Family Caregivers in Older-Person Care: Why Readiness, Support and Safety Matter in Viet Nam
LONG-TERM CARE, HOME & COMMUNITY CARE
Family Caregivers in Older-Person Care: Why Readiness, Support and Safety Matter in Viet Nam
LONG-TERM CARE, HOME & COMMUNITY CARE
Last reviewed: October 2026
Much of older-person care does not happen during a medical appointment. It happens between appointments, after hospital discharge and inside the home.
A family member may organize medications, prepare meals, help an older person with mobility or personal care, arrange transportation, monitor symptoms, communicate with health professionals and decide when a change is serious enough to seek help. When cognition declines or functional needs increase, that role can become substantially more complex.
Health and care systems often depend on this work without making it fully visible. A discharge plan may say that the family will “assist with medication.” A home-care plan may assume that a spouse or adult child can help with mobility or daily activities. Follow-up instructions may depend on someone noticing deterioration and knowing whom to contact.
But an important distinction is often missed:
A family caregiver may be available without being ready.
Caregiver readiness is not a formal legal category in Viet Nam’s current older-person care framework. It is a practical quality and implementation concept. It means more than being physically present. It includes understanding what needs to be done, having the practical and physical ability to do it, knowing the limits of one’s role, recognizing when something is wrong, knowing how to obtain professional help and being able to sustain the responsibility over time.
For Viet Nam, this question has become particularly timely. The Law on Population No. 113/2025/QH15, effective from 1 July 2026, recognizes self-care, care at home, community care and care in formal care and medical settings as different forms of older-person care. Article 18 specifically provides for supporting family members who care for older people through appropriate training, counseling and technical assistance.
The policy direction is therefore increasingly toward supporting family care rather than simply assuming that family care will be available.
Family caregivers are already part of the care system
Family caregiving is sometimes discussed as though it exists outside the health system. In practice, family members frequently carry responsibilities that determine whether formal care succeeds.
A clinician can prescribe the correct medication, but someone may still need to obtain it, understand important changes and help the older person follow the regimen. A rehabilitation plan can be clinically appropriate, but the person may need support practicing safely at home. A hospital can provide excellent treatment, but recovery may depend on whether someone understands the discharge plan and can respond when symptoms change.
Family caregivers therefore often sit at the interface between hospital, primary care, home, community services and long-term care.
Viet Nam’s 2026 legal and professional framework makes this role more explicit. Decree No. 168/2026/NĐ-CP identifies relatives as one of the groups that may provide care at home and sets out the content of home care, including prevention and early recognition of common health problems, support for physical and mental well-being and social connection, and assistance with activities of daily living.
Decision No. 1976/QĐ-BYT, issued by the Ministry of Health on 1 July 2026, adds detailed professional guidance. For older people with reduced intrinsic capacity who are cared for at home, it specifically recognizes care by relatives or domestic workers following training, counseling and technical support organized by the commune health station.
Circular No. 34/2026/TT-BYT, issued on 8 September 2026, goes further by explicitly including older people and family members providing care among the target groups for community older-person health activities. Commune health stations are assigned responsibility for counseling and providing knowledge and practical skills for self-care and care at home and at community day-care points, based on Decision 1976.
Family caregivers are therefore becoming a more visible part of how Viet Nam expects older-person care to work.
Availability is not the same as readiness
The presence of a family member tells us relatively little about whether that person can safely provide the care being assumed.
A daughter may live with her mother but work full time. A spouse may be available throughout the day but have arthritis or cardiovascular disease that makes physical assistance difficult. An adult child may understand the diagnosis but not know how to manage a medication regimen that changed during hospitalization. A family member may be willing to help but feel unsafe assisting with transfers after a fall.
Readiness is therefore multidimensional. It includes understanding the condition and care plan, having the practical skills and physical ability to perform expected tasks, recognizing warning signs and knowing whom to contact, and being able to sustain the responsibility alongside employment, childcare, financial pressures and the caregiver’s own health.
A care plan that assumes these capacities without checking them can look complete on paper while being unworkable at home.
Vietnamese evidence shows why this matters
Recent Vietnamese research provides a useful window into the realities of family caregiving.
