Decision-Making in Long Term Care: Consumer Input and the Role of CMS Information Initiatives

The decision to use a nursing home or home health agency – and then choosing a provider – is one that is not yet fully understood in terms of the factors influencing this decision, the information sources used, and consumer perceptions of the process. The role of quality information in the decision-making process is even less well understood, in part because availability of such information is relatively recent.

This study included surveys of recent users of Medicare home health and skilled nursing care in an attempt to shed light on the following questions:

· When faced with a need for care, how do consumers choose a particular type of provider/setting? To what extent are they aware of the alternatives?

· How do consumers choose a specific nursing home or home health agency?

· Do consumers know about and/or use quality information such as the data that CMS now makes available via its Nursing Home Compare and Home Health Compare web sites? What role, if any, does this information play in their decision-making process?

We found that there was considerable variation in the role of health professionals and the degree of consumer input. While few consumers were aware of public information at the time of the survey, most were satisfied with the decision-making process and their ultimate choice. Consumers value the concept of quality, but define it differently than the ways it is reported on the public web sites.