Abstract
BackgroundLittle is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors’ housing decisions when objective decision making measures are used.ObjectivesTo report on seniors’ and caregivers’ experiences of housing decisions.DesignA cross-sectional study with a quantitative approach supplemented by qualitative data.SettingSixteen health jurisdictions providing home care services, Quebec province, Canada.ParticipantsTwo separate samples of seniors aged ≥ 65 years and informal caregivers of cognitively impaired seniors who had made a decision about housing.MeasurementsInformation on preferred choice and actual choice about housing, role assumed in the decision, decisional conflict and decision regret was obtained through closed-ended questionnaires. Research assistants paraphrased participants’ narratives about their decision-making experiences and made other observations in standardized logbooks.ResultsThirty-one seniors (median age: 85.5 years) and 48 caregivers (median age: 65.1 years) were recruited. Both seniors and caregivers preferred that the senior stay at home (64.5% and 71.7% respectively). Staying home was the actual choice for only 32.2% of participating seniors and 36.2% of the seniors cared for by the participating caregivers. Overall, 93% seniors and 71% caregivers reported taking an active or collaborative role in the decision-making process. The median decisional conflict score was 23/100 for seniors and 30/100 for caregivers. The median decision regret score was the same for both (10/100). Qualitative analysis revealed that the housing decision was influenced by factors such as seniors’ health and safety concerns and caregivers’ burden of care. Some caregivers felt sad and guilty when the decision did not match the senior’s preference.ConclusionThe actual housing decision made for seniors frequently did not match their preferred housing option. Advanced care planning regarding housing and better decision support are needed for these difficult decisions.
Highlights
Action must be taken to assure that seniors can age in desirable, affordable, and appropriate homes, communities and care environments; given that life expectancy is projected to reach new heights and the baby-boom generation is reaching 65 years and older [1, 2]
Qualitative analysis revealed that the housing decision was influenced by factors such as seniors’ health and safety concerns and caregivers’ burden of care
The actual housing decision made for seniors frequently did not match their preferred housing option
Summary
Action must be taken to assure that seniors can age in desirable, affordable, and appropriate homes, communities and care environments; given that life expectancy is projected to reach new heights and the baby-boom generation is reaching 65 years and older [1, 2]. Help from family, friends or home care services are crucial for limiting the consequences of this loss of autonomy [10]. One in four of Canadians aged 65 or older report receiving care through formal home care services (such as the local home care team) or informal caregivers (e.g., family/ friends) [11]. These findings are similar to those reported in the United States where 23% have at least two disabilities requiring care [12]. Little is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors’ housing decisions when objective decision making measures are used
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