A new study found that post-acute patients and caregivers prefer home care to facility care, although with some caveats.
The study results, published in JAMA, come from an eight-question survey conducted in September 2022 among over 1,500 adults ages 45 and older. The survey examined 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 suited their preferences, needs, and family conditions,” the study authors explained. “Survey weights were applied to produce nationally representative estimates.”
By and large, patients and caregivers were willing to pay an additional $58 per day for home health care compared to a shared SNF room. However, people also reported that revenue from home care was declining.
For example, while high-quality home care was strongly preferred by study participants, caregivers’ preference shifted back toward facility-based care when the care load exceeded eight hours per day or participants faced socioeconomic challenges such as job insecurity.
There is also a “strong aversion” to subpar quality of care, which is to be expected.
Ultimately, the study showed that while home health care is definitely the post-acute care of choice for older adults, quality and additional support need to be considered.
“The results of this survey suggest that, despite a prevailing preference for home care, targeted support to disadvantaged groups facing caregiver limitations and socioeconomic difficulties is critical to ensuring equitable access and promoting patient-centered post-acute care “, the authors of the study continued.
As payers and providers begin to adopt more value-based care models, the study authors also believe the results can lead to models that address all patient needs in post-acute settings.
“Alternative payment models in traditional Medicare and Medicare Advantage plans have resulted in post-acute care no longer occurring in institutional settings,” they wrote. “Models that encourage greater HHA utilization should consider the financial and nonfinancial costs incurred by caregivers. Because home care places a financial burden on family carers, we must ensure that these measures do not increase inequalities in care for disadvantaged groups.”