The purpose of this study was to identify stressors associated with family caregiving following entry into the nursing home of the care recipient. A cross-sectional, survey design included 129 family caregivers for care recipients located in sixteen long-term care facilities in north central Texas and Southern Oklahoma. Consistent with prior research stress related to the caregiving role did not end with the care recipient’s entry into the nursing home. Utilizing a conceptual model of stress proliferation, caregiver characteristics, role captivity, constriction of participation in family activities, family conflict and work-caregiving conflict are examined in relation to perceived stress.

Multiple linear regression with forward entry indicated role captivity accounted for the majority of explained variance in perceived stress by family caregivers, followed by constriction of time for participating in family activities, caregiver income and family conflict. Caregiver uplifts (positive beliefs about oneself as a caregiver and personal growth attributed to the caregiving role) originally thought to mediate perceived stress, were eliminated from analysis as almost 100% of participants indicated a high levels of caregiver uplifts. Contextual factors examined included dual caregiving responsibilities, length of time in the caregiving role, visitation schedule and reason for placement. While these variables did not contribute to the model for perceived stress, they do offer insight into the multiple issues faced by family caregivers of loved ones who are in a long term are facility. Family caregivers identified the activities of caring in which they participated following nursing home entry, and if they felt this to be a hassle.

Understanding the multiple and complex ways family caregivers provide support to the care recipient, while at the same time recognizing the unique stressors they face as a consequence of this role provides a challenge for professionals along the continuum of healthcare. Specifically, social workers need to cultivate a knowledge base and skills that support family caregivers throughout the process of institutional care for their loved one.