Models of long-term care use among older people with disabilities in Taiwan: institutional care, community care, live-in migrant care and family care

Cisan and Malahang: Indigenous Older Adults' Voices on Active Aging - Findings from a Qualitative Study in Taiwan

The Taiwan Government follows the policy of active aging to prevent frailty. However, the current services lack cultural safety toward the Indigenous peoples and would benefit from a broader perspective on what active aging may entail. In this research, we study local perceptions of active aging among older Indigenous Tayal taking part in a local day club. The study identifies two formal activities that foster active aging: (a) information meetings about health and illness and (b) physical activities. In addition, two informal activities highlighted by the participants themselves were identified as necessary for promoting healthy and active aging: Cisan and Malahang. While Cisan means "social care," Malahang means "interrelational care practices." In conclusion, we argue for the relevance of listening to Indigenous older adults' voices to develop long-term care services adapted to their cultural values, linguistic competence, and cosmology.

Patterns and determinants of health and social care service needs among community-dwelling older adults

AIM

Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services.

METHODS

Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults.

RESULTS

The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors.

CONCLUSIONS

Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.

"We Tried to Take Care of Her, but it Got Too Exhausting": A Study of the Transition From Family Carer to Employer

In Taiwan an increasing number of families are employing live-in carers from abroad to cope with care responsibilities, including the Indigenous Tayal. The aim of this research was to understand the transition from Indigenous family carer to employer with older family members who have extensive care needs. Six Indigenous employers were interviewed, and a narrative hermeneutic analysis was performed. The Tayal caregivers' cases revealed that their transition to employing live-in carers was complex and filled with ethical dilemmas due to their vulnerable positions. They tried to ensure person-centered care for their family members, but by doing this they risked reproducing vulnerability when transferring their own vulnerability to the live-in carer. The results indicate the interwoven nature of care dependency when it is defined by multiple vulnerabilities, Indigeneity and migration, and the multifaceted components of cultural safety.

Bridge or Barrier? The Impact of Network Capital on the Receipt of Long-Term Care Services in Germany

OBJECTIVES

In Germany, roughly 8.3 million people are in need of care, but only one-third of them receive state care benefits. The study investigates whether the individual network of a care-seeking person, as well as its resources, interact with health status on the likelihood of accessing formal care services.

METHODS

German data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2015 were used in several Firth logistic regressions with interaction terms.

RESULTS

Health limitations are a significant predictor for the probability of receiving formal care benefits. As moderating factors, caregivers from the immediate family as well as caregivers with lower levels of education tend to contribute to an increase in this probability.

DISCUSSION

Findings are based on a limited data set and indicate the importance of further research in this area to examine the mechanisms of access to formal care more precisely.

Factors Affecting Long-Term Care Preferences in Turkey

BACKGROUND

This study aimed to identify the long-term care preferences and the factors affecting theses preferences in Turkish society, where long-term care may soon become an important issue.

METHODS

We applied data from the Family Structure Survey of Turkey conducted in 2016. Using data from 35,475 individuals, we performed descriptive analysis and logistic regressions to determine the preferences and determinants of individuals based on the Andersen Behavior Model.

RESULTS

Informal care was the main preference of individuals living in Turkey (37%). Men, individuals living in an extended family, and the young mostly favored informal care, while women, well-educated individuals, and urban individuals preferred institutional or formal care at home.

CONCLUSION

Efforts should be made to raise individuals' awareness regarding existing long-term care services. These services should be strengthened in line with society's preferences, considering regional differences.

Physical Inactivity and Possible Sarcopenia in Rural Community Daycare Stations of Taiwan: A Cross-Sectional Study

Physical inactivity and possible sarcopenia pose a challenge for long-term care, especially in rural areas. We aimed to examine the prevalence of and associated factors for physical inactivity and possible sarcopenia in rural community daycare stations. A total of 275 adults aged 55–98 years (75% women) were recruited from all 11 rural community daycare stations in Northern Hualien, Taiwan. Physical inactivity was defined as less than 150 min/week of moderate-intensity aerobic physical activity. Possible sarcopenia was defined according to the Asian-specific criteria from 2019. Multiple linear and logistic regression analyses were used to determine associated factors for physical inactivity and possible sarcopenia. The prevalence of physical inactivity and possible sarcopenia was 29.1% and 68.7%, respectively. About 86.8% of possible sarcopenia were ascribed to poor five-times-sit-to-stand performance. After adjusting for covariates, poor lower-limb muscle function, e.g., slow gait speed, was associated with possible sarcopenia and physical inactivity. However, physical inactivity was not independently associated with possible sarcopenia (adjusted odds ratio 1.95, 95% confidence interval 0.88–4.30, p = 0.100). Our results indicated that individuals with poor lower-limb muscle function were more likely to have possible sarcopenia and physical inactivity. Improving lower-limb muscle function would be a priority task in rural community daycare stations.

