As the primary caregivers for the millions afflicted with Alzheimer's disease, family members have been the focus of research for the past two decades. Differences in care patterns and deleterious effects of care provision have been clearly established. However, similar demands and hardships associated with care-giving result in different consequences for different families. A greater understanding of the care-giving context and its determinants will enhance knowledge of the differential impacts of care-giving. The most critical determinant of care-giving context is the role relationship between the caregiver and the care recipient. Future research must address role relationship as the primary determinant of what care is provided by whom, and in what manner. This will enhance the understanding of specific caregiver outcomes and lead to optimal targeting of interventions. Future research must also focus on the interface between the family and other social institutions. Evidence calls into question the equity, quality, and capacity of the current system of care, which assumes that family care is best. It will be important for future studies to explore alternate options for long-term care policy. Families and patients will also benefit from studies that assess strategies to ensure an adequate labor pool of qualified formal caregivers.