ORIGINAL ARTICLE

Influence of home care services on caregivers’ burden and satisfaction

Eun-Young Kim and Hyun-E Yeom

Aims and objectives. To examine the factors affecting the burden and satisfaction
of family caregivers, focusing on the beneficial impacts of home care service use. What does this paper contribute
Background. Long-term care for older patients is a multifaceted process that to the wider global clinical
brings both burden and satisfaction to family caregivers. It is expected that home community?
care services offered by the Korean long-term care insurance may contribute to • This study emphasises that
decreasing the burden of family caregivers and enhancing their satisfaction by health professionals should play
assisting with practical caregiving tasks. a critical role in assessing the
family dynamics when providing
Design. A cross-sectional study.
long-term care and guiding fam-
Methods. A convenience sample of 157 family caregivers was recruited from five ily members in supportive inter-
home care service agencies in South Korea. Information about the caregivers, actions.
caregiving history, older care recipients and use of home care services was • Health professionals and policy
assessed. The effects of home care service use on caregiving burden and satisfac- members need to develop practi-
tion were tested using hierarchical multiple regression analyses after adjusting for cal strategies for home care ser-
vices, particularly considering the
the characteristics of the caregivers, caregiving history and older care recipients.
adequacy in quantitative support
Results. There was no significant influence of home care service use on reducing and caregivers’ needs when pro-
caregiving burden or on increasing caregivers’ satisfaction. Although several fac- viding home care services.
tors were associated with caregiving burden and satisfaction, family functioning
was the most unique factor to significantly affect both caregiving burden and
satisfaction.
Conclusions. Home care services might not automatically have a positive impact
on caregivers’ burden and satisfaction, but maintaining healthy family functioning
is an important issue for family caregivers. The findings highlight the important
need to reconsider ways to provide home care services and to develop nursing
interventions to reinforce supportive family functioning.
Relevance to clinical practice. Practical strategies for providing home care services
should be developed through a concrete assessment of the family dynamics and
the needs of family caregivers. Health professionals should play a pivotal role in
performing the assessment and in developing interventions to strengthen support-
ive family functioning.

Key words: caregiver burden, elder care, family care, gerontology, home visits

Accepted for publication: 28 November 2015

Authors: Eun-Young Kim, PhD, RN, MPH, Associate Professor, Correspondence: Hyun-E Yeom, Assistant Professor, Department of
Department of Nursing, Dong-A University, Busan; Hyun-E Yeom, Nursing, Dongguk University, 707 Sukjang-dong, Gyeongju, Gyeong-
PhD, RN, Assistant Professor, Department of Nursing, Dongguk buk (Zip code: 780-714), Korea. Telephone: +82 54 770 2621.
University, Gyeongju, Korea E-mail: [email protected]

© 2016 John Wiley & Sons Ltd

Journal of Clinical Nursing, 25, 1683–1692, doi: 10.1111/jocn.13188 1683
E-Y Kim and H-E Yeom

