For nurses to work effectively with families faced with making a nursing home placement decision, they need to understand cultural issues of the patients and their caregivers. 2. Caregivers spend more time with other family members and in social activities following the elder's placement in a nursing home and also have improved relationships with the elder. 3. Few differences were observed between the African-American and European-American caregivers. Decisions appear to be similar regardless of cultural norms.