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The informal care networks of 242 impaired older people were examined in terms of the primary caregiver and secondary helpers. Most primary caregivers had at least one secondary helper; 88% identified helpers who provided hands-on help, 19% reported that helpers contributed financially, and 44% had helpers involved in care decisions. The size of the network was larger for direct care compared to financial or decision-making assistance. Almost half of primary caregivers reported that their spouse helped. It was expected that after controlling for characteristics of the primary caregiver and of the older person, that characteristics of the secondary caregiver network would influence the amount and type of primary caregiver assistance and formal care used by the older person. However, both hours and type of care by the primary caregiver were independent of size, scope, and composition of the secondary helper network. This independence suggests that efforts to alter the secondary caregiver network may have limited effects on the primary caregiver.

This paper examines the three-way relationships among patient characteristics, type of care (admission to a nursing home or community setting), and 6-month outcomes of 352 long-term care patients. The study found that patient characteristics influenced the type of care received and that substantial portions of the variance in the outcomes were attributable to initial differences among patients in the two types of care. Controlling for the effect of selective admission, type of care had no significant impact on patients' ADL scores, mobility scores, or disposition after 6 months in the long-term care setting.

This study tested the effects on physical functioning of substituting adult foster care (AFC) for nursing home care. Secondary data from Oregon's Medicaid agency were used to compare change in ADL functioning of 1,032 nursing home and 279 AFC residents. Maximum likelihood estimation was used to analyze selection of long-term care setting and change in functioning. One-third of surviving AFC residents would have been better off in a nursing home, whereas almost all nursing home residents were placed appropriately. Further research on outcomes that clients value most along with efforts to support functioning are needed.