Introduction
The aging global population has led to increased reliance on families, organizations, and society to provide care for older adults, resulting in a greater demand for long-term care [2]. Factors such as policies, financial constraints, private service costs, religious considerations, social structures, and cultural traditions often lead to care being provided at home for older individuals [4–8]. Family (informal)carers play a vital role in assisting those who cannot care for themselves, impacting their own health negatively [10]. Previous studies have focused on individual lifestyle changes and overlooked care facilitators, especially in environmental contexts. In 2017, the Iranian Ministry of Health and Medical Education introduced an elderly care program focusing on the health of older adults who seek center-based care, neglecting dependent elderly and their informal carers [13, 14]. The lack of social services for dependent older adults and their carers can disrupt care provision and resource utilization [10]. To create effective health-promoting interventions, it is crucial to identify factors and address educational needs of family carers. This study explores facilitators of elderly homecare and educational needs of family carers for dependent older adults.

Methods
This study was a qualitative content analysis using purposive and snowball sampling from January 2021 to April 2021. The study involved family carers of older adults aged 60 and over at the South Tehran Health Centre and three social service-providing centres based on inclusion criteria and demographic characteristics.
The interviews were open and semi-structured by telephone, focusing on factors that provide easier care and how family members, colleagues, relatives, friends, and society can assist in providing better care. The interviews were supplemented by questions about education and support needs. The sampling process continued until data saturation, with two more participants interviewed. Lincoln and Guba’s criteria were used for validity and reliability. After each interview, the interviewer transferred the audio file into a Word file. The study utilised MAXQDA 2018 qualitative analysis software for data analysis. The interviewer creates initial codes, categories, and sub-categories. To ensure clarity and accuracy in conveying the process of refinement and validation in the data analysis the second researcher modified and reviewed them. To enhance validity and authenticity, the researcher consulted other authors and two elderly health experts. At last, all researchers agreed on the categories and subcategories.

Results
This study investigated the facilitators of elderly homecare from the perspective of family carers, with a focus on personal, interpersonal, and environmental factors. The research involved 17 family carers, comprising four males and 13 females, with an average age of 51.8±11.2 years. The care durations varied between one to 24 hours a day. The care recipients were 12 females and seven males, residing in the south of Tehran, with an average age of 80.6±10.9 years (Table 1).


The facilitators of elderly homecare were classified into three main categories: personal, interpersonal, and environmental, encompassing a total of 11 sub-categories. In terms of personal facilitators, participants highlighted the significance of carers’ characteristics and attitudes towards caregiving. Notably, viewing caregiving as a fulfilling service and considering it a divine gift emerged as important factors facilitating effective care. Perceived positive outcomes, such as strengthened family bonds, increased intimacy, and the development of forward-looking personality traits, were identified as influential elements in supporting caregiving. Carers viewed their role as reciprocating the generosity of older adults, and over time, they gained insights into their own caregiving limitations, leading to the unconscious transmission of proper caregiving practices to new generations. Practical caregiving skills and self-care proficiency were also underscored as crucial facilitators.
Concerning interpersonal facilitators, carers emphasized the importance of maintaining regular visits and improving relationships with the elderly recipients. Factors like limited illnesses, partial dependence, literacy, independent mindset, and a desire for social interactions were recognized as facilitators. Emotional support from family members, marked by understanding the conditions of the elderly, showing respect, and actively participating in caregiving and household duties, was deemed vital. Carers found emotional support, access to caregiving facilities, learning from experienced caregivers, and the availability of substitute caregivers effective in easing the caregiving process, often necessitating help from relatives and friends.
In terms of supportive environments, carers highlighted challenges faced by dependent older adults in utilizing home facilities and mobility. They suggested designing residences tailored to the health needs of dependent seniors and equipping them with supportive tools. The proximity between carers’ and older adults’ residences was seen as a significant facilitator. Carers expressed the need for assistance from governmental and non-governmental organizations, spanning services, equipment, and information. Financial aspects were also addressed, with carers mentioning familial cost-sharing, retirement pensions, and external aid as potential sources of financial support. Moreover, the study emphasized the role of service-providing organizations in offering financial assistance and social benefits.
Lastly, participants acknowledged the influence of past experiences and diverse caregiving situations as facilitators. While healthcare and social service providers, as well as relatives, played a diminished role, participants stressed the importance of caregiving training provided by educated and professional carers within organizations. One of the key needs highlighted was the provision of guidance on meeting the nutritional needs of elderly individuals and assisting in the mobility and positioning of those who are physically disabled. The findings underscore the multifaceted nature of caregiving facilitators and highlight the importance of addressing these aspects to enhance the quality of care for older adults.

