Grounded theory served to develop a model of the family caregiver decision-making process regarding placement of a cognitively impaired elderly relative. Eighteen caregivers were interviewed every 6 months over an average 20 months. Results show the process is activated when the caregiver or a health care professional introduces the possibility of placement. The caregiver's assessment of the pros and cons of placement is modulated primarily by interactions with the formal and informal social network. Three types of longitudinal trajectory emerged from the data suggesting avenues of intervention to support caregivers during this painful process.