Care Recipient Q&A on Preferences Reveals Surprising Answers

Are older adults receiving the type of long-term services and supports (LTSS) they want? A recent study examines whether LTSS preferences match the care arrangements that older adults have, and if this relates to quality of life.

The sample of 1,783 participants came from the National Health and Aging Trends study, a nationally representative survey of Medicare beneficiaries age 65 and older. These individuals were randomly sampled to respond to questions about LTSS care. To determine care preference, interviewers described a scenario in which an 80-year-old individual, Pat, needs help with bathing, dressing, and getting around inside. Participants were asked to choose the best care for Pat among the following options: living at home with help from friends and family; living at home with paid help; living with an adult child; living in an assisted living facility or Life Plan Community; or living in a nursing home. By asking about care preference indirectly, the interviewers hoped to ascertain respondents’ true care preferences regardless of their own care arrangement.

The majority of participants said that staying at home was the best care option, which was an expected result. However, almost one-third believed that assisted living/Life Plan Community was best. This is a change from past decades. Only a small percentage of individuals felt that living in a nursing home or with an adult child were the best options. In addition, only one-third of participants were receiving care that matched their preference. This was more likely among the oldest participants, perhaps indicating either a change in care or a change in preference over time.  Surprisingly, there was no difference in quality of life between those with preferred care and those with care not matching their preference. The researchers acknowledged that there are many additional factors that influence quality of life, but also suggested that future studies utilize alternate quality of life measures to see if the results change.



Kasper JD, Wolff JL, & Skehan M. Care arrangements of older adults: What they prefer, what they have, and implications for quality of life. The Gerontologist (2019); 59(5):845-855.


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