With the growing number of older populations in the United States, much attention has been paid to the risk of developing Alzheimer’s disease and related dementia (ADRD). Along with the population trend, the proportion of older Asian Americans is expected to rise over the next few decades. This growth will affect the rate of older Asian Americans with ADRD and a greater need for family caregiving. While it has been well recognized that familism and filial piety in Asian cultures influence caregiving trajectories, little is known about perceptions of nursing home placement (NHP) for persons with dementia (PWD) among Korean American family caregivers. This study aims to gain a deep understanding of the contexts related to NHP as a long-term care option for PWD by exploring various perspectives of Korean American family caregivers.
Using a purposive sampling method, 16 Korean American family caregivers for PWD residing in the Los Angeles area were recruited from November 2021 to February 2022. Recruitment was conducted via public advertisement and referrals. Participants had an in-depth semi-structured face-to-face interview for 90 minutes. All interviews were audio-recorded with the participants' consent. All participants were born in Korea and used Korean as a primary language. Nine participants provided care for their parent(s), four for their parent-in-law, and three for a grandmother, spouse, and relative. Using a qualitative content analysis method, each transcript was open-coded and categorized based on its similarities and differences, and the iterative process continued until a consensus theme emerged.
Through the analysis of the interview transcripts, eight themes emerged under four categories. The first category was recognized needs for nursing home care, including subthemes of (1) readiness for the advanced stage, (2) potential challenges in caregivers' health. The second was personal reluctance to NHP with (1) resistance by care recipients, (2) emotional bonding, and (3) filial duty. The third was about negative perceptions of nursing homes with subthemes of (1) lack of individualized care, (2) concerns about adjustment. Finally, the last category was positive perceptions of NHP with a subtheme of (1) prompt medical treatment. One notable finding was strong resistance from PWD to the NHP, influencing caregivers’ perception of nursing homes. While some participants have appreciated the professional medical care at nursing homes, others concerned about the lack of personalized care. One female caregiver said, "...If she doesn't want to eat, I can feed her later with different foods. At nursing homes, staff usually take the tray away immediately after mealtime even if it was untouched, and that's it."
Conclusions and Implications
This descriptive qualitative study provides how Korean American caregivers perceive NHP for persons with dementia. Beyond filial obligations, many caregivers held negative perceptions of nursing homes, which seemed to limit their care options and increase burden. Attention is needed to not only culturally appropriate care but also personhood in care at nursing homes. Other options, such as community-based services, require further investigation among ethnic minority caregivers and persons with ADRD.