life related to the provision of care services (Bastawrous

Introduction
2013). A number of studies have revealed that family care-
Caregiving is a multifaceted process that has both negative givers experience physical, psychological and social distress
and positive aspects for family caregivers, including both throughout the process (Choi-Kwon et al. 2005, Etters
caregiving burden and satisfaction (Mackenzie & Green- et al. 2008, Kong et al. 2009). In particular, the burden of
wood 2012). Supporting family caregivers is essential family caregivers has been reported in numerous empirical
because they play a key role in sharing the societal burden studies as a critical issue that is intimately associated with
of long-term care for the growing frail older population in psychological distress (e.g., depression) and poor physical
South Korea. In contrast to the traditional view that health status (Choi-Kwon et al. 2005, Yajima et al. 2007,
regards family caregivers as needing to fulfil a moral duty Etters et al. 2008, Kong et al. 2009, Bastawrous 2013). In
to their families, in today’s aging society, family caregivers addition, caregiving burden has been found to be a mean-
are considered important partners in the social health care ingful factor affecting families’ decisions to continue care-
system (Lee 2013). It is also critically important to support giving at home or to transfer the older care recipients to a
family caregivers in that they could become potential care long-term care facility (Etters et al. 2008). The evidence
recipients if the physical and psychological distress caused indicates that when family caregivers are overwhelmed with
by their caregiving becomes overwhelming (Etters et al. the burden from caregiving duties, the demand for long-
2008, Camak 2015). term care in a facility consequently increases. As such,
As one of the most rapidly ageing countries in the world, reducing the burden of family caregivers is an important
the management of long-term care for older patients in issue related to the quality of life of family caregivers and
South Korea is a significant issue affecting families and to the societal burden of providing long-term care.
society. In response to the increasing demand for long-term While there has been a substantial body of literature on
care, the Korean long-term care insurance system has caregiving burden, there is relatively limited research on the
offered two types of social support since 2008: long-term positive aspects of caregiving. Caregiving satisfaction,
care facility services and home care services (National defined as a positive feeling related to the experience of pro-
Health Insurance Corporation 2011). Home care includes viding care (Son et al. 2003), is one example of the positive
several services: home-visit nursing care by a registered aspects of caregiving. Family caregivers’ satisfaction is linked
nurse (e.g., medication and treatment management), home- to a sense of fulfilment of having executed their moral duty
visit helper services (e.g., general assistance in activities of as family members and having contributed to maintaining
daily living) and home-visit bathing. Families have tradi- family harmony (Kim 2001, Kong et al. 2009, Lee 2013).
tionally shouldered the burden of all older persons’ care There is a general notion that caregiving burden and
because of the Korean cultural virtue of filial piety. With satisfaction are opposite facets related to the caregiving
the introduction of these home care services through the experience and that caregivers may not perceive both at the
national health insurance, it is expected that family care- same time. However, a few studies have reported interest-
givers’ physical and financial burden, which traditionally ing findings that family caregivers perceive both burden and
rested solely on the family in South Korea, will decrease satisfaction simultaneously (Andren & Elmstahl 2005,
and thereby improve their quality of life (National Health Kong et al. 2009), and that they feel satisfaction even when
Insurance Corporation 2011). However, despite positive carrying out the burdensome and stressful demands of pro-
expectations for home care services, there has been limited viding care for the care recipients (Kong et al. 2009,
information about the influence of these services on the Mackenzie & Greenwood 2012). Another study also found
burden and satisfaction of Korean family caregivers. that caregivers’ satisfaction was not necessarily low even
when they reported high levels of burden (Hsiao & Tsai
2014).
Background
A large body of empirical studies has demonstrated that
Long-term care for older patients is a critical issue affecting neither caregiving burden nor caregiving satisfaction is
the quality of life of family caregivers, which includes both determined by a single factor; rather, they are both associ-
the negative and positive experiences of caregiving ated with a variety of factors. For example, caregiving bur-
(Mackenzie & Greenwood 2012). One of the most repre- den has been shown to be affected by the health status of
sentative negative aspects of caregiving is caregiving bur- the caregivers (Chumbler et al. 2003), the cognitive and
den, which means the subjective and cognitive evaluation physical functioning of the care recipients (Chappell &
of the difficulties or discomfort experienced in all aspects of Reid 2002, Chumbler et al. 2003), the relationship between

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1684 Journal of Clinical Nursing, 25, 1683–1692
Original article Home care services and family caregivers

