Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

Valuation of Multiple Environmental Programs

We examined sequence effects on willingness-to-pay (WTP) when people evaluate a series of environmental goods. Each respondent evaluated five different environmental goods using WTP and four evaluative attitude ratings. There was a strong sequence effect: WTP was much larger for the first good than for goods evaluated afterward. Also, total WTP for the bundle of five goods depended on which good was evaluated first: the more highly valued the first good, the higher the total WTP for the bundle. The attitude ratings are shown to be more statistically efficient than WTP in measuring the relative importance of different environmental goods.