Methods: This cross-sectional survey study included 146 caregivers of frail older KIs recruited from local aging service agencies, Korean organizations, and churches. The survey was conducted via telephone by bilingual interviewers. First, it examined KI caregivers' knowledge and perceived helpfulness of and likeliness to use seven types of HCBS programs (respite, adult day care, personal care, housekeeping, home-delivered meals, transportation, and caregiver support group). Guided by the health behavioral model, logistic regression was then conducted to identify factors affecting caregivers' likeliness to use these services. Variables examined included: caregiver gender, relationship, education in Korea, and years in the U.S as predisposing factors; functional dependency, cognitive impairment, and chronic conditions as care recipient needs; family network, caregiver self-efficacy, and service knowledge as enabling factors; and burden, caregiving hours, and perceived service helpfulness as needs of caregiver.
Results: Majority of KI caregivers reported limited knowledge about the seven types of HCBS programs (68.5% to 98%). The percentage of caregivers who considered these programs helpful varied (27% to 54%), but solid majority (73% to 86%) indicated their likeliness to use these services. Logistic regression models were all significant (Nagelkerke R-squares ranged from 0.55 to 0.24) and showed caregivers' perceived helpfulness of the service as a significant factor affecting their likeliness to use all but transportation service : respite care (OR = 11.85, 95% CI [2.46, 57.14]), adult day care (OR = 22.14, 95% CI [2.00, 244.63]); personal care (OR = 18.89, 95% CI [2.19, 163.24]); housekeeping (OR = 7.38, 95% CI [2.11, 25.84]), home-delivered meals (OR = 23.32, 95% CI [2.86, 190.12]), and support group (OR = 12.62, 95% CI [3.72, 42.85]). Two other variables also emerged as significant factors: family support network with the likeliness to use adult day care (OR = 0.74, 95% CI [0.56, 0.99]); and functional dependency of care recipient with the likeliness to use adult day care (OR = 0.87, 95% CI [0.77, 0.98]), housekeeping services (OR = 0.93, 95% CI [0.87, 0.99]), and transportation (OR = 0.89, 95% CI [0.81, 0.99]).
Conclusion & Implications: Limited knowledge and perceived helpfulness about HCBS programs and the significance of caregivers' perceived helpfulness in their likeliness to use these programs point to a need for educational outreach in the KI community about the benefit of HCBS. The results also suggest a potential increase in the demand for these services in KI communities, calling for a collaborative effort to explore innovative ways to extend existing HCBS programs to meet the demand.