the caregiver and care recipient (Chumbler et al. 2003, home care services in Busan, South Korea. We initially
Choi-Kwon et al. 2005) and overall family functioning made a list of all long-term care agencies in the city of
(Heru & Ryan 2006). Similarly, caregiving satisfaction has Busan and contacted the prospective agencies explaining
been associated with the relationship between care recipi- the purposes of and providing detailed information about
ents and caregivers (Yajima et al. 2007), and care recipi- the study. Five of the agencies agreed to co-operate in this
ents’ physical and psychological health conditions (Son study and each agency gave formal approval. Data were
et al. 2003), and perceived social support (Son et al. 2003). collected by nurses or social workers working in these five
In addition, other sociodemographic characteristics of care- long-term care agencies. Before contacting potential partici-
givers and care recipients (e.g., age, education, family pants for this study, the primary investigator provided
income) and the sociocultural context of caregiving (e.g., detailed training for the nurses and social workers about
filial piety, familialism) have been found to be factors how the questionnaires were to be completed. Then, the
related to caregivers’ burden and satisfaction (Chappell & interviewers contacted older patients who received home
Reid 2002, Son et al. 2003, Choi-Kwon et al. 2005, Yajima care services and their family caregivers in their agencies.
et al. 2007). In spite of the evidence, there has been no The inclusion criteria were being a family caregiver aged
solid comparison of whether there is a difference in the fac- 18 or older and taking primary responsibility for an older
tors related to caregivers’ burden and satisfaction, support- care recipient using home care services. Family caregivers
ing the need for further studies that can lead to a more were excluded if they self-reported having severe mental
concrete understanding of the burden and satisfaction of health problems such as depression or cognitive impairment
family caregivers. that had been medically diagnosed by a health professional.
According to recent empirical findings, the actual demand Written consent forms were obtained from all individual
and supply of home care services in South Korea has sub- participants who voluntarily agreed to participate in the
stantially increased (Kim et al. 2012, Lee 2013). However, study, after which the survey was conducted. Family care-
despite this increase, some studies have indicated that givers filled out the self-administered questionnaires except
Korean family caregivers still carry out the majority of when they requested help, in which case a social worker or
caregiving duties and their physical and psychological dis- nurse assisted them. The physical and cognitive functioning
tress remains high (e.g., Kwon et al. 2011, Kim et al. of the older care recipients was directly measured by one of
2012). These findings trigger concerns about the benefits of the nurses or social workers.
home care services to support Korean family caregivers. In According to a power analysis using the G*POWER
addition, while it is certain that caregiving is a multidimen- (Germany) program, the required sample size was 146
sional activity associated with both negative and positive when the alpha was at 0
05, the desired power level was at
experiences for family caregivers (Andren & Elmstahl 0
80, the number of predictors was 17 and anticipated
2005, Kong et al. 2009, Mackenzie & Greenwood 2012), effect size was 0
15; thus, the sample size of this study was
there is little research offering a concurrent comparison of satisfactory.
the factors related to caregiving burden and satisfaction in
the same sample. Therefore, the purpose of this study is to
Measures
examine the factors affecting the burden and satisfaction of
family caregivers who care for older patients at home, par- Characteristics of the family caregiver, caregiving history
ticularly focusing on the beneficial impacts of home care and older care recipient
services in South Korea. Each caregiver filled out a sociodemographic questionnaire
that collected data on the caregiver’s age, gender, education
level, health insurance status, job status, relationship with
Methods
the older care recipient and whether the caregiver cohabited
with the care recipient.
Design
With regard to caregiving history, we collected informa-
A cross-sectional study was conducted. tion of the duration of caregiving (in years), average num-
ber of caregiving hours per day, whether there was a
second caregiver and quality of family functioning. The
Sample and data collection
quality of family functioning was measured using the Kor-
A convenience sample of 157 primary family caregivers was ean version of the Family APGAR, which was translated
recruited from five long-term care agencies that provide and validated for Koreans by Kim and Baik (2003). The

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Journal of Clinical Nursing, 25, 1683–1692 1685
E-Y Kim and H-E Yeom

Family APGAR assesses five aspects of family functioning For the service time of home care services, the respon-
(i.e., adaptability, partnership, growth, affection and dents were asked about how much time (hours) was spent
resolve) with five items using a three-point scale ranging for the home care services per visit and this information
from 0 (hardly ever) to 2 (almost always). The sum of the was assessed for each home care service (i.e., home-visit
item scores ranges from 0–10, with higher scores indicating nursing, home-visit helper services and home-visit bathing).
better family functioning. The Cronbach’s alpha in this The total service time that care recipients had received in
study was a = 0
90. the past month was counted for each service time for the
As for sociodemographic and health-related characteris- three types of home care services. In addition, an average
tics of the older care recipients, information on age, gender service time for each home care service per visit was calcu-
and physical and cognitive functioning was collected. Physi- lated.
cal functioning was measured using the Korean version of
the Barthel Activities of Daily Living Index (Mahoney & Caregiving burden
Barthel 1965). This scale comprises 10 items to assess gen- Caregiving burden was measured using a modified version
eral functioning on a three-point (0, 5, 10) scale, two items of the Korean version of the Burden Interview (BI) that
to assess movement and walking on a four-point scale (0, Kwon (1996) adapted from the original BI developed by
5, 10, 15) and two items to assess bathing and individual Zarit et al. (1980). The Korean version of the BI consists of
hygiene on a two-point (0, 5) scale. The sum of the item 28 items rated on a five-point Likert scale. The sum of the
scores, ranging from 0–100, was calculated, with higher item scores, ranging from 28–140, was calculated with
scores indicating better functional status. The internal con- higher scores indicating a higher level of caregiving burden.
sistency (Cronbach’s alpha) in a previous study in the Internal consistency was a = 0
91 in the original version by
Korean population was a = 0
84 (Kim 2001) and that in Zarit et al. (1980) and was a = 0
96 in this study.
this study was a = 0
86. Cognitive functioning was assessed
with the Korean version of the Short Portable Mental Sta- Caregiving satisfaction
tus Questionnaire, which has been validated for the Korean Caregiving satisfaction was assessed using the Korean ver-
population (Song et al. 2007). The questionnaire consists of sion of the Caregiver Satisfaction Scale (K-CSS; Son et al.
10 dichotomously rated items. The number of items that a 2000). The K-CSS consists of 16 items rated on a four-
respondent did not answer correctly was counted. Accord- point Likert scale, and the sum of the item scores, ranging
ing to the number of erroneous answers, cognitive function- from 16–64, was calculated with higher scores indicating a
ing was categorized into four levels as follows: intact higher level of caregiving satisfaction. Internal consistency
intellectual functioning (0–2), mild intellectual impairment was a = 0
90 in the study by Son et al. (2000) and
(3–4), moderate intellectual impairment (5–7) and severe a = 0
94 in this study.
intellectual impairment (8–10) (Pfeiffer 1975). The Cron-
bach’s alpha in this study was a = 0
89.
Data analysis

