Not surprisingly, consumers overwhelmingly prefer home-based care to facility-based care. Difficulties coordinating caregivers or preexisting socioeconomic challenges, however, can lead some people to favor facility-based alternatives, according to the results of a study published in JAMA Network Open.
The researchers asked 1,555 adults who had an average age of 62.6 years about their willingness to pay for care in various settings. The sample included both individuals who would need healthcare and unpaid caregivers who make care decisions for older family members. The investigators found that both individuals and their family caregivers were more willing to pay for at-home care and also overwhelmingly prioritized higher-quality care.
On average, respondents said they were willing to spend an extra $51.81 per day for care that takes place in the home compared with facility-based care such as that in a skilled nursing facility. They also were more willing to pay more for care that can reduce their recovery time or reduce the burden on their unpaid caregivers. Family caregivers, meanwhile, also prioritized higher-quality care, even if it came with a heftier price tag.
“Our data highlighted a unanimous preference for higher-quality care with a pronounced aversion to below-average care,” the researchers wrote. “[Family c]aregivers were more inclined to pay a premium for better care for patients than the patients themselves.”
Participants who had prior experience with home health agencies were willing to spend the most, on average, for at-home care. Those individuals said they were willing to spend an extra $52.28 per day for care in the home, according to the report.
Socioeconomically disadvantaged respondents, on average, however, had a lower willingness to pay for home-based care. Respondents with job insecurity, or those who were unemployed, were less willing to pay a higher price for home care, according to the study.
Given this finding, “our financial and social systems must ensure adequate support of home-based care across diverse socioeconomic contexts,” the researchers said. President Biden recently announced a swath of reforms meant to improve care and better support family caregivers, including enhanced access to respite care services, improved funding for services that support caregivers and more.
“Those reforms provide an opportunity to address the underlying complexities identified in our study, ensuring a more equitable distribution of care that reflects patient preferences and caregiver capacities,” the researchers wrote.
And although new payment models seek to shift post-acute care from institutional settings such as nursing homes into peoples’ homes, stakeholders must ensure that those initiatives do not exacerbate care disparities already felt among disadvantaged groups, they added.
