The Role of a Multicomponent Home-Health Intervention in Reducing Caregiver Stress in Singapore: A Qualitative Study.

Purpose: The relationship between caregiving and negative health outcomes is well established in the literature. Previous studies have shown that community-based programs reduce caregiver stress. However, the mechanisms by which this happens have not been well investigated. This qualitative study examines caregivers' experiences as a part of the Aging-In-Place intervention, a home-health program in Singapore targeted at frequently hospitalized patients and their caregivers. Method: We interviewed 32 caregivers to study the underlying processes by which caregiver stress was ameliorated. Transcripts from semistructured interviews were analyzed thematically within the theoretical framework of the stress process model. Results: Primary stressors related to routine patient care were reduced through the intervention program that provided health monitoring to patients and facilitated linkages to community-based services. Increased access to advice and medical information provided by intervention staff reduced caregivers' uncertainty, a substantial secondary stressor. Caregivers who employed a foreign domestic worker (FDW) gained additional reductions in both primary and secondary stressors. Discussion: The multidimensional home-health intervention reduced both primary and secondary stressors for caregivers. FDWs constituted a resource that caregivers could rely on and the training provided to FDWs by intervention staff further reduced caregiver stress. Implications for program planning and future research are discussed.

Effect of caregiving relationship and formal long-term care service use on caregiver well-being.

AIM: Despite efforts to revise the traditional long-term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front-line care providers. The present study aimed to understand the effect of informal caregiving on caregivers' well-being in Singapore with respect to different types of patient-caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers' well-being. METHODS: Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed. Multilevel regression models were used to examine the association between caregivers' well-being (self-rated general health, stress level and quality of life) and LTC service use among different patient-caregiver relationships. RESULTS: Spousal caregivers reported significantly lower quality of life compared with adult children caregivers. Non-immediate family caregivers showed better overall well-being compared with spouse and adult children caregivers. Caregivers of patients referred to nursing homes reported higher levels of stress and poorer self-rated general health compared with caregivers of patients referred to community-based services. Spouse and non-immediate family caregivers of patients who utilized nursing home or home-based services presented poorer self-rated general health than caregivers of the patients who did not use any formal services. CONCLUSIONS: Developing a better understanding of the associations between well-being and formal LTC service use for different types of patient-caregiver relationships is critical for policy makers and healthcare providers who aim to create holistic systems of care. Geriatr Gerontol Int 2017; 17: 1714-1721.

Community-Based Long-Term Care Services: If We Build It, Will They Come?

OBJECTIVE: This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use. METHOD: We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services--service quality, convenience, social connectedness, and affordability--were measured on a 5-point scale. RESULTS: Among the four perceived attributes, perceived affordability was significantly associated with future utilization for all types of CBLTC services. Perceived service quality and convenience was significantly associated with center-based LTC services use. DISCUSSION: Caregivers are critically involved in the decision of using CBLTC services, and their perception of service characteristics is significantly associated with the uptake of CBLTC services. It is important to incorporate both care recipients' and caregivers' needs and preferences when designing and promoting integrated health care delivery models.