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Public preferences for home care services for people with dementia: A discrete choice experiment on personhood

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  • Walsh, Sharon
  • O'Shea, Eamon
  • Pierse, Tom
  • Kennelly, Brendan
  • Keogh, Fiona
  • Doherty, Edel

Abstract

Dementia is a progressive and debilitating neurodegenerative condition which significantly impacts on quality of life and the ability to live independently. It is a leading cause of disability in older populations and carries significant economic and social costs. It is no wonder, therefore, that dementia has been identified as a major global health and social care challenge, especially with prevalence projected to triple by 2050. In many countries, the stated policy aim is to care for people with dementia in their own homes for as long as possible and practicable. However, home care systems vary significantly across countries in their approach to personhood in dementia, particularly the extent to which care provision reflects the needs and preferences of recipients. In this paper, we undertook a discrete choice experiment, with data collected from 551 individuals in Ireland between November and December 2018, to elicit public preferences for personhood-oriented home care services for people with moderate dementia. We capture the concept of personhood with two attributes, one that refers to whether care provision is flexible and tailored to the individual needs of the person with dementia, and a second that refers to whether communication with the person with dementia is expressed in a personalised manner. Using mixed logit models, we find that flexible service provision, personalised communication and increased home care hours are highly valued by citizens. While people are indifferent to a means-tested co-payment for home care relative to no co-payment, they are opposed to a universal co-payment. We also estimate the welfare impact of a move from the status quo to alternative personhood-oriented home care arrangements, providing useful insights for policymakers regarding the future design and funding of home care services. The paper has significant implications for the recalibration of health and social care systems towards personhood in dementia care.

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  • Walsh, Sharon & O'Shea, Eamon & Pierse, Tom & Kennelly, Brendan & Keogh, Fiona & Doherty, Edel, 2020. "Public preferences for home care services for people with dementia: A discrete choice experiment on personhood," Social Science & Medicine, Elsevier, vol. 245(C).
    • Handle: RePEc:eee:socmed:v:245:y:2020:i:c:s0277953619306707
    DOI: 10.1016/j.socscimed.2019.112675
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    2. Amilon, Anna & Kjær, Agnete Aslaug & Ladenburg, Jacob & Siren, Anu, 2022. "Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark," Social Science & Medicine, Elsevier, vol. 311(C).
    3. Keane, Claire & Seán Lyons & Mark Regan & Walsh, Brendan, 2022. "Home support services in Ireland: Exchequer and distributional impacts of funding options," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT111, June.
    4. He, Alex Jingwei & Qian, Jiwei & Chan, Wai-sum & Chou, Kee-lee, 2021. "Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong," Social Science & Medicine, Elsevier, vol. 270(C).
    5. Teahan, Áine & Walsh, Sharon & Doherty, Edel & O'Shea, Eamon, 2021. "Supporting family carers of people with dementia: A discrete choice experiment of public preferences," Social Science & Medicine, Elsevier, vol. 287(C).
    6. Walsh, Brendan & Lyons, Seán, 2021. "Demand for the Statutory Home Care Scheme," Research Series, Economic and Social Research Institute (ESRI), number RS122, June.
    7. Lea de Jong & Jan Zeidler & Kathrin Damm, 2022. "A systematic review to identify the use of stated preference research in the field of older adult care," European Journal of Ageing, Springer, vol. 19(4), pages 1005-1056, December.

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