OBJECTIVES: Dementia is a major health and social care challenge in developed countries where most people are cared for in their own homes. This study aimed to elicit carer preferences and willingness-to-pay for alternative bundles of home care services in the Milan metropolitan area.

METHODS: A binary discrete choice experiment (DCE) was administered to a sample of informal caregivers recruited through a network of non-profit organizations. The study received approval by the Ethics Committee of Bocconi University. An optimal orthogonal in the differences (OOD) design was used to create nine choice sets with Ngene. Four attributes articulated into three levels each were included based on literature review, expert opinion, and prior interviews with caregivers: 1) the number of home care hours per month; 2) the type of care (i.e., health, social, mixed); 3) the caregiver peer support group (i.e., none; among carers; with also professional support); 4) the monthly family’s cost (€). A mixed logit model was used to analyze the responses using Stata 17.

RESULTS: A total of 90 self-administered questionnaires were collected in January-April 2023. Two thirds of caregivers were female (66.7%) and children (65.6%), and mean age was 59.1±12.3 years. The mean age of people with dementia was 82.1±6.57; around two thirds (65.9%) were female and almost half (48.9%) had also a paid caregiver. The DCE results showed that increased home care hours, mixed health and social home care, caregiver meetings with professional support and lower monthly costs were mostly valued by carers. Some preference heterogeneity was detected in relation to socio-demographic characteristics; for example, female and older caregivers revealed a higher preference for receiving mixed and health care, respectively, for their care recipients.

CONCLUSIONS: The study results are expected to support policymakers in recalibrating public home care services for people with dementia and their informal caregivers according to social preferences.