Home care service use Descriptive statistics were conducted to check the basic
Home care services for frail older people include home-visit features of the data, including the linearity, normality and
nursing, home-visit helper services and home-visit bathing. homoscedasticity of the study variables. The assumptions
Care recipients can receive more than one service per visit. for multiple regression analyses were also examined,
The characteristics related to home care service use were including the multicollinearity between independent vari-
assessed regarding the frequency and service time of the ables (i.e., the characteristics related to the family care-
home care services provided to the care recipients in the givers, older care recipients and use of home care
past month. With regard to the frequency of home care ser- services), and autocorrelation. The tolerance was lower
vices, respondents were asked how many times the care than 1
0 (range = 0
13–0
90), the variance inflation factor
recipients had received each of the three types of home care was 1
16–7
85 (i.e., lower than the standard of 10) and
services in the past month. The total frequency of home the Durbin–Watson statistic was 1
928; thus, no problems
care services that care recipients had received in the past regarding multicollinearity and autocorrelation were
month was counted by summing the frequency for each of found. The effects of home care service use on caregiving
the three types of home care services. In addition, the mean burden and satisfaction were examined using hierarchical
frequency for each of the three types of home care services multiple regression analyses. In hierarchical multiple
was calculated, respectively. regression analyses, we examined the relative contributions

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1686 Journal of Clinical Nursing, 25, 1683–1692
Original article Home care services and family caregivers

