The decision to place an individual with dementia in an institutional care facility is often one of the most difficult judgments made in families. The purpose of this study was to determine the key variables that affect the occurrence and timing of institutional placement for families caring for an individual with dementia. The results of this study indicated that the most salient variables affecting the occurrence and timing of institutional placement for persons with dementia were the caregivers' depression scores and the care recipients' behavior change scores over time. These results indicate the need to screen for behavior change in the person with dementia and symptoms of depression in the caregivers to help families predict the need for institutional placement.