title: Quantifying long-term care preferences.
abstract: . Current policies redirecting long-term care (LTC) delivery away from institutional care to home- and community-based services are being made in the absence of crucial evidence on preferences. Studies indicate that the shift to home care is generally not cost-saving; thus, an empirical assessment of effectiveness is needed to evaluate policies incenting home care investment. This study quantifies LTC preferences between different delivery modes.
  
  
  
  . This study extended the time tradeoff method to elicit utilities and LTC preferences associated with the receipt of different modes of LTC services, conditional on health states defined by varying levels of functional and cognitive impairment. Users' LTC preferences are measured as differential utilities between alternative LTC options for each health state.
  
  
  
  . For the same health state, respondents (n = 81) significantly preferred home care over institutional care, except for the most impaired health state. The preference for home care over institutional care is quantified as 0.30 quality-of-life (QOL) weight when people need help with only 1 activity of daily living (ADL). The preference for home care depends significantly on levels of disability and was weaker once the need for help became greater. Under the most severe health state of having moderate to severe dementia and needing help with 6 ADLs, the quantified home care preference was only 0.03 QOL weight and was not statistically significant.
  
  
  
  . Because the sample is mostly composed of African Americans, the results may not be generalizable to other racial and ethnic groups.
  
  
  
  . People do not always strongly prefer home care over institutional care, as is often assumed. The costs of expanding home- and community-based care should be weighed against these preferences.
authors.affiliation: American Institutes for Research, Washington, DC, USA (JG)
authors.forename: Jing
authors.initials: J
authors.lastname: Guo
authors.affiliation: University of Chicago, Chicago, IL, USA (RTK)
authors.forename: R Tamara
authors.initials: RT
authors.lastname: Konetzka
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Magett
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
authors.forename: William
authors.initials: W
authors.lastname: Dale
mesh_terms: D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D057240:Patient Preference; D011788:Quality of Life; D012959:Socioeconomic Factors
keywords: cost-effectiveness analysis; long-term care; preference; quality of life; time tradeoff