Explaining the use and non-use of community-based long-term care services by caregivers of persons with dementia

The purpose of this paper is to synthesize and critically evaluate the curr ent literature that explains the use and non-use of formal community-based long-term care services by caregivers of persons with dementia. There are f our issues related to formal community service use by caregivers: reluctanc e to initiate formal services; under-utilization of available services; del ayed utilization of services; and inappropriate utilization of services. De spite substantial research efforts to understand these issues, the reasons for low rates of community service use by this population remains unclear. Common methodological problems and limitations in the underlying theoretica l assumptions in the literature, as they relate to caregivers of persons wi th dementia, have, limited the usefulness of the current research for infor ming practice and policy. A conflict-theory model of decision-making is pro posed as an alternative theoretical framework for understanding the particu larity and complexity of the decision-making process leading up to the init iation of formal service use. Utilization of formal services is a result of a complex and subjective decision-making process that is unrelated to obje ctive circumstances. The proposed conflict theory model of decisionmaking c an inform policy and practice regarding the development of appropriate, tim ely and individualized interventions to facilitate the use of formal servic es by caregivers of persons with dementia.