The aims of the present study were: (1) to describe family members' perceptions of nursing homes residents' pain and distress in relation to analgesics and psychotropic drugs; and (2) to compare whether background variables, dementia, help/support, prescribing of analgesics and psychotropic drugs, and quality of care vary between subgroups of residents. Two hundred and thirty-two family members of elderly people in 10 Swedish nursing homes participated in the study. The participants responded to a questionnaire including background variables, pain and distress variables, and the Quality from the Patient's Perspective (QPP) questionnaire. Data on drug prescribing was obtained from the medical records. The head nurse on each ward noted whether or not the resident had a documented or known diagnosis of dementia. The results showed that a high frequency of elderly nursing home residents were estimated as having physical pain and worry. A large number of the residents were prescribed psychotropic drugs. In addition, some of the residents with moderate or severe physical pain were not prescribed any analgesics. The residents were divided into three subgroups based on scores of physical discomfort, physical pain and worry. Subgroup comparisons differed with regard to sex, help/support, drugs and quality of care. Staff have a responsibility to assess the residents' pain and distress since this will form a basis for better pain and distress management. Other suggestions for improving quality of care are the provision of better information to the family members and the residents, meaningful occupation, less task-oriented care, and care that involves residents.