25 Older adults express their choices to guide the long-term care policy

The study is based on a representative cohort of older adults aged between 68 and 82 years living at home in the canton of Vaud. In a first survey in 2012, 3,000 persons were sent a questionnaire. They were presented with a dozen hypothetical situations describing persons in need of care, for which the respondents had to choose the most appropriate care option. A differentiation was made between cases where a spouse could support the disabled person and cases where no spousal support was available. In 2017 the survey was sent again to 3,500 people. The study analysed how details presented in the hypothetical situations and the respondent’s own characteristics influenced their choice. For respondents who participated in both the 2012 and 2017 survey, the study examined how their opinions changed over time.

The need for long-term care will increase significantly in the future. The availability of a variety of long-term care services allows older persons today to make individual choices according not only to their needs, but also to their values. This increases the quality of life of both dependent persons and their caregiving relatives – often spouses. However, older adults’ preferences remained an unknown until now and therefore could not sufficiently be taken into account when developing long-term care policies.

The first aim of this study was to determine, for situations of more or less severe dependency, which long-term care option is considered most appropriate by the older population. In particular, we looked at the limits of home care and at the extent of interest for the option of sheltered housing. A second aim was to examine whether personal characteristics influence preferences. A third purpose was to assess the consistency of responses and the continuity of opinions over time.

The severity of the disability described in the vignettes, as well as the possible help of a spouse, are the primary determinants of the preferences of the older population. The personal characteristics of respondents - such as age, gender, level of education or caregiver role - only moderately influence choices. Respondents' health characteristics, reflecting their own needs, do not significantly affect the opinions expressed. Vignettes indicating a need for help in managing incontinence cause a clear shift in choices towards institutional solutions, pointing to the limits of home care. The results also showed a growing interest, between 2012 and 2017, in the option of sheltered housing, particularly in cases of low or medium dependency.

This project demonstrated the feasibility of consulting older citizens on their opinions regarding long-term care options. In the canton of Vaud, it showed a growing interest in sheltered housing. It also pointed to incontinence prevention and professional support for family caregivers as determining factors for home care. Since preferences can be influenced by regional and cultural factors, they must be analyzed at the local level. The vignettes used in this survey are available to the cantonal health departments to question their population of older adults and to orient their long-term care policy accordingly.

• DOI
  

Preference for long-term care options in community-dwelling older adults