Family Frustration: Nursing Home Medical Care

Several of my clients are in skilled nursing facilities (SNF) or nursing homes.  One of the complaints I frequently hear is, why can’t I see my own doctor?  In order to be seen by your own MD/NP, they need to be credentialed with the facility.  This means the MD/NP have to submit their credentials for review and verification.  Medical professionals usually submit credentials to facilities they interact with frequently like hospitals and insurance companies.  If they have one patient in a facility, it is unlikely credentialing will occur.

SNF/nursing homes are required to have a medical director and ability to oversea care.  Facilities contract with doctors/NPs and health centers to provide residential medical care.  They often have full practices away from the facility and visit several times a week.  As per medicare regulations, the doctor needs to be available for emergencies.

I tell clients and families when investigating different  nursing homes, ask about the medical team.  Questions to consider are:                                                                                    Who is the medical director?                                                                                                        Which doctors/NPs visit the facility?                                                                                           How many days are they onsite?                                                                                                 Are they available for family conferences?                                                                                How do I reach them if there is a concern?                                                                              Are there mental health services?                                                                                                How are emergencies dealt with and how will the family be contacted?

I find most people don’t ask questions about the medical team.  Knowing frequency and times of visits when a medical provider is onsite is valuable information.   If visits are every day by a team member, then medical concerns are generally taken care of quicker.  There is more opportunity for a family member to request a visit and be present.

It is important to know how to contact the medical team.  I have found some facilities doctors/NPs respond in a timely manner to calls, while others may never call back.  At some facilities, the nursing staff acts as a buffer between the doctors and families.  Unfortunately, I find in those situations miscommunication is greatest.

Since the medical team is contracted with the facility, where does the family and the patient’s needs fit in? The relationship of doctor/NP to resident is not the same as in primary care.  Generally, this can be a difficult transition for patients and families.  It is not always a simple task to get medical information, updates, and a concern heard or acted on.

The lack of medical communication is a major source of frustration for families. Any medical changes or emergencies should be communicated immediately especially if a family member is the healthcare proxy.  Some facilities are exceptional in communicating medical changes while others are sorely lacking. It can be helpful to have the staff write in the chart, how and when the family needs to be contacted.

My advice for families that speak to me with these concerns is, to continue to ask questions, remind staff to call and don’t think everything is fine if there are no calls.  If problems keep occurring, I then advise speaking with an administrator starting with the nursing director.  If nothing changes, track down the top administrator of the facility.  I find that can be very helpful and gets results.  Also, make sure you have all correct facility contact information including voicemails, emails, after hours contact, and  emergency phone numbers.  Speaking with someone high on the authority chain doesn’t always guarantee  sustainable changes in facility behavior.  It will be necessary to continue to advocate for the family member’s needs.

If nothing changes, find a patient advocate to speak with the facility or medical team.  This can be a game changer.  I like to tell people, having an advocate changes the dance between the players.  An advocate can hone in on the issues and work quickly to resolve problems.