Older Adults Far Prefer Home-Based Post-Acute Care, But With Some Caveats

A new study found that post-acute patients and caregivers greatly prefer home-based care to facility-based care, although with some caveats.

Published in JAMA, the study’s results came from an eight-question survey conducted in September 2022 of over 1,500 adults aged 45 and older. The survey dissected the participants’ willingness and preference to pay for certain services, such as skilled nursing facility (SNF) care versus home health care.

“Using a discrete choice experiment, participants acting as patients or caregivers chose between facility-based and home-based post-acute care that best met their preferences, needs and family conditions,” the study authors explained. “Survey weights were applied to generate nationally representative estimates.”


Broadly, patients were willing to pay an additional $58 per day for home health care compared to a shared SNF room.

“Patients and caregivers strongly preferred high-quality, home-based care,” Fangli Geng, a PhD candidate in health policy at Harvard and a lead study author, told Home Health Care News. “Support for disadvantaged groups facing caregiver constraints and socioeconomic hardships is crucial for ensuring equitable access to care. Those familiar with home health agencies and skilled nursing facilities demonstrated a stronger preference for home-based care. This highlights the significance of patient and caregiver education regarding available post-acute care options.”

But the individuals also suggested that there were diminishing returns to home-based care. 


For instance, while quality home-based care was strongly preferred among the study’s participants, when caregiving burden exceeded eight hours daily or participants faced socioeconomic challenges like job insecurity, the caregiver preference shifted back toward facility-based care.

There was also a “strong aversion” to below-average quality care, which is to be expected.

Ultimately, the study showed that while home-based health care is definitely the preference of older adults for post-acute care, quality and additional support need to be considered. 

Also, as payers and providers begin leveraging more value-based care models, the study authors also believe that the findings can lead to models that address all of patients’ needs in post-acute settings. 

“We must explicitly consider the costs of post-acute care burdens on family caregivers and shared family finances,” Geng said. “Understanding the full financial implications of payment model changes in traditional Medicare and Medicare Advantage expansion is crucial for providing adequate support to disadvantaged groups and ensuring that new payment models and Medicare Advantage plans do not exacerbate existing disparities.”

Companies featured in this article: