Table 3 Key themes identified from the focus group discussions/ individual interviews and questionnaire survey

(i) Awareness of voucher scheme

– Some elderly people and carers expressed limited knowledge and understanding of the voucher scheme

– The roles of social workers (both social workers and caseworkers) are pivotal during their applications

– The copayment mechanism was complicated and difficult for the elderly people and their carers to understand by only reading the invitation letter and the introduction leaflet

– 10% of the nonusers revealed that insufficient knowledge and understanding of the scheme was the reason for no-participation in the voucher scheme

– A higher proportion of users (68.1%) than nonusers (45.0%) thought that the voucher scheme information was sufficient

– Users generally had a better understanding of the pilot scheme than nonusers

(ii) Service needs and types

– Carers believed that the immediate need for residential care services emerging from sudden changes in the health condition of elderly people was the main reason for joining the voucher scheme

– Many carers noted that the voucher scheme allows elderly people to be placed in homes in a substantially shorter period of time compared to the waiting lists for subsidized homes

– Carers of elderly people who withdrew from the voucher scheme no longer indicated immediate needs. A number of nonusers did not accept the copayment level, and some stated that there were no places available in their preferred homes

– 45.8% of users joined the voucher scheme due to an urgent need for residential care services

– 39.5% joined because they believed that the scheme could shorten their waiting time for subsidized homes for elderly people

– 34.0% of non-users did not join the voucher scheme because the elderly people did not have an immediate need for residential care services

– 87.8% of voucher users and 79.0% of nonusers agreed that the service package under the voucher value could meet the needs of the elderly people

(iii) Shared responsibility

– A few of the carers agreed in principle with the idea of shared responsibility

– Many carers felt that unless the copayment was equal to or lower than the non-means-tested standard copayment fees charged for all government-funded places in the different types of homes allocated from the central waiting list, elderly people would have less incentive to participate

– Some further noted that the voucher scheme was not particularly attractive for elderly people who were assessed at copayment level 7 (i.e., co-pay of $1532) as the amount of subsidy was relatively low.

– There were concerns among carers that the possibility of an increase in fees of the homes for elderly people in the future might exceed the adjustment in voucher value

– 66.8% of voucher users were willing to make top-up payments to purchase enhanced or value-added services in addition to the standard service package

– 86.7% of voucher users and 80.0% of nonusers agreed that in the means test, the applicants should only be assessed on their personal income and asset to determine the copayment level and not that of their households

– 72.8% of voucher users and 57.0% of nonusers (57.0%) thought the copayment mechanism was suitable

– The majority of vouchers users who agreed with the means test and copayment mechanism were at copayment level 0 (without copay)

(iv) Choice and flexibility

– Valued the choice and flexibility of the voucher scheme because it provided additional subsidized residential care places on top of the current places allocated from the central waiting list and the enhanced bought places scheme. However, some carers reported that their choice was limited by the number of homes participating in the voucher scheme and the limited availability of bed places in their preferred homes

– 78.1% of elderly people and their carers thought the voucher scheme was helpful in increasing their choice and flexibility in residential care services, while 14.6% thought it was not helpful

– Those who thought it was helpful was mainly those who were currently already in homes for elderly people and those with shorter waiting times on the central waiting list as of their date of admission to a participating home under the voucher scheme (p value < 0.05)

– 11% of the non-users indicated that there was no available bed place in their preferred participating homes for the elderly people; and 7% stated that they did not prefer the participating homes for elderly people on the list as their reason for nonparticipation

(v) Service quality

– Many users and their carers were generally satisfied with the service quality of participating homes for the elderly people, despite dissatisfactions in some areas, such as manpower, hygiene, environment and the attitude of the staff in the homes. They added that the entry requirement set by the government on staff and space for the participating homes could ensure quality

– For carers of nonusers, they felt that the environment and service quality among participating homes varied, particularly in private homes. However, they thought that the idea of money-following-the-user could encourage participating homes for elderly people to improve their service quality to remain competitive and to attract more admissions, since if the participating homes did not provide service high-quality services, voucher users could select or switch other homes with better service quality

– Some carers believed the casework service by the government would have a positive effect on the service quality of participating homes for the elderly, and could indirectly improve their service quality through regular checking by caseworkers

– 93.7% of voucher users agreed that the support received from caseworkers was sufficient

– 62.1% of voucher users and their carers agreed that the voucher scheme was helpful to improve the service quality of homes for elderly people (60% were already living in these homes before participating in the voucher scheme)

– However, voucher users thought that the voucher scheme was more helpful in relieving their financial burden (98.7%), reducing carers’ stress (97.0%) and the waiting time for subsidized homes (89.0%), increasing choice and flexibility (62.1%), and improving service quality (62.1%)