Caregiver burden and the changes in caregiving following nursing home placement in Taiwan.

As a result of economic and health improvements in the general population, there is an increasing need for long-term care facilities for the elderly in Taiwan. Little is known about the caregiving practice and burden of Chinese family members who place their elderly in nursing homes. The purpose of this study was to explore and describe changes in caregiving practice and perceived burden from initial nursing home placement (Time 1) to 4 months after nursing home placement (Time 2) among Chinese primary caregivers of the elderly. A descriptive correlational design was used to describe and explore the extent of burden and changes in caregiving. Structured questionnaires and interview questions were used to assess 77 primary family caregivers who live in Taipei City and have placed their elderly in a nursing home for the first time. All questions were translated into Chinese, and 'back translation' from Chinese to English was completed prior to the interviews. Content validity of Chinese questionnaires was assessed by 5 Chinese researchers. A pilot study was conducted, and Chinese questionnaires were modified based on the pilot work. Correlation, paired t test, multiple regression, and content analysis were used to examine the research questions. The results indicated the contribution to perceived burden caused by lack of family support, impact on schedule, and impact on health. All three were significantly decreased from Time 1 to Time 2 among the primary caregivers. The overall perceived burden of caregiving was significantly decreased from Time 1 to Time 2. However, the impact on finances and caregivers' self-esteem was not changed significantly. The frequency of activities of daily living and instrumental activities of daily living assistance provided by the primary caregivers decreased after the placement. The primary caregivers reported significant improvement in their physical health, but not emotional health from Time 1 to Time 2. The higher burden of caregiving at Time 2 is predicted by (a) higher burden at Time 1, (b) caregiver's higher educational level, and (c) poor health at Time 2. Seven types of assistance were mentioned by the primary caregivers as needed to help them manage their caregiving practices. Recommendations for nursing practice and future research are also included.