A 2025 qualitative study interviewed 20 family caregivers of people with dementia receiving care through the Department of Geriatrics at Nhan dan Gia Dinh Hospital in Ho Chi Minh City. Participants were predominantly women, all lived with the people they cared for and reported an average of more than nine hours of caregiving each day. Importantly, the study required a Distress Thermometer score of at least four for eligibility, so it intentionally examined caregivers experiencing meaningful distress.
The study identified challenges in daily care, behavioral and sleep problems, help-seeking, personal sacrifice, emotional stress and limited dementia knowledge and caregiving skills. Caregivers described gaps in areas such as dementia knowledge, fall prevention, pressure-injury care, infection management and management of comorbid conditions; some relied largely on personal experience or internet searches to learn how to provide care.
These findings should not be generalized to all Vietnamese family caregivers. This was a small, purposively selected group of dementia caregivers from one Ho Chi Minh City hospital, and participants were selected partly on the basis of elevated distress. Its value lies elsewhere: it demonstrates concretely that being a family member does not automatically provide the knowledge or skills required for complex care.
Earlier Vietnamese research adds another dimension. A 2021 qualitative study found that dementia caregiving could be shaped by family obligation, gender and sibling order. Caregivers described time constraints, income loss, social isolation and physical and emotional strain, while many resisted describing caregiving itself as a “burden,” reflecting the moral and family meanings attached to care.
Together, these studies suggest that caregiver experience cannot be reduced to an assumption that Vietnamese families simply “can” or “cannot” provide care.
Caregiver support should begin before discharge and continue at home
Hospital discharge is one of the clearest moments when responsibility can move rapidly from professionals to families.
Inside a hospital, medications are administered by trained staff, deterioration can be escalated quickly and help is readily available. Once an older person returns home, much of that day-to-day responsibility may shift within hours to the patient and family. The family may suddenly need to understand new medications, mobility restrictions, wounds, nutrition, appointments, rehabilitation, equipment and warning signs. The older person may also return home weaker, more confused or more dependent than before admission.
Evidence suggests that caregivers need more than a printed discharge sheet. A 2025 scoping review of hospital-to-home transitional care for caregivers of functionally dependent older people found that support commonly included health education, involvement in decision-making, emotional support, telemonitoring and post-discharge home visits. The authors emphasized the need to adapt support to the caregiver’s context and available support network.
The quality question is therefore not simply whether an older person has family at home. It is whether the person who will actually provide care understands the plan, can carry it out and knows where to obtain help.
Medication is a particularly useful safety test. Older people may leave hospital with medicines stopped, started, changed or temporarily added. A qualitative meta-synthesis published in 2025 reviewed 13 studies and identified recurring problems with medication continuity, participation in medication decisions, communication and information transfer during transitions of care.
A caregiver may therefore need to understand not only what medicines the older person should take, but what changed, what was stopped, which adverse effects matter and when professional advice is needed. This does not mean turning family caregivers into pharmacists or prescribers. Medication decisions remain professional responsibilities. The caregiver’s role is to help the older person follow the agreed regimen safely in everyday life.
Cognitive impairment can make this task even more complex. A caregiver may need to support medication, nutrition, personal care, behavior, safety and appointments while also trying to distinguish chronic cognitive impairment from acute deterioration. A new episode of confusion may be mistaken for “the dementia getting worse” when delirium, infection, dehydration or medication effects require assessment.
Caregiver education therefore needs to be practical, ongoing and connected to a place where questions can be answered when the situation changes.
More family involvement is not automatically better care
Family involvement is intuitively appealing, but the evidence should not be overstated.
A systematic review published in its 2026 journal issue examined active involvement of family caregivers in adult hospital care. It included 13 studies, of which 11 were randomized controlled trials. Some individual studies reported benefits in outcomes such as readmission, length of stay, activities of daily living, psychological distress, quality of life or caregiver satisfaction, while others did not. Clinical and methodological heterogeneity prevented meta-analysis.
The appropriate conclusion is therefore not that more family involvement is always better.
