Understanding the role of informal caregiving in preventing or delaying nursing home entry among chronically disabled elders is increasingly important for policy. Continued aging of the population and other demographic shifts are likely to increase the caregiving burden for a smaller number of caregivers per elder in the coming decades. The success of state and federal policies to prevent or defer admission to nursing facilities or help nursing facility residents return to the community will depend in part on the willingness and ability of informal caregivers to maintain disabled elders in their homes. In this study, we examine how informal care, paid formal care, and stress or burden experienced by caregivers relates to nursing home placement. We use data from the 1999 National Long Term Care Survey and its companion Informal Caregiver Survey merged with Minimum Data Set and other external data and instrumental variables estimation methods to estimate nursing home entry. We also estimate a richer probit model to explore the factors associated with high caregiver stress. We find that stress is a strong predictor of entry over follow-up periods of up to two years, and that caregiving-related physical strain and financial hardship and recipient behavior problems are important predictors of high levels of caregiver stress. Reducing important stress factors such as physical strain and financial hardship would significantly reduce caregiver stress and, as a result, nursing home entry. Our analysis provides support for initiatives to reduce caregiver stress as a strategy to avoid or defer nursing home entry and to underpin current efforts to return nursing home residents to community-based care.
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