Family members face a variety of challenges when placing a cognitively impaired relative in a nursing home. However, few studies have determined how stressors and psychological well-being prior to placement influence the institutionalization experience for caregivers. In this article, the authors hypothesize that stress and negative mental health before institutionalization will have a significant effect on variables that reflect caregivers' postplacement involvement, including satisfaction with the nursing home environment, weekly visits, and problems with staff. Primary caregivers (N = 185) were assessed prior to and after the institutionalization of a cognitively impaired elderly relative. A multivariate regression found that several preplacement stressors (behavior problems, activities of daily living dependencies, role captivity), depression, and socioemotional support were predictive of nursing home involvement. As these results suggest, the stress process has important implications for caregivers throughout the nursing home transition.