The decision‐making processes and preferences of older Australians purchasing home support services: An explorative inquiry using a “think‐aloud” technique

Abstract

Consumer-directed care (CDC) programmes, in principle, provide consumers with choices around who provides care services to them, what services and when. However, literature around consumer behaviour of older adults, especially concerning the factors that may support home care choices, is sparse. The purpose of this study was to understand the decision-making processes and spending preferences of communitydwelling seniors assessed eligible for CDC home care services. We completed an explorative inquiry using a "think-aloud" technique with eligible consumers in South Australia. The inquiry had two components. First, consumers used imitation money to simulate the purchase of home care supports while talking out loud their decision-making processes. Then, semistructured interviews were completed to identify underlying thoughts that informed the decisions made and spending preferences. Fifteen consumers, mean age 82 years (range 70-94), participated. The most frequently prioritised choice was domestic assistance. However, choices were made based on a perceived | 373 RAHJA et Al.

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].…”

“…Tere is an inherent assumption that decision making is a static and rational process that lends itself to economic models, i.e., when a person makes a decision, the judgement is fnal and the individual will consistently choose in line with that judgement [31]. Models of decision making often assume that associated strategies are homogenous and consistent over the life course [24,31] and that rational choice will reliably lead to optimal allocation of resources [26,28], provided the consumer is fully aware of all possible constraints and outcomes [13,15,30] and is able to process available information [28]. In reality, these assumptions do not hold [28,31].…”

“…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.…”

“…Altered patterns in decision making need to be accounted for, acknowledging that older people are more inclined toward heuristic thinking than younger people [24]. General patterns suggest that older people require more time to process information [24], are more inclined to make decisions emotionally rather than factually (i.e., the afect heuristic) [13,15,24,25,30,32], and will make decisions based on what is familiar to them (i.e., the availability heuristic) [13,15,[24][25][26]28]. It is therefore important for decisions to be framed in meaningful, relevant ways [24].…”

“…Where behavioural economic theory has been applied to health, it is usually in relation to drug advertising [9], medical insurance [10], or clinician bias [11]. A small number of studies have applied these theories to understand the impact of heuristic decision-making on quality of life [12][13][14][15]. None have evaluated the possible impact of heuristic decision making on cost efectiveness or program outcomes.…”