Population aging has become a common problem worldwide and leads to the issue of elderly care. To respond to elderly care requirements, all countries have implemented long-term care policies. The ultimate goal is "aging in place." To develop home- or community-based care policies, with the goal of aging in place, we intend to provide older adults with a reliable and comprehensive service. Needs assessments conducted by professionals regarding community or home care provide cross-professional integration services and resource links. This is called community-integrated care. The case manager is the key role in this project, and nursing staff members are suitable for this role. They provide various types of service to enhance the quality of care, including case-needs assessments, plan formulation, care implementation, prevention, diseases education, effectiveness tracking, resource linking, and one-stop services, to improve effectiveness and reduce the care hours required for individual cases. To encourage and train more home nursing staff to invest in long-term services, in 2018, the Ministry of Health and Welfare has operated a project aimed at increasing home care agency. With the support from government's policy, they aim to enable home nursing staff to lead the project of developing community-based care resources, which are based on the community and the customers, and to train more home nursing staff to provide care service in the community. In this case, nursing is not limited to institutions and is also performed in the community. In addition, home nursing staff could improve their skills, increase their knowledge, and try to provide multiple innovative services, such as foot care and dementia care. Thus, they can provide multiple services, fully assume the functions of the case manager, and perform strongly in community-integrated care.