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family involvement, family visitation, use of proxy



  1. Port, Cynthia L.
  2. Hebel, J. Richard
  3. Gruber-Baldini, Ann L.
  4. Baumgarten, Mona
  5. Burton, Lynda
  6. Zimmerman, Sheryl
  7. Magaziner, Jay


Background: The involvement of family and friends in nursing home care represents an important resource for an overburdened long-term care system. However, little guidance exists for researchers interested in measuring family involvement.


Objectives: This methodological report provides an overview of approaches to measuring family involvement in nursing home care and examines agreement between family and staff on the frequency of visits and telephone calls to a resident by family and friends. Agreement is also assessed for subgroups of the sample based on characteristics of the family, staff, facility, and resident.


Methods: From a large and representative sample of nursing home residents, 823 pairs of significant others and staff were interviewed. Primary variables were reports of visitation and telephone contact received by the resident in the preceding 2 weeks according to the significant other and staff person.


Results: Significant other reports of visitation and telephone contact were significantly higher than staff reports (p < .001 and p < .01). Agreement (via intraclass correlation) between significant others and staff was moderate for reports of visit and telephone call frequency. With one exception, no significant differences in agreement were found between subgroups defined by characteristics of the family, staff, facility, or resident. For visits, agreement between nurse's aides and significant others was lower than between other staff persons (e.g., LPNs and RNs) and significant others (p < .05).


Discussion: Due to the complexity of nursing home settings as well as of the social support system of residents, researchers need to carefully consider their approach to the measurement of the involvement of family and friends in the nursing home.