OLDER PERSONS PREFERENCES FOR SITE OF TREATMENT IN ACUTE ILLNESS

OBJECTIVE: To explore how older persons form preferences for site of m edical care by examining their perceptions of home care and hospital c are. DESIGN: Qualitative analysis of in-depth interviews using the con stant comparative method. SETTING: Respondents' homes. PARTICIPANTS: T wenty-nine persons age 65 to 89 years who had been hospitalized with c ongestive heart failure, chronic obstructive pulmonary disease, or pne umonia and were receiving home care services. MAIN RESULTS: Respondent s, who thought of home care only as a means to provide low-intensity a nd low-frequency services, were initially skeptical about expanded hom e care services to treat acute illness. Regardless of their opinions a bout home and hospital, all respondents preferred the site associated with the greatest chance of survival. If the sites offered equal survi val, 52% of the respondents preferred treatment at home because of Fre edom from the constraints of the hospital and the comfort of familiar surroundings, Far respondents who preferred the hospital, the home rep resented a frightening and lonely place to be sick. Respondents' views of the home and hospital were shaped by their social supports, self-r eliance, religious beliefs, and past illness experiences. CONCLUSIONS: Because survival appears to be the most important determinant of pref erence, home treatment of acute illness is a viable alternative only i f it provides outcomes equivalent to those of hospitalization. Strongl y held perceptions that home care can only be a low-intensity service may limit preferences for home treatment. When expected outcomes at th e two sites are similar, the challenge to the health care system will be incorporating patient preference about the process of care into dec isions about the appropriate site of care.