Is the Doctor In? The Physician’s Role in Long-Term Care

My Elder discusses the facts about physician services in nursing homes

 

The physician who takes care of the resident in a nursing home is called the attending physician. The attending physician, or alternate, must be available to respond promptly to reported acute medical problems and other significant changes in the resident’s clinical condition. He plays a key role in elder care in nursing homes.

Your loved one may keep his or her own family doctor upon entering a nursing home if that physician is willing to provide care in the nursing home and agrees to abide by the nursing home’s rules and regulations. If your loved one’s private physician does not provide care in the nursing home, and many do not, the nursing home can tell you which physicians visit the home regularly. You or your loved one can choose to use one of these doctors or find another physician who will agree to provide care in the nursing home.

The Physician’s responsibilities:

1. Examining the resident on admission and again within the first 30 days

2. Visiting the resident every 30 days thereafter

       – If a nurse practitioner or physician’s assistant makes the interim visits on behalf of the physician, the attending physician must approve the overall care plan. The attending physician must visit the resident at least every 120 days.

4. Writing orders for medications, treatments and the appropriate diet

5. Prescribing over-the-counter medications

6. Gathering information about the resident’s medical history

7. Providing information to help establish an appropriate level of care

Unfortunately, many physicians choose not to practice in nursing homes. One barrier is the public image of the nursing home as a place of last resort with not much hope for positive outcomes and progression of health. Second, the “magnetism” of the acute care world attracts medical students, residents, and attending physicians to hospitals and specialty practices. Third, the paucity of training in geriatric medicine during medical school and residency, and worsening shortage of geriatricians discourages physicians from entering geriatrics. Fourth, the lack of specialists willing to visit nursing home residents often requires  nursing home attending physicians to extend their scope of practice beyond their ordinary hospital or office practice. There are no regulatory limitations on consultations, but few specialists visit  nursing home residents, who must be transported to consultants’ offices.

Fifth is a financial disincentive: Medicare does not reimburse physicians for coordinating services or providing interdisciplinary care across settings. Nursing home physicians spend time traveling between facilities, practicing telephone medicine and managing paper flow without reimbursement. Finally, high liability risk is generated by the fact that most long-term care  nursing home residents die in the nursing home, with the potential for “wrongful death” claims. And the problem of persistent under-funding of  nursing home care can limit services. 

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The resident and family members may call the attending physician directly, but the nursing staff usually makes contact with the doctor to discuss a change in condition, the need for medication or the like. The name and phone number of each resident’s doctor must be placed at the bedside table or another easily accessible place in the room.

With all that goes on a daily basis in a nursing home, most families will admit that they don’t even know the name of the attending physician taking care of their loved one. If you compare a nursing home to an orchestra, the attending physician is the conductor. His responsibility is to coordinate the work that is required of all other professional disciplines. In the real world, people go to see a particular orchestra because of the conductor. They could probably not give you the name of an orchestra member.

In accordance with Federal and State Law, attending physicians should lead the clinical decision-making for patients under their care. They can provide a high level of knowledge, skill, and experience needed in caring for a medically complex population in a climate of high public expectations and stringent regulatory requirements. Of all the important services in a nursing home, physician services are the most important. If you can’t get a handle on these services you better run and get an advocate that can.

All nursing homes are also required by law to have a Medical Director who is supposed to coordinate the care rendered by facility physicians.

What you MUST do:

1. Know the attending physician’s name, address, phone number, and office hours.

2. Know the same about the Medical Director. He spends a certain amount of time at the facility.

3. If your loved one is getting poor elder care, speak to the physician and the medical director. They are accountable.

4. Call MyElder® to support your needs. An elder advocate will help make sure that your loved one gets proper elder care services and prevent neglect and elder abuse.

My Elder provides elder advocacy services to families. Talk to us about long-term planning, finding the right home for your loved ones, preventing crisis and abuse, and ensuring they receive the best care possible.

Photo Credits Matt Briney