In today’s customized world, people expect to have choices—and that extends to senior living and long-term care. You can pick a burger exactly the way you want it or configure a car with every preferred option. Yet a Johns Hopkins University study suggests many older adults don’t receive care in the setting or manner they would choose for themselves.
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How the study explored care preferences
Researchers in the Department of Health Policy and Management at Johns Hopkins’ Bloomberg School of Public Health analyzed responses from 1,783 older adults enrolled in the National Health and Aging Trends Study, a national survey of Medicare beneficiaries age 65 and older. Participants answered questions about long-term services and supports (LTSS) by responding to a hypothetical scenario.
Interviewers described an 80-year-old person named “Pat” who needs help with bathing, dressing, and moving around the house, then asked which option would be best for Pat. The choices were:
- Living at home with help from friends and family
- Living at home with paid help
- Living with an adult child
- Living in an assisted living facility or continuing care retirement community (CCRC or “life plan community”)
- Living in a nursing home
Using this hypothetical scenario gave participants a way to express what they would prefer in a realistic situation, without directly forcing them to reflect on their own current circumstances.
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Key findings about preferences and reality
The majority of respondents preferred that Pat remain at home, which aligns with numerous surveys showing most seniors want to stay in their own homes as long as possible. Few people selected living with an adult child or a nursing home as the best option.
Yet the study also revealed some notable shifts. Nearly one-third of participants indicated that assisted living or a CCRC would be the best solution for Pat. That percentage represents a meaningful change from previous decades, when home-based care—either through family or paid help—was far more dominant as the preferred choice.
Preferences were influenced by participants’ own living situations. Overall, about three in ten respondents chose each of the following as the best option for Pat: assisted living/CCRC, home care with family help, and home care with paid help. However, people already living in assisted living or a CCRC were substantially more likely to name assisted living or a CCRC as the best choice for Pat. That suggests firsthand experience with a living arrangement can shape perceptions of its value.
Another concerning discovery: only one in three respondents who were themselves receiving care were living in a setting that matched their stated recommendation for Pat. In other words, most people receiving care did not receive it in the setting they seemed to prefer. This mismatch was especially common among the oldest participants, which could reflect changes in needs or preferences over time, limited options, or barriers to accessing preferred care.
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Plan ahead to get the care you prefer
The Johns Hopkins findings highlight a critical point: about two-thirds of older adults are not receiving care in the setting they would prefer. That gap underlines the importance of planning ahead to secure the type of care and the living environment a person wants—ideally before assistance is needed.
One advantage of choosing a CCRC while still healthy is that it preserves choice. CCRCs typically offer independent living with access to a full range of on-site services, from in-home assistance to skilled nursing care, so residents can transition as their needs change without relocating to a new community. Moving to a CCRC proactively can ensure continuity of care and give individuals greater control over how and where they receive services.
The study’s observation that residents already living in CCRCs were much more likely to select that option for Pat reinforces this point. Those residents often have firsthand knowledge of how CCRCs work and the benefits they provide, and that experience appears to influence their preference.
Planning in advance, discussing options with family and care professionals, and understanding the full continuum of available services can help people match their future care with their personal values and needs. Making informed choices early increases the likelihood that seniors will receive care in the setting they prefer when the time comes.
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