of the three groups of independent variables (i.e., charac- Table 1 Characteristics of family caregivers, caregiving and older
teristics of family caregivers, older care recipients and the care recipients (n = 157)
use of home care services) to predict caregiving burden Variables Mean  SD or n (%)
and satisfaction.
Family caregivers
Age 57
86  12
91
Ethical considerations Gender
Male 36 (22
9)
All procedures for this study were approved by the Institu- Female 121 (77
1)
tional Review Board (approval number: 10-10-200) of the Education level
≤Elementary school 25 (15
9)
university affiliated with the primary investigator. Official
≥Middle school 132 (84
1)
permission was also obtained from the five long-term care Health insurance
agencies from which the participants for this study were Yes 148 (95
5)
recruited. The purposes and detailed information of this No 7 (4
5)
study and the rights as a study participant were explained Job
to the potential participants and written consent forms Yes 73 (47
1)
No 82 (52
9)
were obtained from all participants.
Relation with the older care recipients
Spouse 42 (26
8)
Son 20 (12
7)
Results
Daughter 47 (29
9)
Daughter-in-law 36 (22
9)
General characteristics of family caregivers and older Others 12 (7
6)
care recipients Living with the older care recipients
Yes 106 (67
9)
Table 1 shows the characteristics of the family caregivers, No 50 (32
1)
caregiving and older care recipients. The average age of the Caregiving
caregivers was 57
86 years (SD = 12
91) and most of them Period of caregiving (years) 4
49  4
10
(77
1%) were female. Approximately, 15
9% of the care- Time of caregiving (hours) 11
33  8
72
Second caregiver
givers had an elementary school education level or less, and
Yes 78 (50
5)
52
9% of them were unemployed or retired. A majority of No 78 (50
5)
the caregivers (95
5%) had health insurance. Caregivers Family functioning 5
53  3
02
were the daughters (29
9%), spouses (26
8%), daughter-in- Caregiving burden 75
49  20
67
laws (22
9%) or sons (12
7%) of the older care recipients. Caregiving satisfaction 45
13  7
74
Older care recipients
The mean duration of caregiving was 4
49 years
Age 77
61  9
82
(SD = 4
10) and the mean amount of time spent per day Gender
providing care was 11
33 hours (SD = 8
72). Most of the Male 48 (30
6)
caregivers cohabitated with their care recipients (67
9%), Female 109 (69
4)
and 50
0% of them had second caregivers. The mean Physical function 38
73  22
87
family functioning score was 5
53 (SD = 3
02). Cognitive function
Intact 60 (38
2)
The mean age of the older care recipients was
Mild 18 (11
5)
77
61 years (SD = 9
82) and the majority of them (69
4%) Moderate 25 (15
9)
were female. The mean score for physical functioning was Severe 54 (34
4)
38
73 (SD = 22
87). Regarding the cognitive functioning,
the proportions of care recipients were as follows: intact
(38
2%), severe (34
4%), moderate (15
9%) and mild
Descriptive information of home care service use
(11
5%).
Regarding the levels of caregiving burden and satisfaction The average frequency of each home care service provided
of family caregivers, they reported an average caregiving to care recipients in the past month was 2
6 (SD = 3
7) for
burden of 75
49 (SD = 20
67, possible range = 28–140), home-visit nursing, 20
8 (SD = 6
9) for home-visit helper
which corresponds to 2
7 on a five-point scale. Their care- services and 7
2 (SD = 7
2) for home-visit bathing. The
giving satisfaction was an average of 45
13 (SD = 7
74, average frequency of all services that older care recipients
possible range = 16–64). had received in the past month was 21
4 (SD = 8
1).

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Journal of Clinical Nursing, 25, 1683–1692 1687
E-Y Kim and H-E Yeom

The average time of each service provided to the older care care services on predicting caregiving satisfaction. In the
recipients in the past month was 1
8 (SD = 3
5) hours for first model, 16% of the variance in caregiving satisfaction
home-visit nursing, 67
0 (SD = 23
2) hours for home-visit was explained by the characteristics of family caregivers.
helper services and 8
5 (SD = 4
0) hours for home-visit bath- This proportion increased to 24
3% in the second model
ing. In total, older care recipients received home care services including the characteristics of the older care recipients. In
for an average of 64
7 (SD = 26
2) hours in the past month. the last model, which included the variables related to
More detailed information is shown in Table 2. home care service use, a slight increase in the variance
explained (24
5%) was detected. In the last model, caregiv-
ing satisfaction was significantly predicted by the education
The influence of home care service use on caregiving
level of caregivers (b = 5
090, p = 0
046), the quality of
burden
family functioning (b = 0
695, p = 0
014) and the age of
Table 3 shows the results of the hierarchical multiple the older care recipients (b = 0
233, p = 0
018); however,
regression analysis that examined the relative influence of no significant effects of the home care service use variables
each group of family caregivers, older care recipients and on caregiving satisfaction were detected. This result indi-
the use of home care services on predicting caregiving bur- cates that caregivers were likely to perceive greater caregiv-
den. In the first model, 45
5% of the variance in caregiving ing satisfaction when their education level was high (i.e.,
burden was explained by the characteristics of family care- middle school or above) compared to those who had gradu-
givers. This proportion increased to 48
8% in the second ated from elementary school or lower. In addition, care-
model including the characteristics of the older care recipi- givers who perceived better family functioning and who
ents. In the last model, which included the variables related cared for older care recipients were more likely to report
to home care service use, a slight increase in the variance greater caregiving satisfaction.
explained (48
9%) was detected.
The last model showed that the education level of the care-
Discussion
givers (b = 14
515, p = 0
008), presence of secondary care-
givers (b = 9
106, p = 0
021) and the quality of family With a rapidly growing frail older population, there is an
functioning (b = 2
741, p < 0
001) all significantly pre- urgent need to support family caregivers in South Korea.
dicted the caregivers’ burden; however, no significant effects This study provides important findings related to the care-
of home care service use on caregiving burden were detected. giving burden and satisfaction of Korean family caregivers
This result indicates that caregivers were likely to perceive who receive social support from home care services.
greater caregiving burden when their education level was low As the key issue, this study found that the characteristics
(i.e., elementary graduation or less) compared to those who of home care service use (i.e., frequency of services used
had graduated from middle school or higher. In addition, care- and service time) were not significant factors affecting care-
givers tended to report lower levels of caregiving burden when giving burden and satisfaction, after adjusting for the char-
they had secondary caregivers who could help out as needed acteristics of caregivers and older care recipients, and
and when they had better perceived family functioning. caregiving history. This finding builds on prior evidence
that the utilization of home care services might not be an
indispensable benefit for caregivers (Chappell & Reid
The influence of home care service use on caregiving
2002). Thus, information about home care service use
satisfaction
should be reviewed. The average frequency of home care
Table 4 presents the results of the hierarchical multiple services that each family in this sample received for the past
regression analysis of the relative influence of each group of month was 21
4 days with an average service time of only
family caregivers, older care recipients and the use of home 3
6 hours per visit. This finding indicates that caregivers
Table 2 Information about home care services provided in the past month

