Preference of Older Adults for Flexibility in Service and Providers in Community-Based Social Care: A Discrete Choice Experiment

Abstract

Empowerment of control and choice of the service users in health and social care has been incorporated into service provision in various countries. This study aimed to elicit the preference of community-based long-term care (LTC) service users on levels of flexibility in service provision. A discrete choice experiment was performed among older community care service users to measure their preference for attributes of LTC services identified from a prior qualitative study. Each participant was asked to make choices in six choice tasks with two alternatives of hypothetical LTC services that were generated from the attributes. A generalized multinomial logistic model was applied to determine the relative importance and willingness to pay for the attributes. It found that the participants preferred multiple flexible providers, determining services by themselves, meeting case managers every month and social workers as sources of information on service provision. Significant preference heterogeneity was found for flexibility in providers and flexibility in services between those with and without activity of daily living impairment. The findings highlighted the preference of older adults for greater flexibility in LTC, while they rely heavily on social workers in decision making. The enhancement of flexibility in LTC should be supported by policies that allow the older service users to make decisions based on their own preferences or communication with social workers instead of determining the services and providers for them. Options should be offered to users to decide their preferred level of flexibility to better reflect their divided preferences.

What constitutes a quality community aged care service—client perspectives: An international scoping study

“…Clients valued a highly skilled workforce who received adequate training to meet their individual needs (Anderson et al, 2006 ; Royal Commission, 2020 ; Spoorenberg et al, 2015 ). The relationship between a highly skilled workforce and client satisfaction was also evident with clients valuing the use of skilled social work professionals to act as care managers coordinating a clients' care needs (Chesterman et al, 2001 ; Wang et al, 2022 ). Having consistent staff who were well trained was a strong theme throughout the literature that resulted in improved client satisfaction (Byrne et al, 2011 ; Groenewoud et al, 2008 ; McCaffrey et al, 2015 ; Royal Commission, 2020 ; Samuelsson & Wister, 2000 ).…”

“…Clients valued a highly skilled workforce who received adequate training to meet their individual needs (Anderson et al, 2006;Royal Commission, 2020;Spoorenberg et al, 2015). The relationship between a highly skilled workforce and client satisfaction was also evident with clients valuing the use of skilled social work professionals to act as care managers coordinating a clients' care needs (Chesterman et al, 2001;Wang et al, 2022).…”

Preference of caregivers on residential care homes for older persons with versus without communication problems: a discrete choice experiment

“…Regarding flexibility of choice in care services, previous studies in the UK reported that care home residents with fewer cognitive problems were more likely to benefit from individualized care services than residents with greater cognitive disadvantages, as the latter had limited capacities to exercise their choices [ 10 , 36 ], and older persons with ADL impairment in Hong Kong were found to have less preference for flexible services [ 37 ], while communication problem was not found associated with this preference. However, the ability of those with communication problems to exercise flexible choices is threatened by their limited mental capacity [ 38 ], which suggested that there should be personnel and mechanisms in place to assist these residents in optimizing their control and choices over services.…”

Heuristics, Biases, and Decisions in Resource Allocation for Home Care Packages under Consumer Directed Care: A Systematic Review and Thematic Synthesis

“…Ten of the eleven papers reference the complexity of decision making [13,15,[24][25][26][27][28][29][30]32]. Factors that complicate decision making in older age are numerous, including time, trade-ofs, information quality, the number of decisions being made, and the number of choice options within those decisions [13,25,26,28].…”

“…Another prevalent assumption is that decision-making strategies remain fxed, i.e., that a person will make a decision in the same way when they are 20 as they will when they are 60 [31]. Evidence presented in ten of the articles suggests this is not the case, indicating that age-related changes in decision making are measurable and that the overall efect is a decline in decision quality [13,15,[24][25][26][27][28][30][31][32]. Te reasons for this decline are generally related to cognitive function [13,15,24,28,31,32], including decreases in processing speed [24,31], executive function [24], and working memory.…”