Conclusion
It seems that the issue of elderly care and caregivers around the world has a similar pattern. This study uncovered that caregiving benefits, encompassing positive emotions and personal growth, served as facilitators. Notably, emotional bonds within families took center stage, particularly the sense of responsibility felt by children towards their aging parents, viewing caregiving as a form of compensation. Moreover, certain attributes of older adults, coupled with emotional attachment, played a pivotal role in facilitating caregiving. Key factors included maintaining a conscientious mindset and fostering respectful relationships with elders. Additionally, the study highlighted the outcomes of partial dependence among older adults and their aspiration to uphold independence and relationships.
Carers emphasized the pivotal role of caregiving skills, with some highlighting the importance of self-care activities for enhancing both physical and mental well-being. Carers sought comprehensive support, encompassing shared family responsibility, leveraging the wisdom of experienced individuals, and expanding the scope of homecare services. The positive encouragement provided by relatives and friends was identified as a significant driving force in fostering ongoing elderly homecare.
In terms of creating supportive environments, participants stressed the importance of aligning physical environmental factors with the capabilities of the elderly. Recommendations included raising awareness about modifying living spaces to meet specific standards and providing resources to empower families to take proactive measures. On the topic of service-providing organizations, carers expressed a perceived lack of available support. Proposals aimed at mitigating carers’ burdens and enhancing the caregiving process encompassed increasing the availability of homecare providers offering assistance with daily activities, providing medical and nursing services, and fortifying the safety of older adults within their homes. This gap in support was particularly evident in Iranian families. Many participants relied on experiential learning, as organizational training for carers was notably limited.
Family carers voiced a clear need for caregiving skills when tending to older adults, yet a majority gained these skills through personal experience, with minimal formal training provided by organizations.

Ethical Considerations
Compliance with ethical guidelines
This article has not any details, images, or videos relating to an individual person. Electronic or in-person informed consents to participate in the study will be obtained from all participants. The study was approved by the Ethics Committee of Tehran University of Medical Sciences, School of Public Health and Allied Medical Sciences (Protocol Code:IR.TUMS.SPH.REC.1399.226 approved on December 2, 2020, and IR.TUMS.SPH.REC.1399.328 approved on March 10, 2021).

Funding
This work was supported as PhD thesis and a Health Systems Research project by the Vice Chancellor for Research of the School of Public Health (grant number: 9711108001) and the Vice Chancellor for Health of Tehran University of Medical Sciences (Grant No.: 1400-1-129-51605).

Authors' contributions
Investigation, writing initial draft, and project administration: Fatemeh Rahimi; Editing and funding acquisition: Fatemeh Rahimi and Elham Shakibazadeh; Supervision: Elham Shakibazadeh; Methodology, analysis and visualization: Fatemeh Rahimi, Elham Shakibazadeh and Mahnaz Ashoorkhani; Validation: Elham Shakibazadeh and Mahnaz Ashoorkhani; Conceptualization and approval of final draft: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellors for Research and Health of the School of Public Health & Allied Medical Science, Tehran University of Medical Sciences, the health center of the South of Tehran, the Imam Khomeini Relief Foundation in Tehran Province, the Tehran Municipality, the Welfare Organization in Tehran Province, and the participants for their support and cooperation.


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