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 institutionalization of frail elders. Evidence for benefits of community-based services is examined from four perspectives: (1) relief for family caregivers; (2) benefits to older clients; (3) delay or prevention of institutionalization; and (4) cost-effectiveness or cost-benefits of a service. Studies are grouped according to the type of service (in-home respite, adult day care, overnight respite, case management and multicomponent programs) and type of clients (dementia only or mixed). There are surprisingly few empirical studies overall and the reported benefits typically are modest. Methodological problems as well as providing relatively small amounts of service may have accounted for these findings. Studies in which clients and/or their families received adequate amounts of help showed more consistently positive outcomes. There is little evidence, however, to suggest that community services delay placement. More needs to be done to examine the benefits of innovative programs, and particularly to incorporate the dementia patient's perspective into these evaluations.