Staff nurses and family caregivers of hospitalized elderly patients (> or = age 70) play crucial roles in the health care and recovery of patients. This exploratory study identified and compared nurse and family caregiver perceptions about the patient's health condition, needs to stay healthy, and problems in self-care at admission and discharge. Agreement between nurse and caregiver reports at both time points was assessed. Overall, findings confirmed a lack of agreement between nurses and family caregivers. At both time points, fewer nurses than caregivers focused on disease in describing the patients' health condition, and there was low agreement about diseases when mentioned. Although the great majority of nurses and caregivers reported one or more patient needs to stay healthy, and problems with self-care, there was little agreement about specific needs or problems mentioned at either time point. Findings may be attributed, in part, to current limitations on staff nurses' bedside time or insufficient opportunities, skills, or both to communicate with families about patients as part of comprehensive discharge planning. Organizational factors in large tertiary care hospitals may serve as a deterrent to nurse-family caregiver contact and communication during hospitalization.