Nursing Homes

Each nursing home also has a medical director, a doctor who oversees the medical care. In some nursing homes, the medical director is the only doctor who provides medical care. But in most nursing homes, several doctors, often working with nurse practitioners or physician assistants, provide care. Sometimes a doctor who has been taking care of the person before the move, perhaps their family doctor, continues to provide care. Otherwise, the person chooses or is assigned a doctor. According to federal regulations, a doctor, nurse practitioner, or physician assistant must see every nursing home resident at least once every other month. Many residents see a health care professional more often because they need treatment for chronic disorders or they develop additional disorders, such as infections or confusion. Some state regulations may require more frequent visits. Also, nurses may call a doctor to discuss problems and changes in treatments. However, these discussions do not count as a visit.

Many nursing homes provide services previously thought to occur only in hospitals such as continuous administration of oxygen and fluids or medications given by vein (intravenous therapies).

Almost all nursing homes provide rehabilitation, including physical, occupational, and sometimes respiratory and speech therapies. Many people are admitted to nursing homes specifically for rehabilitation, then are discharged to their home after several weeks.

Dentists and medical specialists, such as podiatrists, ophthalmologists, neurologists, or psychiatrists, may examine and treat residents on site. But most often, people with a specific problem have to be transported to a different site for treatment. In the United States, Medicare should cover all transportation costs for medically necessary visits.

Some nursing homes have special units for people with dementia. These units are staffed by specially trained nurses. Many nursing homes provide hospice care for people who are dying.

All nursing homes provide access to members of the facility's interdisciplinary team, including doctors, nurses, social workers, therapists, and pharmacists. Social workers help residents adjust to the nursing home and, when appropriate, help residents return to their own home or to a lower level of care. They identify residents who are lonely and withdrawn and help residents, staff members, and family members communicate with each other. They may also help residents and family members make financial arrangements. For example, they may show family members how to apply for Medicare and Medicaid coverage. Social workers often help coordinate the care provided by the different health care professionals in a nursing home. These clinicians work together to enable each resident to function as well as possible and to have the best possible quality of life.

Although some nursing homes resemble hospitals rather than homes, many nursing homes are trying to change from a more institutional environment with rules and regulations to a more homelike environment that gives residents more control over their care. Some nursing homes permit pets, encourage residents to maintain existing hobbies or develop new ones, and provide many opportunities for contact between residents and people of all ages who live in the community around the nursing home. Providing this kind of environment is complicated because the residents of nursing homes are usually sick and frail. Many nursing homes have dining rooms, recreation rooms, beauty salons, patios, and gardens. All nursing homes provide recreational and social activities.

Nursing homes are overseen by the government. To monitor and evaluate quality in nursing homes, state health departments conduct surveys and inspections and interview residents and staff members. A copy of this evaluation is kept at the nursing home and can be reviewed by residents and their family members. Nursing homes also use other programs that monitor and help improve the quality of care.

The COVID-19 pandemic highlighted a number of problems with quality of care in nursing homes and has caused government surveyors to look more carefully at care in nursing homes. In response, surveyors provided enhanced training for nursing home staff about infection control, and some states require nursing homes to have full-time staff with expertise in infection prevention.

Even though nursing homes are monitored and regulated by government, they vary considerably in quality, personality, and cost. So people or family members who are interested in a nursing home should try to get as much information as possible. They can ask the administrator of the nursing home to see the state’s evaluation of the home.

Medicare's nursing home comparison tool also provides detailed information about every Medicare- and Medicaid-certified nursing home. The Centers for Medicare and Medicaid Services created the Five-Star Quality Rating System to help people needing care, their families, and caregivers compare nursing homes more easily. This rating system includes information regarding how well nursing homes are caring for their residents’ physical and clinical needs, including looking at problems that commonly develop or worsen in residents of nursing homes, including the following:

• A decline in the ability to do daily activities

• Undernutrition

• Weight loss

• Pressure sores

• Incontinence

• Pain management

• Constipation

• Infections

• Depression

• Use of too many medications

Whether these rating systems are valid is debated. Nonetheless, they provide information that can help people better compare nursing homes.

Other important questions to ask the administrator include

• Whether the nursing home is certified to provide Medicare and Medicaid coverage

• How often care of residents is reviewed

• What type of medical care is available

• Whether residents and family members are included in the review of care

• Whether there is a family and/or resident council

For some questions, the administrator may direct people to the nursing home’s medical director or director of nursing.

Talking to other people who are familiar with the home is helpful. Such people include long-term care ombudsmen (who visit nursing homes and investigate complaints), doctors, clergy, family members of residents, residents, and employees of the nursing home. Some homes have resident council organizations, consisting of family members and friends of residents who meet to discuss issues that come up in the nursing home. These organizations can provide family members of prospective residents with helpful information. However, making an unscheduled visit to a home for several hours is usually the best way to determine whether the quality of services is good and whether the home will be a good place for a loved one.

In the United States, Medicaid, Medicare, and the U.S. Department of Veterans Affairs (VA) pay for most nursing home care. Medicare pays for rehabilitative care for a short time in certified nursing homes if skilled care is needed daily after a hospital stay lasting 3 days or more. People are eligible for up to 100 days of Medicare coverage as long as they show continued improvement. Medicare pays all costs for 20 days, then requires a co-payment for the remaining 80 days. After 100 days, payment is either with private funds or, if the person is qualified, through Medicaid.