 2025; effective 1 July 2026. Official Government source

2. Government of Viet Nam. Decree No. 168/2026/NĐ-CP detailing selected provisions and implementation measures of the Law on Population. 15 May 2026; effective 1 July 2026. Official Government source

3. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026. Population Department, Ministry of Health

4. Ministry of Health of Viet Nam. Decision No. 2141/QĐ-BYT issuing the plan for implementation of Decree No. 168/2026/NĐ-CP. 14 July 2026. THƯ VIỆN PHÁP LUẬT

5. Ministry of Health of Viet Nam. Circular No. 34/2026/TT-BYT guiding selected components of Phase I (2026–2030) of the National Target Program on Health Care, Population and Development 2026–2035 within the Ministry of Health’s state-management remit. 8 September 2026. Official Government source

6. World Health Organization Regional Office for Europe. Setting the Foundation for Quality Management in Home- and Community-Based Long-Term Care. 2025. WHO publication

7. World Health Organization. Global Standards for Long-Term Care — Public Consultation. Consultation opened 18 May 2026 and closes 30 October 2026. WHO consultation page