Frequency of service in the Service time (hours) per Service time (hours) in the
Types of home care services past month Mean  SD visit Mean  SD past month Mean  SD

Home-visit helper services (n = 137) 20
8  6
9 3
4  1
1 67
0  23
2
Home-visit nursing (n = 47) 2
6  3
7 0
6  0
2 1
8  3
5
Home-visit bathing (n = 13) 7
2  7
2 1
7  0
7 8
5  4
0
Total (n = 157) 21
4  8
1 3
6  1
3 64
7  26
2

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1688 Journal of Clinical Nursing, 25, 1683–1692
Original article Home care services and family caregivers

Table 3 The effects of home care service use on caregiving burden (n = 157)

Model 1 Model 2 Model 3

Variables b p b p b p

Characteristics of family caregivers and caregiving

Age 0
345 0
062 0
199 0
362 0
198 0
369
Gender* 8
447 0
140 12
682 0
059 13
127 0
065
Education level† 14
299 0
005 14
283 0
007 14
515 0
008
Health insurance‡ 13
579 0
119 11
250 0
211 11
209 0
221
Job§ 0
5
454 0
131 5
281 0
155 5
627 0
148
Relation with older care recipient¶
Spouse 2
031 0
803 3
997 0
671 4
282 0
656
Son 7
893 0
359 11
953 0
202 12
021 0
224
Daughter 1
635 0
801 2
127 0
748 2
468 0
715
Daughter-in-law 4
284 0
543 4
839 0
502 5
120 0
485
Living with older care recipients** 3
959 0
394 3
981 0
399 4
012 0
401
Period of caregiving 0
799 0
082 0
886 0
060 0
891 0
061
Hours of caregiving a day 0
078 0
737 0
040 0
868 0
028 0
911
Second caregiver†† 8
252 0
029 8
866 0
021 9
106 0
021
Family functioning 2
740 0
000 2
757 0
000 2
741 0
000
Characteristics of the older care recipients
Age 0
144 0
482 0
141 0
494
Gender* 5
297 0
236 5
482 0
230
Physical function 0
052 0
502 0
045 0
573
Cognitive function‡‡
Mild 3
034 0
586 3
327 0
559
Moderate 1
421 0
756 1
418 0
759
Severe 6
638 0
093 6
779 0
091
Use of home care services
Frequency of service used for the past month 0
825 0
749
Total service time for the past month 0
011 0
871
F (p) 6
21 (0
000) 4
68 (0
000) 4
18 (0
000)
R2 0
455 0
488 0
489

*Coded male as 1 and female as 0.

