Families of nursing home residents often perceive the care provided by the nursing home staff to be inadequate or inappropriate. Consequently, conflicts and misunderstandings frequently arise between staff and family members. A study was conducted in two midwestern nursing homes which investigated the perceptions of family and staff about the care provided to nursing home residents. The study used a grounded dimensional analysis (grounded theory) involving extensive interviews with 60 family members and 25 nurses at two facilities. Results indicated that family members often perceived themselves as ultimately responsible for making decisions about care and evaluating the effectiveness and appropriateness of care. In contrast, professional staff perceived themselves as ultimately responsible. These differences in attribution of responsibility were found to be based on the incompatability of definitions of expertise. Families perceived expertise in caring for the elderly to be based on personal, biographical experience with a particular resident. More general theories of aging were seen by families as having very little credibility. Staff generally perceived expertise as being based on more formal knowledge gained from a general knowledge of aging and disease process. These differences in source of expertise and responsibility attribution were reflected in what staff labeled family interference with care and what families labeled poor care. A three-page bibliography concludes the document. (NB)