Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China

Background: Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited. Methods: Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden. Results: A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (beta = 0.26, p < .001; beta = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (beta=-0.25, p < .001; beta=-0.24, p < .001; beta=-0.23, p < .001; beta=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (beta=-0.17, p < .001; beta=-0.18, p < .001; beta=-0.17, p < .001; beta=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (beta=-0.11, p < .05; beta=-0.20, p < .001; beta=-0.17, p < .001; beta=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (beta = -0.13, p < .01). Conclusion: Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.