People Prefer Home-Based Post-Acute Care Over Facilities
People Prefer Home-Based Post-Acute Care Over Facilities
A survey study found that patients and caregivers who need medical care after leaving a hospital strongly favor receiving care at home rather than in a facility.
Not only did survey participants prefer being home, but they were also willing to pay extra money per day for home-based care rather than stay in a shared room at a skilled nursing facility. However, if they had to stay at a skilled nursing facility, the survey respondents said they would be willing to pay extra for a private room.
The survey study results, published in the JAMA Health Forum journal, are based on a September 2022 survey conducted with 1,555 participants, who were asked to act as patients or caregivers needing post-acute care, which is medical care required after a hospital discharge.
The survey presented eight hypothetical choice scenarios, and participants were given the option to choose between a home health agency and a skilled nursing facility that best met their preferences, needs, and family conditions.
The survey participants were aged 45 and older. The researchers said they focused on this age group because they account for most discharges to post-acute care. Also, they are usually the primary decision-makers for themselves and their families when it comes to post-acute care, according to the researchers.
According to the survey, two out of five U.S. hospital stays result in patients requiring post-acute care.
“However, a lack of clear guidelines and understanding of patient and caregiver preferences makes it challenging to promote high-value patient-centered care,” the study said.
The study notes that while patients in the hospital often receive discharge setting recommendations, the settings for diverse patients that best meet their preferences “remain ambiguous,” and there is not enough data comparing skilled nursing facilities and home health agencies.
While the U.S. Centers for Medicare & Medicaid Services (CMS) has tools to measure the quality of nursing home and home health care, CMS does not typically provide direct comparisons between skilled nursing facilities and home health agencies, the study said.
“Consequently, patients and caregivers often hastily base postacute care decisions on prior experiences, perceptions, preferences, and trade-offs concerning quality, cost, and location,” the report said.
Because of this, the study highlights the importance of patient and caregiver education about post-acute care options.
“Proactive measures, such as collecting comprehensive postacute quality information and developing decision aids, may significantly guide preference-aligned choices,” the study said.
Survey Results
The survey assessed preferences and willingness to pay for different aspects of post-acute care settings. Researchers examined these differences based on demographic factors, socioeconomic status, job security, and previous care experience.
In many cases, survey respondents were willing to pay extra to make sure their care preferences were met. They were also willing to pay extra for a private room at a skilled nursing facility instead of a shared room.
Additionally, caregivers who had personal experience with home health agencies indicated that they were most willing to pay more for the home-based option compared with staying in a shared room at a skilled nursing facility.
When caregiving demands rose to the level of a full-time job (more than eight hours a day), caregivers opted for skilled nursing facilities.
“This trend was amplified among socioeconomically disadvantaged groups, such as those in insecure jobs,” the report said. “Despite a clear preference for home-based care within these groups, the added caregiving burden can overshadow its benefits, underlining the need for policies that address these disparities.”
When it came to the patient group, the study survey said prior experience with home health agencies and skilled nursing facilities, as well as family income, was significantly linked to their preferences for receiving care at home through home health agencies or at a skilled nursing facility.
Survey Participants Want Quality Care
Receiving quality care was essential for all respondents, but especially for those acting as caregivers, according to the survey.
“Our data highlighted a unanimous preference for higher-quality care with a pronounced aversion to below-average care,” the study said. “Caregivers were more inclined to pay a premium for better care for patients than the patients themselves.”
For instance, to avoid below-average care at a skilled nursing facility, patient respondents and caregivers were willing to pay more on average than compared with average-quality care.
The results were similar for home health agencies. For instance, patients and caregivers were willing to pay more to avoid receiving below-average care and to pay more for above-average care.
Survey Results Align With Current Post-Acute Care
The study noted a growing policy shift toward focusing on patient care at home rather than in institutional settings. This change is reflected in the rise of alternative payment models within traditional Medicare and the increase in Medicare Advantage beneficiaries, which is typically associated with reduced post-acute care use.
With a shift in policy and the survey’s findings, researchers say these insights may offer valuable guidance to policymakers, healthcare clinicians and networks, and insurers “as they strive to design and deliver high-value, patient-centered postacute care, with a particular focus on the needs of disadvantaged groups.”
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