Choice and quality in home-based and community-based aged care: insights from two rapid evidence reviews

Abstract

As consumer-directed care programmes become increasingly common in aged care provision, there is a heightened requirement for literature summarising the experience and perspectives of recipients. We conducted rapid evidence reviews on two components of consumer experience of home- and community-based aged care: (a) drivers of choice when looking for a service (Question 1 (Q1)); and (b) perceptions of quality of services (Question 2 (Q2)). We systematically searched MEDLINE and EMBASE databases, and conducted manual (non-systematic) searches of primary and grey literature (e.g. government reports) across CINAHL, Scopus, PsychINFO, and Web of Science, Trove and OpenGrey databases. Articles deemed eligible after abstract/full-text screening subsequently underwent risk-of-bias assessment to ensure their quality. The final included studies (Q1: N = 21; Q2: N = 19) comprised both quantitative and qualitative articles, which highlighted that consumer choices of services are driven by a combination of: desire for flexibility in service provision; optimising mobility; need for personal assistance, security and safety, interaction, and social/leisure activities; and to target and address previously unmet needs. Similarly, consumer perspectives of quality include control and autonomy, interpersonal interactions, flexibility of choice, and safety and affordability. Our reviews suggest that future model development should take into account consumers’ freedom to choose services in a flexible manner, and the value they place on interpersonal relationships and social interaction.

The measurement of structural ageing – an axiomatic approach

“…Policymakers could be misled to believe that particular areas are projected to age more rapidly than others based on the conventional measures of structural ageing, where that might not necessarily be the case based on an axiomatically-consistent measure. For example, this might have consequences for the quantity and quality of community-based and home-based aged care services (Hunter et al, 2019), the provision or rollout of 'agefriendly' infrastructure or services (O'Brien, 2014), or the priority attached to the development of 'ageing-in-place' strategies (Heumann and Boldy, 1993). Misallocation or mis-targeting of resources in these areas could have significant consequences on the future quality of life for older people.…”