Older Citizens' Opinions on Long-Term Care Options: A Vignette Survey

BackgroundOlder citizens are directly concerned, as potential beneficiaries and informal caregivers, by access to long-term care (LTC) services matching their expectations. The aim of this research was to collect their opinions regarding LTC arrangements for a diversity of disability profiles.Design/Setting/ParticipantsMailed vignette survey in a representative population-based sample of 3133 community-dwelling persons 68 years or older residing in a Swiss region.MeasurementsAll persons received a set of 10 vignettes. For each vignette, they considered 2 social situations successively: a person (1) living with an able-bodied spouse, and (2) living alone or with a spouse unable to help (resulting in 20 vignettes). Subjects selected a care setting (home, sheltered housing, or nursing home) and specified the preferred type of caregivers (spouse, professionals, or both) after community-based care options. Population estimates were based on weighted data accounting for the stratification of the survey sample.ResultsA total of 2985 participants (95.3%) expressed opinions on 55,178 vignettes (mean 18.5 vignettes, SD 4.1) Institutionalization was selected by 0.8% (95% confidence interval 0.3-1.4) of the population for the vignette of lowest disability with able-bodied spouse and 78.8% (76.1-81.6) for the vignette of highest disability and no possible help from a spouse. Continence, cognitive, and behavioral difficulties further influenced the preferences expressed for LTC options. Community-based LTC choices involved professionals mostly as a complement to informal help by the spouse, except for vignettes describing isolated moderate cognitive impairment or difficulties in instrumental activities of daily living. In these cases, most favored help provided by spouses only.ConclusionsThis survey had high acceptance. Responses to variations in the disability and social profile displayed in the vignettes suggested the validity of measurements.