ARE LONG-TERM CARE REFORMS IN RESIDENTIAL FACILITIES ALIGNED WITH OLDER ADULTS' PREFERENCES? FINDINGS FROM A DISCRETE CHOICE EXPERIMENT IN SIX OECD COUNTRIES
Author(s)
Anais Cheneau, PhD1, Thomas Rapp, PhD2, Jonathan Sicsic, PhD3.
1Université Paris Cité - LIRAES, PARIS, France, 2Liraes, Paris, France, 3Université Paris Cité, Paris, France.
1Université Paris Cité - LIRAES, PARIS, France, 2Liraes, Paris, France, 3Université Paris Cité, Paris, France.
OBJECTIVES: Population ageing is increasing demand for long-term care (LTC) across OECD countries, driving reforms that promote ageing in place and rebalance care towards home-based services. Yet residential care remains central for individuals with severe dependency, and observed patterns of LTC use do not necessarily reflect preferences, but also institutional design, service availability, family norms, workforce constraints, and affordability. This paper examines whether current LTC reforms are aligned with older people’s stated preferences. We compare individuals aged 60 and over across six OECD countries representing distinct LTC configurations: France, Italy, the Netherlands, Spain, England, and the United States.
METHODS: We use data from the international AgingUP! Survey, which includes a harmonized discrete choice experiment eliciting preferences over LTC configurations. Respondents are asked to imagine a situation of severe dependency and to choose between alternative nursing-home (NH) packages described by six attributes: facility size and hotel quality, proximity, waiting time, degree of medicalization, quality of professional care, and out-of-pocket cost. We estimate the relative importance of each attribute, the willingness to wait for entering the chosen NH and examine choices between respondents’ preferred home-care and NH configurations.
RESULTS: Out-of-pocket cost is the most important attribute, especially in the United States and England. Facility size and hotel quality rank second, with strong preferences for smaller structures and marked disutility for large facilities. The relative importance of proximity, waiting time, and medicalisation varies across countries: Dutch respondents prioritize location, Spanish respondents give more importance to waiting time and medicalisation. When choosing between their preferred NH and home-care configurations, most respondents favor home care - yet NH acceptability ranges from 19% in England to 37% in Spain, and is sensitive to the quality of both options.
CONCLUSIONS: These findings suggest that ageing-in-place policies should be complemented by efforts to improve and diversify residential care.
METHODS: We use data from the international AgingUP! Survey, which includes a harmonized discrete choice experiment eliciting preferences over LTC configurations. Respondents are asked to imagine a situation of severe dependency and to choose between alternative nursing-home (NH) packages described by six attributes: facility size and hotel quality, proximity, waiting time, degree of medicalization, quality of professional care, and out-of-pocket cost. We estimate the relative importance of each attribute, the willingness to wait for entering the chosen NH and examine choices between respondents’ preferred home-care and NH configurations.
RESULTS: Out-of-pocket cost is the most important attribute, especially in the United States and England. Facility size and hotel quality rank second, with strong preferences for smaller structures and marked disutility for large facilities. The relative importance of proximity, waiting time, and medicalisation varies across countries: Dutch respondents prioritize location, Spanish respondents give more importance to waiting time and medicalisation. When choosing between their preferred NH and home-care configurations, most respondents favor home care - yet NH acceptability ranges from 19% in England to 37% in Spain, and is sensitive to the quality of both options.
CONCLUSIONS: These findings suggest that ageing-in-place policies should be complemented by efforts to improve and diversify residential care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE32
Topic
Economic Evaluation, Methodological & Statistical Research, Patient-Centered Research
Disease
Geriatrics