NANCY Seminar – Jonathan SICSIC (U. Paris Cité)

Event details :

Title: Care at home vs. in a nursing home: a mixed-methods approach to understanding elderly preferences, co-written with Anais CHENEAU et Thomas RAPP

Abstract: As populations age, long-term care policies are increasingly challenged to balance individual preferences with budget constraints. In France, the prevailing “aging in place” policy has prioritized home care. This study investigates, for the first time in France, the preferences of elderly individuals when choosing between home care and nursing home care. Using a mixed-method approach that combines qualitative interviews and a discrete choice experiment (DCE), we explore how individual socioeconomic characteristics, care-related experiences, and specific features of nursing homes shape these preferences. The DCE employed a two-stage methodology: first, respondents evaluated hypothetical nursing home packages based on four attributes (quality of equipment and facilities, quality of professional care, geographical proximity, and out-of-pocket expenses); then, they chose between their preferred nursing home option and remaining at home. Our analysis, based on responses from 2,886 individuals aged over 60, reveals substantial heterogeneity in preferences. While a majority consistently favored staying at home, in a hypothetical situation of heavy dependence, a significant proportion shifted their choice in response to improved nursing home characteristics, particularly enhancements in the quality of care and facility atmosphere. Additional factors, such as higher income, caregiving experience, and expectations of longevity, are associated with a greater propensity to choose institutional care. These findings suggest that targeted investments in nursing home quality and affordability could better align long-term care services with the diverse needs of the elderly, complementing existing home care policies.