Objective: To examine the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization. Method: Medicare administrative data for beneficiaries residing in a nursing home between July 2007 and June 2009 were used in multivariate analyses controlling for beneficiary, nursing home, and market characteristics to assess the association between two measures—percentage of months with a PCP visit and whether the patient maintained the same usual source of care after nursing home admission—and hospital admissions and ER visits for all causes and for ambulatory care sensitive conditions (ACSCs). Results: Both measures of strength of patient–provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ACSC ER visits. Discussion: Policy makers should consider increasing the strength of nursing home resident and PCP relationships as one strategy for reducing inpatient and ER utilization.