Skip to main content
SpringerLink
Log in

Primary Care in the Nursing Home

  • Chapter
  • First Online:
Book cover Primary Care for Older Adults

  • 935 Accesses

Abstract

Over the past four decades, since reports of poor medical care in nursing homes became public, healthcare professionals, including physicians and advanced practice clinicians, have developed standards for nursing home care as well as a number of models of primary care tailored for nursing home residents. This chapter reviews several approaches to primary care delivery in the nursing home, including the EverCare model and the OPTIMISTIC model. The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program will also be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Butler RN. Why survive? Being old in America. New York: Harper & Row; 1975.

    Google Scholar 

  2. Subcommittee on Long-Term Care of the Special Committee on Aging. United States Senate. Nursing home care in the United States: failure in public policy. Washington: U.S. Government Printing Office; 1974.

    Google Scholar 

  3. Committee on Nursing Home Regulation, Institute of Medicine. Improving the quality of care in nursing homes. Washington: National Academies Press; 1986.

    Google Scholar 

  4. Omnibus Budget Reconciliation Act of 1987. https://www.gpo.gov/fdsys/pkg/STATUTE-101/pdf/STATUTE-101-Pg1330.pdf. Accessed 15 Oct 2016.

    Google Scholar 

  5. Centers for Disease Control and Prevention. National Center for Health Statistics. Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013–2014. 2016.

    Google Scholar 

  6. The Kaiser Commission on Medicaid and the Uninsured. Medicaid and long-term services and supports: a primer. Kaiser Family Foundation. 2015.

    Google Scholar 

  7. Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy. Chapter 7: skilled nursing facility services. March 2016. http://www.medpac.gov/docs/default-source/reports/chapter-7-skilled-nursing-facility-services-march-2016-report-.pdf?sfvrsn=0. Accessed 8 Oct 2016.

  8. Centers for Disease Control and Prevention. National Center for Health Statistics. Nursing home care. 2016. http://www.cdc.gov/nchs/fastats/nursing-home-care.htm. Accessed 8 Oct 2016.

  9. Dwyer LL, Han B, Woodwell DA, et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother. 2010;8:63–72.

    Article  PubMed  Google Scholar 

  10. Nguyen JK, Fouts MM, Kotabe SE, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother. 2006;4:36–41.

    Article  PubMed  Google Scholar 

  11. Medicare Payment Advisory Commission (MedPAC). Skilled nursing facility services payment system. 2016. http://medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_snf_final.pdf?sfvrsn=0. Accessed 11 Dec 2016.

  12. Sahyoun NR, Pratt LA, Lentzner H, et al. Centers for Disease Control and Prevention. National Center for Health Statistics. The changing profile of nursing home residents: 1985–1997. 2001. https://www.cdc.gov/nchs/data/ahcd/agingtrends/04nursin.pdf. Accessed 8 Oct 2016.

  13. Williams C, Rosen J, O’Malley M. Profiles of nursing home residents on Medicaid. Washington: The Kaiser Commission on Medicaid and the Uninsured; 2006.

    Google Scholar 

  14. Kojima G. Prevalence of frailty in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2015;16:940–5.

    Article  PubMed  Google Scholar 

  15. Kaiser Commission on Medicaid and the Uninsured. Private long-term care insurance: a viable option for low and middle-income seniors? 2006. http://www.kff.org/uninsured/upload/7459.pdf. Accessed 20 Nov 2016.

  16. Kelly A, Conell-Price J, Covinsky K, et al. Length of stay for older adults residing in nursing homes at the end of life. J Am Geriatr Soc. 2010;58:1701–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Code of Federal Regulations, 42 CFR §483.30 Physician Services.

    Google Scholar 

  18. AMDA-The Society for Post-Acute and Long-Term Care Medicine. Role of the attending physician in the nursing home. 2003. http://www.paltc.org/amda-white-papers-and-resolution-position-statements/role-attending-physician-nursing-home. Accessed 16 Oct 2016.

  19. Diamant J. Responsibilities of attending physicians in long-term care facilities. J Am Med Dir Assoc. 2002;3(4):254–8.

    Article  Google Scholar 

  20. Diamant J. Roles and responsibilities of attending physicians in skilled nursing facilities. J Am Med Dir Assoc. 2003;4(4):231–43.

    Article  Google Scholar 

  21. The Medical Direction and Medical Care Work Group, New York State Department of Health. Role of the attending physician in the nursing home. 2011. https://www.health.ny.gov/professionals/nursing_home_administrator/docs/11-13_att_phys_role.pdf. Accessed 16 Oct 2016.

  22. Centers for Medicare & Medicaid Services. Better care. Smarter spending. Healthier people: paying providers for value, not volume. 2015. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html. Accessed 10 Dec 2016.

  23. Katz PR, Karuza J, Kolassa J, Hutson A. Medical practice with nursing home residents: results from the National Physician Professional Activities Census. J Am Geriatr Soc. 1997;45:911–7.

    Article  CAS  PubMed  Google Scholar 

  24. American Academy of Family Physicians. Practice profile I survey. 2008. http://www.aafp.org/about/the-aafp/family-medicine-facts.html. Accessed 20 Nov 2016.

