The Effects of in-Home Respite Care on the Burden of Caregivers in Taiwan

Study Aim/Purpose:  The purpose of this study was to investigate the effects on caregiver burden of in-home respite care for older adults, offered under Taiwan’s National Ten-Year Long-Term Plan 1.0. Under this program, staff evaluate care recipients’ functional disability level based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Caregivers of people with mild disability are eligible for up to 14 days of in-home respite care in a year and caregivers of persons with moderate or to severe disability are eligible for up to 21 days of in-home respite care.

Summary of Methods: The researchers analyzed interview data in program records from 2011 to 2015 held in Taiwan’s Long Term Care Plan 1.0 database. The information was collected by LTC Plan program staff during routine in-person interviews at enrollment and one year later when they reapplied for services. From the program database from 2011 to 2015, the researchers identified 10,385 care recipient-caregiver dyads who had used the basic home services, which provide personal care and perform domestic chores for the care recipients. After applying exclusion criteria and conducting propensity score matching of those that used in-home respite care and those that did not, the study sample was composed of 969 caregivers (323 users and 646 non-users). Users and non-users were matched on several variables including: 1) predisposing factors (the care recipient’s age, gender, body mass index [BMI], education level, disability level, and degree of cognitive impairment and the caregiver’s age, gender, and relationship to the care recipient); 2) enabling factors (household income level, caregiver’s employment status, and amount of caregiving time; and 3) need factors (caregiver burden level) at enrollment. The key study outcome measure was perceived caregiver burden. This was assessed using responses to questions on the initial needs assessment tool, and change in burden over the one-year period was measured by three Likert scale items in the tool focused on physical health, mental health, and family interaction. The authors used a mixed linear effect model for repeated measures to estimate the change in caregiver burden from baseline to the second interview. Univariate and multivariate mixed models were used to assess the single and joint effect of in-home respite care and other factors associated with caregiver burden. Respite users were divided into two groups based on the number of days of respite they had used (1-14 days or more than 14 days).

Summary of Results: There were no statistically significant differences in caregiver burden between respite users (using respite for any duration) and non-users overall. However, the burden scores for the group who received more than 14 days of in-home respite decreased significantly over the one-year period compared to non-users.

The authors also analyzed several characteristics of the caregivers and care recipients to identify potential associations with caregiver burden levels. They found caregiver burden was lower when the care recipient was female and the burden of caregivers was higher if their care recipients were illiterate than if their care recipients had received an elementary school to junior high or high school education. Moderate ADL disability and low IADL function were also both correlated positively with high caregiver burden. Additionally, caregivers aged 71 or older and spousal caregivers had greater perceived burden than younger caregivers and non-spousal caregivers.

Study Limitations (as cited by authors):  A noted limitation of the study was that the dataset did not include information on additional caregiver characteristics which may have affected caregiver burden, such as the caregiver’s health conditions, education level, and economic factors. Information on the disease status of care recipients and the skills of the program care managers were also not available to determine if these had independent effects on caregiver burden. They also noted that the lack of effect of a lower duration of respite use (less than 14 days) on caregiver burden may be due to the fact that all respite users also received home care services, which can separately have reduced caregiver burden, though not as much as 14 days or more of respite.

Authors’ Discussion/Conclusions: The authors conclude that the Taiwanese government should prioritize increasing the number of days of in-home home respite care available and update its content to focus on reducing caregiver burden. Given limited resources, the authors suggest that the government prioritize increasing the provision of respite services to lower-income groups. The authors also recommend a follow-up study to assess whether Taiwan’s 2018 Long Term Care Plan 2.0 expansion of respite care has reduced caregiver burden more effectively.