†
Coded if education level is ≤Elementary school as 1 and over elementary school graduation as 0.
‡
Coded if they have health insurance as 1 and if not, as 0.
§
Coded if a respondent has a job as 1 and otherwise as 0.
¶
Coded if a primary caregiver is not spouse, son, daughter or daughter-in-law as 0.
**Coded living with a care recipient as 1 and not living with a care recipient as 0.
††
Coded if there is a secondary caregiver as 1 and if not as 0.
‡‡
Coded if older care recipients with intact cognitive function as 0.

still take on the major responsibility for caregiving and recipients (e.g., bathing, medication) and rarely include
spend most of their time providing care at home. This assistance with the daily activities of family caregivers, such
information reveals that the quantity of home care services as household chores. A recent study that compared several
in the current system might be insufficient to substantially daily tasks affecting the quality of life of family caregivers
affect caregivers’ burden and satisfaction. found that carrying out household chores was the most crit-
It is necessary to consider the individual needs of care- ical factor affecting caregivers’ quality of life, compared to
givers when providing home care services. Family caregivers general caregiving tasks such as bathing and assisting with
perform a variety of tasks including not only direct care for activities of daily living (Freedman et al. 2014). This find-
the older patients but also tasks related to their own lives. ing implies that services such as help with household chores
However, the types of home care services in South Korea could be added to the types of services offered to help
mostly focus on assistance with direct care for older care reduce the burden and increase satisfaction for caregivers.

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Journal of Clinical Nursing, 25, 1683–1692 1689
E-Y Kim and H-E Yeom

Table 4 The effects of home care service use on caregiving satisfaction (n = 157)

Model 1 Model 2 Model 3

Variables b p b p b p

Characteristics of family caregivers and caregiving

Age 0
070 0
430 0
068 0
505 0
067 0
517
Gender* 3
323 0
227 2
281 0
466 1
859 0
575
Education level† 3
463 0
155 4
859 0
048 5
090 0
046
Health insurance‡ 0
189 0
964 2
117 0
616 1
921 0
654
Job§ 0
378 0
828 1
060 0
545 0
990 0
589
Relation with older care recipient¶
Spouse 2
375 0
543 2
598 0
557 2
891 0
522
Son 4
503 0
276 2
463 0
575 1
980 0
669
Daughter 0
596 0
849 1
179 0
705 1
329 0
676
Daughter-in-law 1
267 0
708 2
804 0
408 2
813 0
415
Living with older care recipients** 0
492 0
827 1
361 0
543 1
326 0
558
Period of caregiving 0
278 0
206 0
384 0
082 0
384 0
085
Hours of caregiving a day 0
011 0
921 0
022 0
849 0
018 0
879
Second caregiver†† 0
457 0
799 1
057 0
554 0
968 0
597
Family functioning 0
672 0
017 0
690 0
013 0
695 0
014
Characteristics of the older care recipients
Age 0
232 0
017 0
233 0
018
Gender* 1
623 0
439 1
772 0
409
Physical function 0
009 0
803 0
007 0
855
Cognitive function‡‡
Mild 2
422 0
373 2
315 0
403
Moderate 1
075 0
618 1
095 0
615
Severe 2
240 0
227 2
152 0
253
Use of home care services
Frequency of service used for the past month 0
447 0
712
Total service time for the past month 0
006 0
853
F (p) 1
87 (0
049) 1
83 (0
043) 1
61 (0
081)
R2 0
160 0
243 0
245

*Coded male as 1 and female as 0.

†
Coded if education level is ≤ Elementary school as 1 and over elementary school graduation as 0.
‡
Coded if they have health insurance as 1 and if not, as 0.
§
Coded if a respondent has a job as 1 and otherwise as 0.
¶
Coded if a primary caregiver is not spouse, son, daughter, or daughter-in-law as 0.
**Coded living with a care recipient as 1 and not living with a care recipient as 0.
††
Coded if there is a secondary caregiver as 1 and if not as 0.
‡‡
Coded if older care recipients with intact cognitive function as 0.

Thus, this study suggests that assessing the individual the older care recipients and family functioning. It is inter-
needs of family caregivers is important for effective home esting that family functioning is a significant issue affecting
care services and in particular, considering the provision of both caregiving burden and satisfaction. Caring for a frail
services that support family caregivers with housework older family member could trigger conflicts between family
such as cleaning and cooking as a strategy to reduce the members (Etters et al. 2008). However, the finding of this
burden and increase satisfaction (Lee 2013, Freedman study demonstrates that the way a family works together to
et al. 2014). manage the situation could lead to positive feelings for
Another key finding of this study is that there was a dif- caregivers in terms of caregiving satisfaction, or it could
ference between the factors affecting caregiving burden and aggravate the caregivers’ burden.
those affecting satisfaction. Caregiving burden of caregivers Empirical studies have demonstrated the significant impact
was significantly affected by their education level, the pres- of the relationship between the caregivers and care recipients
ence of a second caregiver, and family functioning. In con- on the caregiving experiences of caregivers (e.g., Yajima
trast, caregiving satisfaction was associated with the age of et al. 2007, Lee 2013). In addition, the characteristics of

