Nursing Home Specialists May Improve Quality of Care

Mar. 16, 2009
Rochester Experts’ National Journal Article Proposes Development of New Specialty to Address Long-Term Care Needs

Geriatrics experts at the University of Rochester Medical Center are urging the medical community to consider developing a new specialty to meet the needs of nursing home residents. “Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care,” in the March 17 issue of Annals of Internal Medicine, is a call to action to explore the potential of nursing home specialists in improving the quality of care in nursing homes, according to lead author Paul R. Katz, M.D., professor of Medicine and chief of the Division of Geriatrics and Aging at the University of Rochester School of Medicine and Dentistry.

“Physician care positively influences nursing home residents’ hospitalization rates, functional status and satisfaction. As we face a serious decline in the number of geriatricians, rather than accepting a diminished presence of physicians in nursing homes and finding alternative care models, it is time to fully consider, appropriately fund, and test the nursing home specialist model,” says Katz, who is also president-elect of the American Medical Directors Association (AMDA), the professional association of long-term care practitioners.

Katz’s article points to a recent Institute of Medicine report that highlights a shortage of geriatricians and recommends shifting nursing home care to mid-level providers, such as nurse practitioners. “Rather than accepting that disengagement of physicians in nursing home practice is inevitable, we make the case that quality of care in nursing homes is directly linked to physician practice, and that only by moving toward a nursing home specialist model will the needs of residents with complex post-acute problems, who also suffer from other conditions, chronic illnesses and functional limitations, be met,” Katz says.

People have a 46 percent chance of being admitted to a nursing home at some point in their lives. Yet, only 20 percent of physicians currently practice in nursing homes and, of that 20 percent, nursing home care accounts for just 4 percent of their work time. Logistics play a part for many physicians, who are challenged both by time and low reimbursements to travel to various facilities to care for their patients. Additionally, some feel unprepared to provide nursing home care. Katz reports that, in a survey of graduating resident physicians, fewer than 15 percent reported feeling “very prepared to provide nursing home care.”

“We believe that nursing home specialists could practice under many different models, ranging from full-time practitioner to a primary care physician in the community who devotes one day per week to nursing home residents. However, we propose that nursing home specialists devote at least 20 percent of their practice to nursing home care,” Katz says. He also recommends enhanced training in nursing home medicine, with possible residencies and fellowships to foster competence in the specialty.

As medicine works to address the growing need for primary care physicians, Katz hopes to stir debate about the role of physicians in providing quality long-term care. “This is a call to action. Let’s talk about the possibility of a nursing home specialty, see if the concept should be explored and if it could improve quality.”