Decision-making of Chinese caregivers for adult out-of-home placement

Background: In the light of the existence of lengthy waiting lists for out-of-home placements, this study examines the factors affecting the decision to apply or not to apply for this facility in a city traditionally characterized by a cultural and policy emphasis on family responsibility and by relatively low levels of welfare commitment to residential services. Method: A sample of 321 people responsible for providing care for adults with moderate to severe intellectual disability (ID) from 22 service units of seven non-governmental organizations in Hong Kong was surveyed by means of a structured questionnaire. Results: The non-application group reported better emotional ties with the people with ID and greater confidence in their caregiving skills, but also tended to be caring for more challenging people with poorer health and higher or more frequent levels of self-harm behaviour than the application group who exhibited higher levels of worry and fear. Discriminant analysis successfully predicted 80% of non-application cases, while logistic regression revealed that decline in perceived competence to care, absence of other health problems and at least one parent of the client having long-term illness were better predictors of the decision to apply than handicap-specific characteristics of the people with ID themselves. Conclusion: The implications of this finding are discussed, and consideration given to the possibility of developing policies designed to strengthen and treasure family values while not detracting from the importance of providing proper community support.