Family involvement should be purposeful, appropriate to the older person and caregiver, and supported by the health system.
An older person may not want a family member involved in every conversation. A caregiver may not be able or willing to perform certain tasks. Family members may disagree with each other. Greater involvement without adequate preparation can simply transfer more responsibility to someone who is already overwhelmed.
Supporting the caregiver must not replace the older person’s voice
Family involvement should never make the older person disappear from their own care.
Decision No. 1976 emphasizes respect for older people, attention to their needs and wishes and protection of confidentiality during counseling and care. A family member may know the person extremely well and provide essential support, but the caregiver’s preferences are not automatically the same as the older person’s preferences.
Where an older person is able and wishes to participate in decisions, their own goals, preferences and choices should remain central. Where cognitive impairment limits participation, care should still protect dignity, rights and previously expressed preferences as far as possible.
Caregiver readiness therefore has two dimensions: can the caregiver perform the necessary tasks, and can those tasks be carried out in a way that respects the older person’s wishes, autonomy and dignity?
Both matter.
Family caregivers need boundaries as well as skills
Good caregiver support should also make clear what family members are not expected to do.
Families can help an older person follow a prescribed medication regimen, support mobility and daily activities, monitor symptoms and communicate with professionals. But family involvement should not become a substitute for clinical assessment or treatment when professional care is required.
A care plan should therefore make escalation boundaries understandable. Caregivers need to know which changes can reasonably be monitored, which require advice and which situations need urgent assessment. Without those boundaries, families can be left with two unsafe options: trying to manage problems beyond their competence or waiting too long before seeking help.
Readiness includes knowing when not to continue alone.
Caregiver well-being and sustainability are part of care quality
Caregiver well-being is sometimes treated as separate from patient care. In long-term and home-based care, the two are closely connected.
A caregiver who is exhausted, distressed, financially strained or unable to sleep may find it increasingly difficult to sustain a demanding care plan. This does not mean that stressed caregivers provide poor care. It means that any model depending heavily on one person should consider whether that arrangement is realistic over time.
WHO’s 2026 consultation draft of the Global Standards for Long-Term Care reflects this broader perspective. It contains a dedicated chapter on support for unpaid carers, with proposed standards covering early identification and needs assessment, respite care, education and skills training, social protection and financial security, and caregiver engagement and recognition. The document remains a consultation draft, with public consultation open until 30 October 2026, and is not yet a finalized WHO standard.
A 2026 systematic review of caregiver-support policies across the European Union also found substantial variation in national approaches. Financial support and respite were widespread, while training, counseling, employment protections and social-security measures varied considerably.
There is therefore no single international caregiver-support package that Viet Nam can simply copy. Support needs to fit the country’s own health, social, family and financing context.
Training matters, but readiness requires more than attendance
Viet Nam’s 2026 policy architecture appropriately places strong emphasis on training and guidance.
Circular No. 34 assigns responsibilities for training and capacity building to the Population Department, provincial health authorities and commune health stations. It specifically requires commune health stations to provide older people and family caregivers with knowledge and practical skills for care at home and at community day-care points.
This is an important foundation, but readiness cannot be measured simply by whether someone attended a training session.
A useful process should ask whether the caregiver understands the care plan, can perform the expected tasks safely, knows when to seek help, understands important medication changes and has somewhere to turn when new problems arise. For tasks with meaningful safety consequences, teach-back, practical demonstration and follow-up may provide more useful information than attendance alone.
If a care plan depends substantially on a family caregiver, it is also reasonable to ask whether that assumption is realistic. This does not require another long questionnaire for every family. A practical conversation can cover which tasks the caregiver is expected to perform, whether they understand and feel able to perform them, whether physical or time constraints exist, whether backup help is available, which tasks cause concern and whether professional support is accessible.
The purpose is not to judge whether someone is a “good caregiver.” It is to identify assumptions in the care plan that may not be realistic.
A caregiver who says, “I cannot safely lift him,” has provided useful safety information. They have not failed the care plan.
The plan needs to change.
Commune health stations could become an important support point
The 2026 Vietnamese framework creates a potentially important role for commune health stations.
