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Cited by 47Economic and Environmental ValuationHealthcare innovation and challengesDementia and Cognitive Impairment Research

Public preferences for home care services for people with dementia: A discrete choice experiment on personhood

Walsh, Sharon, O'Shea, Eamon, Pierse, Tom, Kennelly, Brendan, Keogh, Fiona, Doherty, Edel·2020·Social Science & Medicine
DOI 10.1016/j.socscimed.2019.112675
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Abstract

Dementia is a progressive and debilitating neurodegenerative condition which significantly impacts on quality of life and the ability to live independently. It is a leading cause of disability in older populations and carries significant economic and social costs. It is no wonder, therefore, that dementia has been identified as a major global health and social care challenge, especially with prevalence projected to triple by 2050. In many countries, the stated policy aim is to care for people with dementia in their own homes for as long as possible and practicable. However, home care systems vary significantly across countries in their approach to personhood in dementia, particularly the extent to which care provision reflects the needs and preferences of recipients. In this paper, we undertook a discrete choice experiment, with data collected from 551 individuals in Ireland between November and December 2018, to elicit public preferences for personhood-oriented home care services for people with moderate dementia. We capture the concept of personhood with two attributes, one that refers to whether care provision is flexible and tailored to the individual needs of the person with dementia, and a second that refers to whether communication with the person with dementia is expressed in a personalised manner. Using mixed logit models, we find that flexible service provision, personalised communication and increased home care hours are highly valued by citizens. While people are indifferent to a means-tested co-payment for home care relative to no co-payment, they are opposed to a universal co-payment. We also estimate the welfare impact of a move from the status quo to alternative personhood-oriented home care arrangements, providing useful insights for policymakers regarding the future design and funding of home care services. The paper has significant implications for the recalibration of health and social care systems towards personhood in dementia care.

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  • Simply increasing home care hours without investing in system and cultural change-embracing personhood, increasing PSW wages, and providing dementia-specific education and quality standards-will not result in better outcomes.

    “Simply increasing home care hours without investing in a system and cultural change—embracing tenets of personhood, increasing PWS wages, and providing dementia-specific education and quality standards—will not result in better outcomes [16,43,44].”

    From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [43]

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Authors
Walsh, S., O'Shea, E., Pierse, T., Kennelly, B., Keogh, F., & Doherty, E.
Affiliations
Ollscoil na Gaillimhe – University of Galway (IE)
Corresponding author
Walsh, Sharon
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2020-01
Volume
245
Pages
112675
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2019.112675
OpenAlex
W2984835395
Cited by
47
References
67
Citations by year
2026: 8 · 2025: 7 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 8 · 2020: 7
FWCI
6.87
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
Health Research Board (RL - 2015 - 1587)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
  • Social Sciences › Education › Healthcare innovation and challenges
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
dementia, home care, personhood, public preferences, copayments, welfare effects, care funding, social care policy, moderate dementia, Ireland
MeSH terms
Consumer Behavior, Dementia, Home Care Services, Humans, Ireland, Social Support, Personhood

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