geriatrics
Skilled Nursing Facilities
Supervision of care
Physicians must complete the initial admission of residents to a nursing home. Then they may delegate routine follow-up of residents to a nurse practitioner or physician assistant, who alternate with the physician in visiting residents. Visits must be done as often as medically necessary but not less than every 30 days for the first 90 days and at least once every 60 days thereafter; however, some states require a minimum of one visit every 30 days. For long-term care patients, nurse practitioners may provide independent care of the residents (patients) depending on whether their state allows independent practice. During routine visits, patients should be examined, drug status assessed, and laboratory tests ordered as needed. Findings must be documented in the patient’s chart to keep other staff members informed. Some physicians, nurse practitioners, and physician assistants limit their practice to nursing homes. They are available to participate in team activities and staff education and to consult with other staff members, thus promoting better care than that given in hurried visits every other month. Some nurse practitioners and physicians collaborate to manage patients’ disorders. By administering antibiotics when appropriate and monitoring IV lines, suctioning equipment, and sometimes ventilators, nurse practitioners may help prevent patients from being hospitalized. Many physicians work closely with a nurse practitioner or a physician assistant to provide team-based care. Detecting and preventing Elder Abuse is also a function of physicians, nurses, and other health care practitioners. All practitioners involved in care of older adults should be familiar with signs of abuse or neglect and be ready to intervene if abuse is suspected. A public advocacy system exists, and nursing homes can be cited by regulatory agencies. The federal and state governments are legally responsible for ensuring that a facility is providing good care; surveyors attempt to assess a facility’s performance and to detect deficiencies by monitoring outcome measures, observing care, interviewing patients and staff members, and reviewing clinical records. The COVID-19 pandemic has highlighted a number of problems with quality of care in nursing homes and has caused government regulators to look more carefully at care in nursing homes. In response, regulators have provided enhanced training for nursing home staff about infection control and in some states require nursing homes to have full-time staff with expertise in infection prevention. In 2022, the National Academies of Sciences, Engineering, and Medicine (NAM) formed the Committee on the Quality of Care in Nursing Homes to study the state of nursing home care in the US. This committee issued recommendations for improving nursing home care ( Supervision of care reference ): Deliver comprehensive, person-centered, equitable care that ensures the health, quality of life, and safety of nursing home residents; promote resident autonomy; and manage risks Ensure a well-prepared, empowered, and appropriately compensated workforce Increase transparency and accountability of finances, operations, and ownership Create a more rational and robust financing system Design a more effective and responsive system of quality assurance Expand and enhance quality measurement and continuous quality improvement Adopt health information technology in all nursing homes In the upcoming years, efforts must be focused on implementing these recommendations to ensure that vulnerable older adults receive the high quality and safe care they deserve. 