Recent decades have seen a substantial policy shift in the balance of care provided between nursing homes, hostels and community care under the Aged Care Reform Strategy (Mid-Term Review 1991), with admission to residential care becoming more controlled to prevent premature and unnecessary admission. There has also been an emphasis on community care of younger people (adults and children) with disabilities; integration and deinstitutionalisation policies apply in all disability sectors providing intellectual, sensory, physical and psychiatric services. 1
While these policies do address the rights and quality of life of people with disabilities, even where family carers are available, serious impairment and the innate stresses of caregiving may mean that residential placement becomes inevitable. The longitudinal nature of our study enabled us to profile carers with a relative already in residential care and take a prospective view of the factors affecting residential placement.
Previous studies have identified significant factors in the decision to use residential care. Factors associated with the care-recipient (older age, 2 cognitive impairment 3 and physical and instrumental dependencies 4) have been commonly identified as reasons for institutional placement. Specific problems associated with disability (wandering, forgetfulness and incontinence 5) have been isolated as key predictors.
In terms of the carer, offspring carers 6 and carers not living with