Provider Discretion and Consumer Preference in Long-Term Care for Seriously Disabled Elderly

The service selection process in long-term care programs could be structured to conform to either a professional or a market model. In the former, services are assigned by experts. In the latter, they are claimed by the user. When professionals and families with disabled elderly negotiated in-home service selection as part of a demonstration program, reasonable but significant disagreements between the two parties emerged. Therefore, authority over selection placed unambiguously in the hands of the user may be the best method for satisfying professionals and users. Professionals would be free to advertise and recruit, and users would be free to select the provider and most attractive package.