Studies have focused on the effects of caring for a family member on the caregiver. Studies also have focused on the response of caregivers to the death of the care recipient. But little is known of the impact on the caregiver of the transition of a care recipient from home to an institution. In this situation, the caregiver continues in the caregiving role. Schulz and colleagues sought to determine the conditions that lead to placement, the interaction of the caregiver with the care recipient and the care recipient’s environment after placement, and the effect of these factors on the caregiver’s health after the transition has taken place.

The study draws its information from data collected in the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) study, which included 1,222 caregiver–care recipient pairs at multiple sites. In addition to collecting survey data, the study randomized pairs to a social/behavioral intervention or to usual care. Although the treatment group did better in this aspect of the trial, this result was not relevant to the findings in the present analysis. Recipient cognitive and physical functioning and health were assessed, as were caregiver burden, mental health, and satisfaction with help from family and friends. Information also was collected on the frequency of visits to the recipient’s facility, satisfaction with the facility, and the kind of help the recipient continued to provide.

Of the 1,222 caregiver and recipient pairs, 180 institutionalized their relative, with those reporting greater caregiver burden being more likely to take this step and those reporting greater satisfaction with their caregiver role being less likely to do so. Less severely demented patients and black and Hispanic patients were more likely to stay in the home. Almost all caregivers visited their relative in the institution at least once per week, more than one half of them helped with physical patient care, and almost one half were very satisfied with various aspects of the facility.

Indicators of depression did not change with placement after a median 12-week postplacement time. Depression and anxiety tended to be higher in caregivers who visited at least daily and who were less satisfied with help from others. A longer period of follow-up revealed no significant difference in caregiver depression after institutionalization, although there was less anxiety. No predictors of change in depression or anxiety were identified. Of note, postplacement satisfaction with social activities and the percentage of caregivers who were satisfied with the help they received from others did increase after placement.

Ethnicity, caregiver burden, and degree of dementia predicted institutionalization in this study. Caregiver burden was greater for spouses than for nonspouses. Interestingly, caregivers have a decrease in depression after the death of a relative for whom they have been caring. In this study, institutional placement did not have a similarly positive effect. On the contrary, the degree of depression and anxiety in the caregiver was relatively unchanged when the relative was institutionalized. The authors speculate that this lack of improvement may be related to the continued demands of visiting the facility and taking on new managerial responsibilities, as well as the emotional demands of witnessing the often more rapid decline of the institutionalized relative, and dealing with feelings of guilt.