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...

This study explored predictors of willingness to use a nursing home in Korean American elders. Andersen's behavioral health model was adapted with predisposing factors (age, gender, education, length of residence in the United States), potential health needs (chronic condition, functional disability, self-perceived health), and network-related enabling factors (marital status and living arrangement, family network, having someone close living in a nursing home). Among 427 participants, 45% reported their willingness to use a nursing home. Logistic regression analysis showed that the likelihood of willingness increased when individuals had poorer perceived health and had a close other living in a nursing home. Findings indicate that (a) self-perceived health serves as a proxy for future needs for long-term care services, and (b) indirect exposure to formal care is an important enabler for more acceptance of nursing home use. Implications of the findings and further directions for research are discussed.

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

We examined the psychopharmacological services provided within 3 months of nursing home (NH) admission to a whole population of newly admitted Florida NH residents 65 years and older (N = 947) for a 1-year period via secondary analyses of selected variables from Medicaid and the Online Survey and Certification and Reporting System. Within 3 months of admission, 12% received nonpsychopharmacological mental health care. However, 71% of new residents received at least one psychoactive medication, and more than 15% were taking four or more psychoactive medications. Most of those being treated with psychoactive medication had not received psychopharmacological treatment 6 months prior to admission (64%) and had not received a psychiatric diagnosis 6 months preceding admission (71%). Blacks were less likely to receive medications than non-Hispanic Whites. Results expand on past research by identifying an increase in the amount of psychoactive medications prescribed to NH residents, a lack of prior psychiatric treatment and diagnoses for those currently receiving psychoactive medications, only limited provision of nonpsychopharmacological mental health care, and racial or ethnic differences in the use of medications by NHs.