PATIENTS AND CARER PERSPECTIVES Nursing home care for older people in Taiwan: a process of forced choice Shu-Chen Wu, Alan White, Keith Cash and Sally Foster Aim. To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. Background. Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio-economic changes, has resulted in nursing homes becoming a new and significant care option. Design. A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. Methods. Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. Results. The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, ‘becoming a problem’, ‘making a forced choice’ and ‘coping with the forced choice’. Conclusion. Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. Relevance to clinical practice. This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people. Key words: family care, long-term care, nursing home, older people, Taiwan Accepted for publication: 6 September 2008 Background According to Confucius, there are five main ethical codes relating to the five main relationships found in Chinese society: filial piety (to parents), loyalty (to state), respect (for wife), fraternity (with brothers and sisters) and trustworthi- ness (towards friends) (Baker 1979). Of all the Chinese virtues, filial piety is the most important and widely recog- nised, concerning the relationship between parents and children. This can be seen from Confucius’ teaching, who said that ‘the root of the empire is in the State, the root of the State is in the family and the root of the family is in the individual. For an individual, filial piety was the root of all virtues’ (Liou 2002). Therefore, older people in Taiwan, as a Authors: Shu-Chen Wu, PhD, RPN, Assistant Professor, Department of Nursing, Tzu-Chi College of Technology, Hualien, Taiwan; Alan White, BSc (Hons), MSc, PhD, RN, Cert Ed, Professor of Men’s Health, Faculty of Health, Leeds Metropolitan University, Leeds, UK; Keith Cash, PhD, Professor of Nursing, School of Nursing, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Sally Foster, MSc, Senior Lecturer, Faculty of Health, Leeds Metropolitan University, Leeds, UK Correspondence: Shu-Chen Wu, Assistant Professor, Department of Nursing, Tzu-Chi College of Technology, Hualien 97007, Taiwan. Telephone: 886 3857 2158. E-mail: angela5717@yahoo.co.uk 1986 Ó 2009 The Authors. Journal compilation Ó 2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 1986–1993 doi: 10.1111/j.1365-2702.2008.02697.x