Evidence is continuing to accumulate that family caregivers who experience increased stress and strain due to their participation in care activities arc more likely to have higher morbidity and mortality than caregivers who report little or no difficulty (e.g., Schulz & Beach. 1999). It also is becoming increasingly clear that a pivotal factor in making the decision to place a relative in an institutional setting is the caregiver's appraisal of his or her incapability to continue to provide high-quality care for a loved one in the family setting. As concerned caregivers continue periodically to wrestle with the dilemma of placement, they invariably must consider the delicate balance between their capabilities versus the ever-changing requirements for maintaining high-quality care. The decision to place comes when the balance between these two is eroded. It is clearly understood by researchers, practitioners, and policy makers alike that at the point in caregiving when this occurs, there is a monumental economic impact on both family and societal resources. Perhaps the two most important factors in this equation are perceived decline in their own health status along with increasingly demanding and complex health care and behavioral management requirements with regard to their care-receiver. Because stress and strain are proving to be important determinants of health status, efforts to alleviate these not only may improve quality of life in the family unit, but also may be extremely cost-effective in terms of economic resources by delaying or permanently avoiding institutionalization.
Against this backdrop, it is reasonable to consider any and all assistance programs that might serve this end. However, without careful scrutiny the endpoint of such reasoning could be wasteful “shotgun” intervention programs. It behooves interested professionals to expand their notions of what might be considered potential interventions and begin to implement evaluations of their efficacy and effectiveness in alleviating caregiver stress. Furthermore, as one considers the magnitude of factors that potentially aggravate the tasks of caregiving, one could ask if intervention programs at multiple levels (from the individual to the family system and even to the larger community) may operate symbiotically to enhance quality of life for caregivers or antagonistically to increase the burden and stresses confronting them. At the present time we have limited empirical data to address such questions, and even fewer models that