Wives and Daughters: The Differential Role of Day Care Use in the Nursing Home Placement of Cognitively Impaired Family Members

Abstract

Purpose: To expand knowledge concerning the signifi cance of kin relationships in caregiving, this study assessed predictors of the timing of institutionalization for persons with dementia. The focus was on whether use of adult day care by wives and daughters holds the same implications for placement. Design and Methods: Guided by a caregiving stress process model, primary objective and subjective stressors, secondary stressors, caregiver wellbeing, and use of day care services were included as predictors. Cox proportional hazards models were tested using a sample of 371 community-dwelling caregivers, including 141 wives and 230 daughters and daughters-in-law. Results: The main effect of kinship was found to be signifi cant before interactions were introduced. Adult day care use at Time 1, role captivity, role overload, and social impact were subsequently found to interact with kinship. Analyses indicated that wives who used adult day care placed their husbands to a nursing home earlier than their counterparts. Among daughters, however, those who used adult day care were more likely to postpone the placement. The infl uence of role overload was also stronger in wives than in daughters in predicting the timing of placement. A similar pattern was observed in the interaction between social impact and kinship. Implications: The results demonstrate that factors infl uencing nursing home placement may vary according to the caregiver's familial relationship to the relative. Different approaches may be needed when targeting wife vs. daughter caregivers, especially when designing adult day care programs. Key Words: Predictors of nursing home placement , Spouse caregivers , Cognitively impaired elders , DementiaOne of the major challenges faced by family caregivers of elders with disability is the decision to institutionalize. Although placement is diffi cult for most caregivers, the meaning of institutionalization is likely to be different, depending on the kin relationship between caregiver and care receiver. The two most common groups of caregivers, wives and daughters, have very different relationships and obligations, and may differ as well in the resources they have available for providing care and in other demands on their time. Although one of the goals of respite programs such as adult day care services (ADSs) is to delay institutional placement, little is known about how kin relationship might affect its timing. At the program level and from a broader policy perspective, understanding how factors such as kin relationship might affect the placement decision may lead to development of better targeted services that could delay, where appropriate, the use of more expensive institutional care. The present study examines whether kin relationship affects the timing of nursing home placement for caregivers who enroll a relative into an ADS program compared with caregivers not using ADS.Studies of predictors of nursing home placement have generally found that persons with dementia who have more functional limitations, mo...

Health Trajectories of Family Caregivers

“…One of the outcomes most often associated with ADS use is the timing of institutionalization. In particular, ADS use was found to delay placement of IWDs for adult daughter caregivers, though not spouses (Cho, Zarit, & Chiriboga, 2009; Gaugler & Zarit, 2001). …”

Exploring the benefits of respite services to family caregivers: methodological issues and current findings

“…Differences between groups in characteristics such as gender, kin relationship (adult child versus spouse), socioeconomic status or employment status all have implications for the caregiver’s experience and could affect recruitment, retention and outcomes. For example, compared to daughters, caregivers who are wives who use ADS have provided care for a longer period before starting ADS use and show less improvement in subjective stress and positive emotion (Cho, Zarit, & Chiriboga, 2009; Kim, Zarit, Femia, & Savla, 2012). Likewise, characteristics of the person receiving care, such as type of disability or willingness to use services, can affect caregivers’ outcomes.…”

“…Additionally, adult day care use delayed institutional placement for daughters who were caring for a parent, but not for wives caring for a husband (Cho et al, 2009). …”

The influence of day care centres for people with dementia on family caregivers: an integrative review of the literature

“…4) DCCs increase motivation for care and postponement of the need for residential care as they offer information and support regarding dementia-related topics, with the intention to reduce care-related stress [5,8,11,25,28,31,32]. Support for family caregivers aims to develop knowledge and skills in dementia care and prevent the risk of early institutional placement [11,33].…”