Useful services for families: Research findings and directions

A major tenet of gerontological practice and policy has been that community -based services relieve stress on family caregivers and delay or prevent in stitutionalization of frail elders. Evidence for benefits of community-base d services is examined from four perspectives: (1) relief for family caregi vers; (2) benefits to older clients; (3) delay or prevention of institution alization; and (4) cost-effectiveness or cost-benefits of a service. Studie s are grouped according to the type of service (in-home respite, adult day care, overnight respite, case management and multicomponent programs) and t ype of clients (dementia only or mixed). There are surprisingly few empiric al studies overall and the reported benefits typically are modest. Methodol ogical problems as well as providing relatively small amounts of service ma y have accounted for these findings. Studies in which clients and;or their families received adequate amounts of help showed more consistently positiv e outcomes. There is little evidence, however, to suggest that community se rvices delay placement. More needs to be done to examine the benefits of in novative programs, and particularly to incorporate the dementia patient's p erspective into these evaluations. Copyright (C) 1999 John Wiley & Sons, Lt d.