title: Community end-of-life care among Chinese older adults living in nursing homes.
abstract: OBJECTIVE
  The aim of the present study was to investigate the preference and willingness-to-pay (WTP) of older Chinese adults for community end-of-life care in a nursing home rather than a hospital.
  
  
  METHODS
  A total of 1540 older Chinese adults from 140 nursing homes were interviewed. Four hypothetical questions were asked to explore their preferences for end-of-life care. Using a discrete choice approach, specific questions explored acceptable trade-offs between three attributes: availability of doctors onsite, attitude of the care staff and additional cost of care per month.
  
  
  RESULTS
  Approximately 35% of respondents preferred end-of-life care in the nursing home, whereas 23% of them would consider it in a better nursing home. A good attitude of staff was the most important attribute of the care site. Respondents were willing to pay an extra cost of US$5 (HK$39) per month for more coverage of doctor's time, and US$49 (HK$379) for a better attitude of staff in the nursing home. The marginal WTP for both more coverage of doctor's time and better attitude of staff amounted to US$54 (HK$418). Respondents on government subsidy valued the cost attribute more highly, as expected, validating the hypothesis that those respondents would be less willing to pay an additional cost for end-of-life care.
  
  
  CONCLUSIONS
  Older Chinese adults living in nursing homes are willing to pay an additional fee for community end-of-life care services in nursing homes. Both the availability of the doctor and attitudes of nursing home staff are important, with the most important attribute being the staff attitudes. Geriatr Gerontol Int 2013; 14: 273-284.
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; Acute Geriatric Unit, Grantham Hospital, Hong Kong.
authors.forename: Leung-Wing
authors.initials: LW
authors.lastname: Chu
authors.forename: Jason C
authors.initials: JC
authors.lastname: So
authors.forename: Lai-Chin
authors.initials: LC
authors.lastname: Wong
authors.forename: James K H
authors.initials: JK
authors.lastname: Luk
authors.forename: Patrick K C
authors.initials: PK
authors.lastname: Chiu
authors.forename: Cherry S Y
authors.initials: CS
authors.lastname: Chan
authors.forename: Fiona S M
authors.initials: FS
authors.lastname: Kwan
authors.forename: June
authors.initials: J
authors.lastname: Chau
authors.forename: Elsie
authors.initials: E
authors.lastname: Hui
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.forename: Sarah M
authors.initials: SM
authors.lastname: McGhee
mesh_terms: D000369:Aged, 80 and over; D044466:Asian People; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D057240:Patient Preference; D013727:Terminal Care / Q000191:economics
keywords: aging; conjoint analysis; end-of-life care; willingness-to-pay