Whose direction? Conundrums of implementing consumer direction in home-based care: experiences of older Chinese and family members

Consumer-directed care (CDC) for older people enables clients to arrange personalized services and improves their well-being. However, little is known about clients’ preferences for policies in collectivist cultures. We investigate the views of older clients and family members about policies that promote consumer direction in a collectivist cultural setting – Guangzhou, China. Using semi-structured interviews, we recruited older persons and their family members (n = 24) in 2021. Inductive thematic analysis was employed. Two themes emerged. The first theme, the need for flexibility in utilizing benefits, includes the need for: 1) flexibility in selecting care workers; 2) autonomy in choosing budget management agents; 3) flexibility in selecting care-related goods; and 4) adequate and equitable benefits. The second theme, the need for professional support, contains the need for: 1) information and support; and 2) individualized training for care workers. Similar to those in individualistic cultures, people in collectivist environments desire autonomy and choice in service arrangements. However, the welfare and preferences of family members, rather than clients, may be prioritized by family members when making care decisions. Adapting CDC to collectivist cultures requires navigating between client preferences and family preferences.