Decision 1976 places them within the organization of home and community care, while Circular 34 gives them responsibilities for training volunteers and counseling older people and family members on care knowledge and skills.
This could create an important local point of connection between families and the formal health system, but its practical value will depend on implementation.
Can caregivers reach someone when they have a question? Is it clear which concerns can be handled locally and which require referral? Do staff have enough capacity to support families alongside their other primary-care responsibilities? Can relevant information from hospitals reach the commune health station? Can caregivers receive follow-up rather than only one-time instruction?
These questions will matter as much as the guidance itself.
Measurement should ask whether support actually worked
If Viet Nam expands caregiver-support activities, measurement should go beyond counting how many people attended training.
Coverage matters, but it does not tell us whether support worked.
A local pilot might examine whether the caregiver understood the care plan, whether important skills could be demonstrated, whether medication changes were understood, whether the caregiver knew whom to contact, whether the support assumed in the care plan was actually available, whether follow-up occurred and whether the caregiver felt prepared and supported.
These are illustrative measurement questions, not a proposed standardized caregiver-readiness indicator set for Viet Nam.
The purpose is not to create another large dashboard. It is to answer a practical question:
Did we prepare and support the caregiver well enough for the care plan to work safely at home?
Caregiver strain or burden can also be measured, but it should not become the only outcome. The 2021 Vietnamese dementia study helps explain why: caregiving could simultaneously be experienced as demanding, disruptive and meaningful, while the language of “burden” did not necessarily reflect how caregivers themselves understood their responsibility.
A useful quality approach should therefore consider preparedness, confidence, well-being, access to help, financial or employment effects, opportunities for rest and whether the caregiver feels appropriately involved in decisions.
Caregiver support also needs an equity lens
Family caregiving is not distributed evenly.
WHO’s current long-term-care consultation draft explicitly recognizes gender and social-equity dimensions of unpaid care, while Vietnamese qualitative research has also shown that family obligation, gender and sibling order can shape who takes on dementia caregiving.
These findings should not be used to stereotype Vietnamese families. They should prompt practical questions.
If a care plan assumes that a daughter or daughter-in-law will be available, is that assumption realistic? What happens if the caregiver needs to reduce paid work? Are rural families able to access the same information and support as urban families? Can older caregivers themselves safely perform physically demanding tasks?
Equity means looking not only at whether a family exists, but at who is carrying the work and at what cost.
The caregiver should not become invisible infrastructure
Family caregivers will remain essential to older-person care in Viet Nam. The 2026 policy framework does not seek to replace them; it increasingly recognizes their role and begins to create formal support around them.
That is an important step. The next step is to avoid a system in which family caregivers become the invisible infrastructure holding fragmented care together.
If a hospital assumes the family will manage after discharge, the caregiver should be prepared. If a home-care plan depends on family support, the caregiver’s capacity should be understood. If the caregiver identifies a problem, there should be somewhere to escalate it. If care demands become unsustainable, the answer should not simply be that the family needs to try harder. Throughout this process, the older person’s goals, autonomy and dignity should remain at the center.
For Viet Nam, the most useful question is therefore not “How can families do more?”
It is:
“How can the health and care system make sure that when older-person care depends on a family caregiver, that caregiver is informed, prepared, supported and connected to professional help, without replacing the older person’s own voice?”
That is why caregiver readiness is not merely a family issue.
It is a quality, safety and implementation issue for the whole older-person care system.
References
National Assembly of Viet Nam. Law on Population No. 113/2025/QH15. 10 December 2025; effective 1 July 2026. THƯ VIỆN PHÁP LUẬT
Government of Viet Nam. Decree No. 168/2026/NĐ-CP detailing provisions and implementation measures of the Law on Population. 15 May 2026; effective 1 July 2026. THƯ VIỆN PHÁP LUẬT
Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026. THƯ VIỆN PHÁP LUẬT
Ministry of Health of Viet Nam. Circular No. 34/2026/TT-BYT guiding selected components of Phase I (2026–2030) of the National Target Program on Health Care, Population and Development 2026–2035. 8 September 2026. THƯ VIỆN PHÁP LUẬT
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