Friedman and Kaye (1980) reported that one fifth of service plans were rejected and disrupted when family members, other than the care recipient, were not included in the decision-making process. It is possible that the receipt of formal services means different things to the caregiver and care recipient. The care recipient may view such services as unnecessary and may feel overprotected, leading them to resist the help (Pearlin et al., 1990), whereas the caregiver may perceive the extra help as a way to lower strain. This may, in turn, lead them to perceive the care recipient’s impairment quite differently.