title: How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?
abstract: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase?
  
  
  
  We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method.
  
  
  
  Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home.
  
  
  
  Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Sperber
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.|National Bureau of Economic Research (NBER), Cambridge, Massachusetts.
authors.forename: Norma B
authors.initials: NB
authors.lastname: Coe
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, Illinois.
authors.forename: R Tamara
authors.initials: RT
authors.lastname: Konetzka
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jillian
authors.initials: J
authors.lastname: Boles
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Courtney Harold
authors.initials: CH
authors.lastname: Van Houtven
mesh_terms: D000328:Adult; D032721:Adult Children; D000368:Aged; D001290:Attitude; D002755:Choice Behavior; D005195:Family Relations; D005260:Female; D017144:Focus Groups; D006801:Humans; D007353:Insurance, Long-Term Care; D008297:Male; D008875:Middle Aged; D010287:Parent-Child Relations; D010290:Parents; D057240:Patient Preference; D026684:Personal Autonomy; D036301:Qualitative Research
keywords: Family dynamics; Long-term care insurance; Qualitative methods