Family migrant care workers’ workplace must be the family home. However, their appearance in nursing homes is becoming common. Using institutional ethnography as my research approach, I observed the daily care schedule of care workers (both Taiwanese and foreign) and interviewed institutional managers and their care workers, as well as family members serving as caregivers with and without hired in-home foreign care workers. The texts for Taiwan’s nursing home system were also collected to discover how they make for the imbalance between space and care needs, and also why nursing homes, even those very near hospitals, require family caregivers to take clients to rehabilitation and other medical appointments. The truth is that from the hospital to the nursing home, the family has to assume all care responsibility, and when the family can’t handle said responsibility, hiring a foreign care worker is the only alternative. This study’s analysis shows multiple silhouettes of the ruling relations in a nursing home as well as their influences on the disjuncture experiences and institutional actions. One major finding of this study is how institutional managers distribute their care workers according to the number and placement of family-hired foreign care workers stationed in nursing homes, in effect balancing care needs and staff ratio. In addition, although it seems that a seamless care system is in place, the real issues behind the system have yet been illuminated.