A new study found that post-acute patients and caregivers greatly prefer home-based care to facility-based care, although with some caveats.
Published in JAMA, the study’s results came from an eight-question survey conducted in September 2022 of over 1,500 adults aged 45 and older. The survey dissected the participants’ willingness and preference to pay for certain services, such as skilled nursing facility (SNF) care versus home health care.
“Using a discrete choice experiment, participants acting as patients or caregivers chose between facility-based and home-based post-acute care that best met their preferences, needs and family conditions,” the study authors explained. “Survey weights were applied to generate nationally representative estimates.”
Broadly, patients and caregivers were willing to pay an additional $58 per day for home health care compared to a shared SNF room. But the individuals also suggested that there were diminishing returns to home-based care.
For instance, while quality home-based care was strongly preferred among the study’s participants, when caregiving burden exceeded eight hours daily or participants faced socioeconomic challenges like job insecurity, the caregiver preference shifted back toward facility-based care.
There was also a “strong aversion” to below-average quality care, which is to be expected.
Ultimately, the study showed that while home-based health care is definitely the preference of older adults for post-acute care, quality and additional support need to be considered.
“The results of this survey study suggest that despite a predominant preference for home-based care, targeted support for disadvantaged groups facing caregiver constraints and socioeconomic hardships is essential to ensure equitable access and promote patient-centric post-acute care,” the study authors continued.
As payers and providers begin leveraging more value-based care models, the study authors also believe that the findings can lead to models that address all of patients’ needs in post-acute settings.
“Alternative payment models in traditional Medicare and Medicare Advantage plans have shifted post-acute care away from institutional settings,” they wrote. “Models that encourage greater HHA use should account for the financial and nonfinancial costs placed on caregivers. Because home-based care places a financial burden on family caregivers, we need to ensure that these policies do not increase disparities in care for disadvantaged groups.”
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