Preferences for new models of social care for older people with high care needs

A number of factors may affect the choices older people make around their social care needs once the need develops.

Background

The expected future growth in the number of older people could well be accompanied by other changes, including:

• greater asset holdings;
• widening wealth inequalities;
• changing preferences – for greater choice and responsibility;
• changing attitudes to residential care due to the pandemic;
• rising expectations about the quality of care;
• changing policy context, with implications for how social care is financed (balance between public vs private);
• fewer family carers relative to the numbers needing care;
• changing labour market for social care staff because of Brexit;
• new interconnections between NHS, social care and other sectors;
• changes in coverage and value of occupational pensions;
• changes in the age of onset of social care needs;
• growth of multiple long-term conditions.

Almost any one of the above factors alone could potentially alter preferences for care. Two or more of these possible changes could substantially alter social care preferences for many aspects of social care.

Aims and objectives

• To understand current preferences for different aspects and models of social care.
• To speculate, on the basis of the best evidence, how those preferences might change in the future.

Research questions:

1. What are the demographic and needs-related characteristics of older people today?
2. What are the projected future demographic and needs-related characteristics of older people (say over the next few decades)?
3. What are the current models of social care for older people?
4. What are the current and projected future preferences of older people in relation to key dimensions of social care, including:
   • receipt of unpaid care, identity of unpaid carer (spouse, child, other family, other person);
   • care in one’s own home or in a ‘specialist’ care setting;
   • the physical, social and external (community) environments for individuals living in their own homes;
   • type of specialist care setting (from housing with minimal support/supervision through to nursing home care and, indeed long-stay hospital);
   • locality (for example, are people wanting to move to the seaside, or closer to their family?);
   • choice of co-residents (family members, friends, strangers, nobody);
   • preferences linked to ethnic, religious, cultural or other characteristics.

The focus will be on older people with short or critical interval needs requiring 24-hour care or at least needing care several times per day.

We will focus mainly on individuals who develop needs in old age, but also comment on the much smaller number of individuals who have had care needs from earlier in life.

We will be looking not just at ‘averages’, but also at variations across the population of older people in circumstances, experiences and preferences.

Indeed, a core aim of our proposed study is to understand precisely those variations in preferences for care across the population.

We want to understand how those preferences are shaped by individual demographic, socioeconomic and needs-related factors, both now and earlier in life.

We anticipate that much of that ‘shaping’ reflects underlying inequalities in health and wellbeing, and also in the factors that drive them, such as deprivation, social situation, area of the country and so on.

Methods

The proposed project would have two phases, the first with three activities:

• description of current models of social care and new models that are being planned or proposed and may develop soon;
• review of evidence on preferences of older people in relation to social care;
• focus groups with both general population and specific population sub-groups.

We will situate our work on these activities in the context of up-to-date information on current and projected future demographic and needs-related characteristics of older people (linked to research questions 1 and 2 above).

The second phase of our research aims to understand how those preferences are shaped by individual demographic, socioeconomic and needs-related factors. Building on evidence from the first phase, we will conduct a survey to understand variations in preferences.

A Discrete Choice Experiment (DCE) will be included to explore how middle-aged and older people in England would trade-off different features (or attributes) of social care arrangements (including models of housing with care) when thinking about their own (current or future) circumstances if they were to have high care needs. Specifically, we will explore:

• Preference heterogeneity and associations with individual circumstances (particularly age, gender, ethnicity, sexual identity, health status, socioeconomic status, region of residence, need for care, experience of care);
• Reasons for differences in preferences;
• The relative importance that people aged 50 and above attach to specific features of care;
• Trade-offs that respondents make between these features, for example, how great a distance from family and friends are they willing to accept in order to have care and support in their own home (rather than entering a care home); or continuity of care with the same team of care professionals (rather than being cared for by different professionals each day);
• How much people would be willing to pay for models of care they prefer (e.g., to live nearer family and friends) if we include the costs of different care models among the attributes in the DCE.

We will establish advisory and involvement groups, and we will engage with them at key points in the study.

Policy relevance

Our findings could inform the development of policy and practice on financing and commissioning of social care, including implementation of the reforms of social care.

Delivery dates

• Phase I (reviews and focus groups): November 2021 – May 2022
• Phase II (survey): May 2022 – November 2023

Associated publications

• Preferences for new models of care – Executive Summary (PDF)
• Walbaum et al (2024) Preferences of People 50 Years and Older when Thinking of their Future Care Needs (Journal of Long-Term Care) DOI: 10.31389/jltc.200