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Updated: Jun 27, 2025

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Preferences for Postacute Care at Home vs Facilities.

Fangli Geng1,2,3, Brian E McGarry4, Meredith B Rosenthal5

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Patients and caregivers prefer home-based postacute care, but socioeconomic factors and caregiver burden can shift preferences. Quality is paramount, with a strong aversion to below-average skilled nursing facility (SNF) care.

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Area of Science:

  • Healthcare Economics
  • Patient Preferences
  • Postacute Care Delivery

Background:

  • Two in five US hospital stays require rehabilitative postacute care, often in skilled nursing facilities (SNFs) or home health agencies (HHAs).
  • Current care models face challenges due to unclear guidelines and a lack of understanding regarding patient and caregiver preferences.
  • Promoting high-value, patient-centered postacute care necessitates a deeper insight into these preferences.

Purpose of the Study:

  • To assess patient and caregiver preferences for facility-based versus home-based postacute care.
  • To evaluate the willingness to pay for different postacute care settings and attributes.
  • To examine how demographic variations influence these preferences.

Main Methods:

  • A nationally representative survey was conducted in September 2022 with participants aged 45 years and older.
  • A discrete choice experiment was employed to understand choices between facility-based and home-based care options.
  • Survey weights were applied to ensure nationally representative estimates of preferences and willingness to pay.

Main Results:

  • Patients and caregivers demonstrated a significant willingness to pay for high-quality, home-based postacute care (e.g., Home Health Agencies - HHAs).
  • However, increased caregiver demands and socioeconomic challenges, like job insecurity, shifted preferences towards facility-based care (e.g., SNFs).
  • A strong aversion to below-average quality care was observed, with substantial willingness to pay to avoid it.

Conclusions:

  • A prevailing preference for home-based postacute care exists, aligning with current policy directions.
  • Disadvantaged groups facing caregiver constraints and socioeconomic hardships may be overlooked in the shift to home-based care.
  • Equitable support and improved quality measures are essential for patient-centered postacute care, especially for marginalized populations.