'We are All Interdependent'. A Study of Relationships Between Migrant Live-In Carers and Employers in Taiwan

For the past three decades, to meet the increasing need for long-term care, the Taiwanese government’s primary approach has been to import migrant care workers. In this article, we analyse qualitative interview data produced in an Indigenous community. Drawing on Kittay’s feminist dependency theory, we explore the interrelationships and collaborative efforts between live-in carers and their employers. Three types of relationships were identified: ‘unsupportive relationships’, where the live-in carer was treated as a servant; ‘supportive relationships’, where the live-in carer was treated as a care worker; and ‘semi-supportive relationships’, where the live-in carer was treated as a carer-servant. In conclusion, the article sheds light on how the live-in carer arrangement could be practised in ways that allow live-in carers and thereby their care recipients to thrive.

"This Life is Normal for Me": A Study of Everyday Life Experiences and Coping Strategies of Live-in Carers in Taiwan

Recruiting migrant live-in carers has become the main strategy to address the rapid increase in the number of older persons with intensive care needs in many parts of the developed world. This is also the case in northern Taiwan, where this study took place. Thirteen live-in carers from Indonesia and the Philippines were interviewed in the fall of 2019. In this article, we discuss their two main coping strategies: a) "accepting destiny", which refers to carers accepting their life and viewing their role as a live-in carer as a job that allowed them to meet their parents' expectations of financial support; and b) "connecting to significant others", which is the most important way carers found motivation to keep going. However, despite their coping strategies, working as a live-in carer was experienced as a challenging and precarious lifestyle. In the conclusion, we discuss how professional social workers in collaboration with decision-makers and non-governmental organizations in Taiwan could contribute to fostering a system that would support live-in carers in ways that allow them, and the older persons they care for, to thrive.

A discursive paper on the importance of health literacy among foreign domestic workers during outbreaks of communicable diseases

AIM

Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID-19 pandemic is used as an example.

BACKGROUND

Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio-cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community-based nurses.

DESIGN

A discursive paper.

CONCLUSION

Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay-at-home measures for COVID-19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health-related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations.

RELEVANCE TO CLINICAL PRACTICE

Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required.

Ageing in place together: older parents and ageing offspring with intellectual disability

Limited research has been conducted about ageing in place among older parents who co-habit with their ageing offspring with intellectual disability (ID). This study aims to explore which older parents would choose ageing in place together with their ageing offspring with ID instead of moving and what factors are associated with this choice. A face-to-face interview was conducted using the ‘housing pathways’ framework with older parents (⩾60 years) co-habiting with their ageing offspring with ID (⩾40 years) from two local authorities in Taiwan. In total, 237 families completed our census survey between June and September 2015. The results showed that 61.6 per cent of the participants would choose ageing in place with their ageing offspring with ID, while 38.4 per cent of the participants would stay in their previous place without their disabled children, move in with their other children or move to a nursing home. Logistic regression analyses revealed that parents who preferred ageing in place together with their offspring with ID were more likely to own a house (‘personal control’), have higher levels of life satisfaction (‘self-esteem’) and satisfaction with their current community (‘self-identity’), and have a lower level of social support than parents who chose another option. To meet the needs of older parents and their ageing offspring with ID, care and housing transitions should be considered as part of long-term care policy.

Personal care expectations: Photovoices of Chinese ageing adults in Hong Kong

The increasing ageing population contributes to growing demands for personal care that fulfils ageing adults' preferences and expectations. This study explored Chinese ageing adults' expected forms and sources of future personal care and the factors influencing care expectations. A qualitative photovoice research method - which integrated photography, interviews and group discussions - was used for data collection between January and April 2016. Through purposive sampling, 36 community-residing participants aged 51-80 years took photographs that captured personal care preferences or expectations within individual, familial and societal contexts. Participants described feelings of worry, uncertainty and unpreparedness for future care needs and arrangements. They preferred practicing self-care for as long as possible and remaining in their homes and communities ("ageing in place") through support from assistive technologies, family members or home-based and community services. Institutional care was regarded as the last resort. The findings reflected discrepancies between ageing adults' care preferences and realities and their ambivalent attitudes towards filial care when switching between roles. Confronted with the increasingly unreliable family care, financial resources and insufficient community services, participants anticipated receiving institutional care that would be less satisfying or that they would dislike. As caregivers, ageing adults displayed strong commitment to filial obligations, whereas when perceiving themselves as care receivers they felt that they could not expect care from their children because of practical considerations. By understanding preferred care forms and sources, actors can devote resources, policies and interventions to support self-care through proactive planning and technological advancement, foster "ageing in place" through family and community care, and improve institutional care to enable ageing with dignity.

The Sociocultural Meaning of "My Place": Rural Korean Elderly People's Perspective of Aging in Place

PURPOSE

Aging in place becomes an important concept in elderly care plans worldwide. It pursues to enhance quality of later lives and maintain dignity in older adults. However, one's own place may have some kinds of symbols and meanings to an individual in accordance with the culture he/she belongs to. Without considering it, many cultural conflicts can emerge when policies are realized. Thus, the purpose of this study was to explore the sociocultural meaning of "my place" for elderly Koreans ahead of enacting a policy for the so-called "integrated community care" in South Korea, pursuant to aging in place for the elderly population.