© 2016 John Wiley & Sons Ltd

1690 Journal of Clinical Nursing, 25, 1683–1692
Original article Home care services and family caregivers

family caregivers have been regarded as a meaningful factor lights the need to develop intervention programs that guide
that is intimately related to family functioning. family members in healthy interactions related to long-term
One of the interesting findings of this study was the care. It is also important to develop strategies to provide
change in the relationship between family caregivers and more effective home care services, in consideration of the
care recipients compared to traditional Korean society. various quantitative characteristics (e.g., the types and fre-
Despite the traditional Korean society norm of daughters-in- quency of services, service hours) of home care services.
law being the predominant family caregivers (Kong et al. Accordingly, this study provides a fundamental direction to
2009, Lee 2013), over half of the caregivers in this study maximise the benefits of home care services in supporting
were daughters (29
9%) and spouses (26
8%), compared to older care recipients as well as their family caregivers.
only 22
9% who were daughters-in-law. This finding implies
that along with the changes in the relationship between pri-
Relevance to clinical practice
mary caregivers and care recipients, the interaction among
the family members who provide caregiving might differ Family caregivers are a vital informal resource that could
from the norms of traditional Korean society. In addition, contribute to decreasing the societal burden of long-term
this change indicates that more family members are involved care. However, there is a potential risk that family care-
in the care of the older family members, which could lead to givers could themselves become long-term care recipients if
both benefits and conflicts within the family. In particular, the social system does not adequately address their physical
one study reported the recent perceptual changes that may and psychological distress (Etters et al. 2008, Camak
influence the notion of family caregiving in South Korea (Lee 2015). The findings of this study emphasise that health pro-
2013). In contrast to traditional Korean society, individuals fessionals should recognise the urgent need to support fam-
in modern Korean society tend to put a higher value on their ily caregivers and the need to play an active role in guiding
personal well-being in terms of individualism rather than on all family members to engage in more effective means of
sacrificing themselves for the family (Lee 2013). These find- providing long-term care services at home. For this task,
ings emphasize the need to develop programs to strengthen health professionals need to assess the practical needs of
supportive family functioning, and these programs should be family caregivers who perform care activities at home and
based on a more concrete understanding of modern family to assess their preferences for the types and quality of ser-
dynamics and societal contexts for caregiving. vices. The significance of healthy family functioning indi-
Some limitations in this study should be addressed. The cates that there is an essential need to develop programmes
sample was relatively homogeneous because participants that focus on supportive interaction among family care-
were recruited from five agencies that provided home care givers. Prior research has demonstrated the importance of
services in a single city. Another limitation is that this study family caregivers being given opportunities to feel personal
used a cross-sectional design so readers need to be cautious pride from fulfilling caregiving duties, to express their bur-
not to interpret the results as showing a causal impact of den and to share their pleasure with family members
family functioning. A longitudinal study is needed to reach (S€orensen et al. 2002, Pot et al. 2015). Based on this infor-
robust conclusions about home care services to improve mation, health professionals and policy makers should play
our understanding of the caregiving experiences of Korean a pivotal role in suggesting practical strategies for effective
family caregivers. delivery of home care services and in developing nursing
interventions to reinforce supportive family interaction to
enhance the quality of life of family caregivers.
Conclusion
The findings of this study give a critical indication that home
Acknowledgement
care services in the current Korean long-term care insurance
system are insufficient to reduce the burden of family care- This work was supported by the Dong-A University
givers or to enhance their satisfaction. It is notable that a research fund.
critical issue related to both the burden and satisfaction of
primary family caregivers is how family members interact
Contributions
with each other in managing caregiving tasks. The findings
related to family functioning build on prior evidence that has Study concept and design: EYK, HEY; Data collection and
emphasized the significance of supportive family functioning analysis: EYK; Drafting of manuscript: EYK, HEY; Critical
for primary family caregivers. Therefore, the finding high- revisions for important intellectual content: HEY, EYK.

© 2016 John Wiley & Sons Ltd

Journal of Clinical Nursing, 25, 1683–1692 1691
E-Y Kim and H-E Yeom

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