Balancing Needs Amid System Gaps: Expert Perspectives on Home-Based Dementia Care with Migrant Caregivers in Israel.

In Israel, home-based dementia care increasingly depends on migrant live-in caregivers. While enabling aging in place with continuity and personalized care, this arrangement creates significant legal, ethical, and emotional challenges. This qualitative study draws on interviews with 14 Israeli meso-level experts, operating at the intersection of policy and practice, to explore their perceptions of the current arrangement. The analysis reveals a deeply ambivalent stance: migrant live-in caregiving is viewed as functionally indispensable yet structurally flawed, often described as "the least bad solution" within a constrained long-term care system. While benefits for care recipients are acknowledged, concerns about caregiver exploitation, precarious legal conditions, and emotional strain are raised. Recommendations span personal, community, and policy levels, emphasizing person-centered care, improved support and training, and systemic reform. The findings underscore the need for coordinated structural reform to ensure a more equitable and sustainable approach to dementia care.