Service use by family caregivers in Japan.

This paper presents a conceptual framework for understanding how Japanese family caregivers make decisions about the use of formal services such as adult day care, short term hospital stays, and long-term institutionalization. Using grounded theory methodology, 26 Japanese daughters or daughters-in-law who were caring for an elderly demented parent or parent-in-law were interviewed. From these data, an overall process of "navigating among endorsed options" evolved. This process was set in motion when caregivers reached the limit of their tolerance, a point at which they felt they could not continue caregiving under the given arrangement. Caregivers then began to assess three issues which determined whether or not they used formal services: the availability of services; their authority level within the family; and whether or not they could justify their tolerance limit. The availability of a service was determined by the quality of the service, the distance to the service, the sanctions that would incur as a result of using the service, information about the service, and the quantity of the service. The caregivers' authority within the family varied depending on such factors as how much the caregiver was accepted by her married family or the type of family business. This authority level determined whether and how the caregivers could approach other family members in order to obtain their consent to use formal services. Finally, whether the caregivers could justify their tolerance limit depended on the internalization of the societal norm regarding family caregiving, attachment to the care recipient, and the caregiver's belief on how care should be given. Justification of their limit included re-prioritizing the needs of family members, acting in defiance of societal norm, and redefining reality. Each of the three issues was assessed in relation to the others with the final decision to use or not use formal services based on the balance of forces.