Posted on January 26, 2013
Filed Under Boomers and Elders, Providence Journal - Health | Leave a Comment
It?s time for Baby Boomers to turn nursing homes upside down. Many who are searching for places today for those they love use a checklist of questions to ask. It is important to learn about patient-staff ratio, cognitive exercises, music programs, physical activity, and general recreation. However, one of the most important questions seems almost too obvious to ask. ?Is there a doctor in the house?? In nursing homes, the answer is usually, ?No.? There are part-time physicians and consulting physicians, but the concept of full-time physicians has not yet become standard practice.
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Jonathan M. Evans, M.D., M.P.H., is a geriatrician who teaches Aging and the Law at the University of Virginia School of Law. When it comes to physicians assigned to nursing homes, he said: ?The thing that matters most?is being there ? being there for patients when they?re sick; being there for families when they?re in need; being there for staff to provide support and ongoing education. You can?t be part of a team if you?re not present.?
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It was in 2009 that Paul R. Katz, M.D., and colleagues at the University of Rochester wrote about the problem with nursing-home physicians in the Annals of Internal Medicine. They concluded: ?We contend that 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.?
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Yet today, directors of nursing homes both large and small are still expressing concern about the difficulty in finding physicians wishing to serve this population. There are even fewer psychiatrists available to prescribe appropriate medications. Dr. Evans pointed out the problems regarding the overuse of psychotropic medication in patients with dementia in his testimony before the United States Senate Special Committee on Aging, November 2011.
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A big issue with part-time nursing-home physicians is that they often do not see the full picture. While they read charts and talk to staff, by not talking with families and caregivers they often glean an incomplete picture of patient needs.
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At the Gerontological Society of America?s 65th Scientific Meetings this past fall, presentations from experts on caregiving, longevity, long-term care and optimal aging were particularly poignant. Baby Boomers, as the next generation of nursing-home or assisted-living residents, will demand change for the better.
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Some families are taking action now by changing nursing homes that they feel are not in the best interest of a family member. However, other families may accept the status quo, even if they are dissatisfied, because they fear ?transfer trauma.?
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Robert L. Kane, M.D., professor and chairman in the Long-term Care and Aging Department of the University of Minnesota, said that there has been a belief that nursing-home transfers are beleaguered with setbacks.
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Author of ?The Good?Companion,? he explained: ?What we know about care in general is that change introduces an opportunity for bad things to happen. You counter this by preparation and engaging the resident in the decision as much as possible,? adding: ?We do know that humans are incredibly adaptable.?
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Dr. Evans noted: ?We have built a health-care system that tends to focus more on providers and we need to change the model to focus on patients.? Previously at Mayo Clinic, he serves as chair of the Ethics Committee of the American Medical Directors? Association. In September he was named corporate medical director for the Life Care Centers in Tennessee.
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?Rita??Watson,?MPH, is a Providence Journal columnist who wrote this through the MetLife Foundation Journalist in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.
Should every nursing home have a full-time doctor??(Jan 21, 2013,?Thrive, p.?B2)
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Source: http://ritawatson.com/?p=3388
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