In July, La Follette School Professor David L. Weimer contributed to an article in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA) that analyzes factors affecting the likelihood that family members will visit relatives in nursing homes. We asked Weimer, a nationally recognized expert on benefit-cost analysis, to tell us about the project.
What made you interested in trying to predict who visits their relatives in nursing homes?
Over the last ten years, I have been doing research on the quality of nursing homes with Dana Mukamel, a professor at University of California, Irvine. We were joined in this project by Dr. Debra Saliba (UCLA) and Heather Ladd (University of California, Irvine). Our primary objective was to explore alternative ways of developing composite scores for nursing home quality. One of the methods we considered was using survey experiments, called contingent valuations, to assess the relative weights respondents put on different nursing home qualities. Rather than ask respondents to make tradeoffs between quality and money, we asked them to make tradeoffs between quality and travel time. In support of this effort, we asked respondents about the actual time it took to visit their relatives and the frequency of their visits. As considerable research has found that the frequency of visits supports higher quality of care, it was natural also to use our data to assess the factors that predict the frequency of visiting.
What did you learn?
We found that three factors were most important in predicting who would visit their family members in long-term care homes at least weekly. First, the time it takes to travel to the nursing home is very important — people living closer to the nursing home are more likely to visit. Second, the greater the involvement of family members in the selection of the nursing home, the more likely they are to visit frequently. Third, the impacts of these factors differ across age groups. Other things equal, older people are more likely to visit more frequently and are less sensitive to longer travel times.
Can you explain a little about the concept of involvement and how it affects people’s choices to visit relatives in nursing homes?
Our survey did not ask people directly about their psychological attachment to their relatives in nursing homes because we were skeptical about responses to questions about their love of their family members or their sense of responsibility for their care. Rather, we asked about how involved they were in selecting the current nursing home where the family member resides. We interpreted involvement as a proxy for psychological commitment. This raised some statistical issues that made the analysis more interesting for us as researchers.
What might nursing home directors do differently to help encourage people to visit their relatives?
Anyone advising people about choosing a nursing home should keep in mind the importance of shorter travel time in encouraging more frequent visits, which in turn contributes to the quality of care. Directors of nursing homes who are located far from likely visitors might contribute to better outcomes by encouraging family members to consider nursing homes closer to where they live. Also, by engaging with as many family members as possible during the selection of their nursing homes, nursing home directors may contribute to more frequent visiting
Anything else you’d like to share?
Our team enjoyed working together on this project!
Want to learn more? Read the complete article, “Who Visits Relatives in Nursing Homes? Predictors of at Least Weekly Visiting.”