Travel Time Plays Key Role in Nursing Home Visitation Rates Amid Looming Closures

While the rate of visitation is known to play a crucial role in nursing home choice and offers positive benefits for residents and staff, this statistic has become even more significant in the face of potentially hundreds of nursing home closures.

Travel time, for one, plays a significant role in visit probability, and in turn nursing home choice, as facilities particularly in rural and underserved areas face closures. Residents and their families are sometimes separated 40-plus miles from each other as operators make the difficult choice to close their doors to the community.

More than two years years of a pandemic, ongoing workforce shortages and increased federal scrutiny without financial support have all been cited as contributors to such closures.

The Journal of the American Medical Directors Association (JAMDA) published a study in its July issue delving into the factors contributing to – and barriers of – visitation probability.

The time it takes to travel to and from the nursing home was found to have a “substantively and statistically significant negative association on visits for all age groups,” authors said.

There may be a tradeoff between the general “quality” of nursing homes and travel time as a result, authors said.

Family involvement in choosing a nursing home also had a high impact on visit probability, JAMDA authors noted. Relatives who were not very involved in choosing the nursing home weren’t likely to visit even if they lived close by, not to exceed 30% for the probability of a weekly visit.

Of all interviewees, 58% said they visited relatives in nursing homes at least weekly.

Administrators should consider adopting initiatives that “facilitate and empower” family involvement in nursing home choice, because of the connection between involvement and an increase in visitation.

Early family involvement also helps with better presentation of options at the outset, enhances partnerships with hospitals and social workers to make the best choice, and incorporates family and resident values when using Nursing Home Compare, authors said.

Given the “statistical and substantive importance” of family involvement in nursing home choice, JAMDA authors also suggested further studies be conducted to identify psychological factors at play – what makes families choose, or decline, to be involved in picking the nursing home.

Other “barriers” to visitation include transportation access, according to the study, along with psychological factors like feelings of guilt, the health of the visitor and resident and the employment or financial situation of the visitor.

When considering age and gender, authors said younger women were more likely to visit than young men.

JAMDA authors were quick to note that these barriers weren’t as significant as family involvement in nursing home choice and travel time.

Why focus on visitation?

The study found that increased visitation contributed to improved strategies for symptom management for residents, boosted social engagement and preserved a resident’s relationships.

Family involvement helps reduce staff burnout as well, along with improving overall quality of life for residents. Families may feel the need to supplement care provided by the nursing home when they visit, authors said.

Between 1997 and 2017, only 15 studies were conducted to examine why families and loved ones visited – or rarely visited – residents, according to another research article published in the Journal of Gerontological Social Work.

JAMDA authors said such studies were mostly qualitative in nature and didn’t have very large sample sizes – this study involved 4,350 relatives of long-term nursing home residents.

“Findings suggest barriers to family visitation and point toward a need for further research,” said Vivian Miller, author of the Journal of Gerontological Social Work article.

The study was conducted by researchers at the LaFollette School of Public Affairs, University of Wisconsin; Department of Medicine, David Geffen School of Medicine, University of California Los Angeles; and Department of Medicine, Division of General Internal Medicine, iTEQC Research Program, University of California Irvine.