METHODS

This study used an ethnographical methodology. The data were collected by observation, in-depth interviews with 10 informants, home visits, field notes, and photos, and analyzed using Spradley's ethnographic approach.

RESULTS

As a result, the cultural theme of "my place" in elderly Koreans was "A place that makes me be present." Three categories representing the meaning of "my place" were emerged: keeping me safe and comfortable, representing my life, and maintaining my control and influence.

CONCLUSION

Researchers and policymakers should carefully consider the sociocultural perspective when planning, moderating, and implementing a new long-term care policy to achieve aging in place in South Korea.

Urban-Rural Differences in Long-Term Care Service Status and Needs Among Home-Based Elderly People in China

Background: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban–rural differences. This study aims to evaluate the differences of LTC current status and needs between urban–rural areas and age groups, and to identify influencing factors causing the different LTC needs. Methods: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. Results: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). Conclusions: The aged cohort in urban–rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.

Older residents' perceptions of family involvement in residential care

AIM

This study explored the Chinese older people's perceptions regarding family involvement and specific factors influencing family involvement in residential care homes.

BACKGROUND

Family involvement in residential care home is a multi-dimensional construct that connects the resident with their family, friends, neighbours and care professionals to facilitate their physical, psycho-emotional and social well-being. However, it remains unclear as to what Chinese residents perceive as the meaning of involving the family and components of it that are important to later live.

MATERIAL AND METHODS

A descriptive qualitative study using semi-structured interviews was conducted in two residential care homes in Macao. Ten Chinese residents were purposively sampled. The interview data were taped-recorded and transcribed. Fieldnotes and visitors' records were collected. The data were content-analyzed.

RESULTS

Chinese residents' perceptions of family involvement were captured by four themes: components of family involvement, factors influencing family involvement, impacts of family involvement on residents' lives, and promoting family involvement strategies.

CONCLUSION

Findings provided insights for geriatric care providers to acknowledge the contributions that family members can make to be more involved in the residents' live, and to strengthen relationships. Family involvement can also help to facilitate sense of blessing and feelings of achievements for the residents.

Evaluation of Access to Long-term Care Services for Old People Ageing in Place in Slovenia

Theory

The quality of long-term care services has an important effect on the quality of life of their users and their informal carers. By identifying gaps between provision of services and users' needs we can suggest adjustments of the long-term care services and advance their development.

Method

The data from the first Slovenian national survey of social homecare (SHC) users and their informal carers was utilised. Linear regression analysis was used to evaluate factors that affect assessments of five-dimensional concept of access.

Results

On average, affordability was rated the lowest (mean=2.9) and acceptability the highest (4.0), with availability, accessibility and accommodation (mean=3.6) in the middle. Regression analysis explains 15% of variability in affordability, while for other dimensions much less. Caregiver's needs are the most influential predictor of access, negatively influencing the rating of access (availability B=.127, accommodation B=-.113, acceptability B=-.120, affordability B=-.155). Care recipients' needs also affect the rating of affordability (B=-.132). Family income negatively influences the rating of availability (B=-.115), accessibility (B=-.076) and affordability (B=-.270). Residents of rural areas rate availability (B=-.070) and affordability (B=-.067) less favourable.

Discussion

This study showed that affordability is rated the least favourable among components of access. Adjustment in private out-of-pocket co-payment mechanism is suggested.

The effect of health status and living arrangements on long term care models among older Chinese: A cross-sectional study

Background

Currently, there are many studies focusing on the influencing factors of the elderly people’s living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects.

Objective

We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects.

Methods

A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework.

Results

Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the “relatively independent’, “mild disability’, “moderate disability’, and “total disability’, respectively, in comparison with “completely independent’). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the “living with children’, “living with spouse’, “living with children and spouse’, and “living with others’, respectively, in comparison with “alone’). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension.

Conclusion

A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened.

The effects of familism on intended care arrangements in the process of preparing for future care among one-child parents in urban China

Guided by Sörensen and Pinquart's model of preparation for future care, this study investigated the relationship between familism and intended care arrangements. Ordinal logistic regression was performed on a sample of 516 urban Chinese one-child parents aged 45–65 with an equal gender ratio to examine the associations between five care expectations, familism (filial obligation and child gender) and future care planning constructs (awareness, information gathering and avoidance). Awareness and information gathering were positively associated with service-focused care arrangements. Avoidant planners were more inclined to rely on adult children. Participants with a stronger filial obligation had greater expectations for ageing at home with the aid of a spouse, siblings or helper. Child gender was not significantly associated with intended care arrangements. The model of preparation for future care was useful when predicting service-focused care arrangements. Familism was a powerful predictor of family-focused care arrangements. Females were more likely to rely on children regardless of child gender but less likely to rely on spouses and siblings. The study enriches researchers' understanding of urban Chinese older adults' intended care arrangements in the context of fading familism and single-child families.