Wives and daughters: the differential role of day care use in the nursing home placement of cognitively impaired family members.

PURPOSE To expand knowledge concerning the significance 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 well-being, 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 significant 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 influence 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 influencing 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.