Caregivers' Reasons for Nursing Home Placement: Clues for Improving Discussions With Families Prior to the Transition

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Abstract
Purpose: This study identifies the relative importance of reasons for institutionalization endorsed by caregivers of patients with dementia; examines the relationship between caregivers' reasons for institutionalization and indicators of caregiver and patient physical and emotional functioning measured in the prior year; and compares, on these indicators, caregivers who institutionalized their care recipients with caregivers who did not. Design and Methods: Participants were 2,200 caregivers from the National Longitudinal Caregiver Study, including 580 who institutionalized their care recipient during the 3-year interval. Caregivers' reason(s) for institutionalization were examined and correlated with indicators of caregiver and patient physical and emotional functioning. These indicators were used in a proportional hazards model to determine independent predictors. Results: Caregivers' reasons for placement included (a) the need for more skilled care (65%); (b) the caregivers' health (49%); (c) the patients' dementia-related behaviors (46%); and (d) the need for more assistance (23%). Each of these reasons was significantly associated with indicators in the prior year's survey. This study uniquely demonstrates that caregiving task demand and a single-item measure of caregiver life satisfaction significantly predict placement. Implications: These findings emphasize that caregivers' reasons have valid underpinnings and that institutionalization of dementia patients results from caregiver and patient factors evident in the year prior to placement. In routine office visits, caregivers should be systematically screened; accounts of low life satisfaction, dementia problem behaviors, or high task demand should cue clinicians that discussions of nursing home placement would be timely and appropriate.