Does Geographic Distance Affect Family Perceptions of Quality Care?

Consumer research suggests that location and quality of care are the most important factors for families choosing a nursing home (NH). In particular, families generally want to find a homelike, person-centered environment for residents, including collaboration and communication between staff, residents, and their families. How might geographical distance, which can impact the frequency with which families can visit their loved ones and communicate with staff, affect family perceptions of nursing homes?

Researchers drew data from a longitudinal study on 10 Dallas-area NHs collected between 2002 and 2006. The researchers sent questionnaires to 977 family members or significant others of residents at the homes, receiving responses about perceptions of care and demographic characteristics from 586 (or around 60 percent) of those solicited. The researchers then conducted statistical analyses to examine the effect of family distance on perceptions of NH quality of care and of contact between residents and their families.

Most family members lived within 50 miles of the NH; this segment reported that they visited about once per week, and overall had a positive perception about the quality of resident care. As expected, family distance from the NH reduced the frequency of contact with residents and staff. Overall, distance did not have a specific relationship to families’ perception of care quality. However, quality was perceived to be higher for NHs that were perceived as providing a homelike environment for residents.

Also, family members who believed that staff supported the independence of residents had a high perception of NH quality, and this association between perceived independence and quality was positively associated with frequency of contact. In other words, it appeared that family members who saw NH staff encourage independence and choice among residents had a higher perception of overall quality of care.


Dillman JL, Yeatts DE, and Cready CM. Geographic distance, contact and family perceptions of quality nursing home care. Journal of Clinical Nursing (2013); 22:1179–1782.

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