Long-term care for older people is increasingly turning to consumer-directed approaches. As a case in point, the Hong Kong Government recently implemented a new voucher programme for community-based aged care based on a consumer-directed approach: the Community Care Service Voucher for the Elderly (CCSV). The objectives of this study were to explore the lived experience of professional workers vis-à-vis the new programme and to identify barriers to effective voucher use by older people in Hong Kong. In-depth individual interviews were conducted with 16 professionals who had primary responsibility for the voucher programme for community-based aged care. The interview guide covered five main areas: (a) professional's perception and experience on the voucher programme; (b) the decision-making process around the voucher programme; (c) personal capacities of older people; (d) family support and social networks; and (e) institutional support. Findings indicate several barriers to effective use of the CCSV including: lack of self-awareness of service needs, lower education level, poor health condition, lack of financial resources, lack of family support, inadequate family involvement in decision-making, lack of peer and professional support, lack of available services and poor service accessibility. Suggestions for strengthening the voucher programme include institution of a case management model and public education. Different factors or elements are required to facilitate older people to make sound and informed choices, and a case manager can assist in combining different resources and forms of support towards effective use of the CCSV.
Bibliographical noteThe author would like to express appreciation and gratitude to all of participants in the study. Furthermore, the author is also grateful to Dr. Ernest Chui, Dr. Vivian Lou and Prof. Raul Lejano for their advice.
The research protocol was approved by the Human Research Ethics Committee for Non-clinical Faculties of The University of Hong Kong (EA050314).
- case management
- consumer-directed care
- informed choice
- long-term care