  25. Katz PR, Karuza J, Intrator O, et al. Medical staff organization in nursing homes: scale development and validation. J Am Med Dir Assoc. 2009;10:498–504.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Katz PR, Karuza J, Lima J, Intrator O. Nursing home medical staff organization: correlates with quality indicators. J Am Med Dir Assoc. 2011;12:655–9.

    Article  PubMed  Google Scholar 

  27. Lima JC, Intrator O, Karuza J, et al. Nursing home medical staff organization and 30-day rehospitalizations. J Am Med Dir Assoc. 2012;13:552–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Katz PR, Wayne M, Evans J, et al. Examining the rationale and processes behind the development of AMDA’s competencies for post-acute and long-term care medicine. Ann Long-Term Care: Clin Care Aging. 2014;22(11):36–9.

    Google Scholar 

  29. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.

    Article  PubMed  Google Scholar 

  30. Newton PF, Levinson W, Masen D. The geriatric medication algorithm: a pilot study. J Gen Intern Med. 1994;9:164–7.

    Article  CAS  PubMed  Google Scholar 

  31. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy. The process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.

    Article  PubMed  Google Scholar 

  32. Code of Federal Regulations, 42 CFR §483.75 Quality Assurance and Performance Improvement.

    Google Scholar 

  33. Rowland FN, Cowles M, Dickstein C, Katz PR. Impact of medical director certification on nursing home quality of care. J Am Med Dir Assoc. 2009;10:431–5.

    Article  PubMed  Google Scholar 

  34. Code of Maryland Regulations. Title 10 § 10.07.02.11 Medical Director Qualifications.

    Google Scholar 

  35. The Medical Direction and Medical Care Work Group, New York State Department of Health. Role of the Medical Director in the Nursing Home. 2011. https://www.health.ny.gov/professionals/nursing_home_administrator/docs/11-13_med_dir_role.pdf. Accessed 25 Nov 2016.

  36. AMDA-The Society for Post-Acute and Long-Term Care Medicine. White paper on the nursing home medical director: leader and manager. 2011. http://www.paltc.org/sites/default/files/White%20Paper%20NH%20Medical%20Director%20Leader%20and%20Manager.pdf. Accessed 25 Nov 2016.

  37. Saliba D, Kington R, Buchanan J, et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc. 2000;48:154–63.

    Article  CAS  PubMed  Google Scholar 

  38. Ouslander JG, Lamb G, Perloe M, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc. 2010;58:627–35.

    Article  PubMed  Google Scholar 

  39. Morley JE. Opening Pandora’s box: the reasons why reducing nursing home transfers to hospital are so difficult. J Am Med Dir Assoc. 2016;17:185–7.

    Article  PubMed  Google Scholar 

  40. Ouslander JG, Weinberg AD, Phillips V. Inappropriate hospitalization of nursing facility residents: a symptom of a sick system of care for frail older people. J Am Geriatr Soc. 2000;48:230–1.

    Article  CAS  PubMed  Google Scholar 

  41. Ouslander JG, Bonner A, Herndon L, Shutes J. The interventions to reduce acute care transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care. J Am Med Dir Assoc. 2014;15:162–70.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Interventions to Reduce Acute Care Transfers (INTERACT). 2016. www.interact2.net/about.html. Accessed 3 Dec 2016.

  43. Boockvar K, Brodie HD, Lachs M. Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument. J Am Geriatr Soc. 2000;48:1086–91.

    Article  CAS  PubMed  Google Scholar 

  44. Langley GJ, Moen RD, Nolan KM, et al. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.

    Google Scholar 

  45. Ouslander JG, Perloe M, Givens JH, et al. Reducing potentially avoidable hospitalizations of nursing home residents: results of a pilot quality improvement project. J Am Med Dir Assoc. 2009;10:644–52.

    Article  PubMed  Google Scholar 

  46. Tena-Nelson R, Santos K, Weingast E. Reducing potentially preventable hospital transfers: results from a thirty nursing home collaborative. J Am Med Dir Assoc. 2009;13:651–6.

    Article  Google Scholar 

  47. Bonner A, Tappen R, Herndon L, Ouslander J. The INTERACT institute: observations on dissemination of the INTERACT quality improvement program using certified INTERACT trainers. Gerontologist. 2015;55:1050–7.

    Article  PubMed  Google Scholar 

  48. Ouslander JG, Naharci I, Engstrom G, et al. Lessons learned from root cause analyses of transfers of skilled nursing facility (SNF) patients to acute hospitals: transfers rated as preventable versus nonpreventable by SNF staff. J Am Med Dir Assoc. 2016;17:596–601.

    Article  PubMed  Google Scholar 

  49. Ouslander JG, Naharci I, Engstrom G, et al. Root cause analyses of transfers of skilled nursing facility patients to acute hospitals: lessons learned for reducing unnecessary hospitalizations. J Am Med Dir Assoc. 2016;17:256–62.

    Article  PubMed  Google Scholar 

  50. Ouslander JG, Handler SM. Consensus-derived interventions to reduce acute care transfer (INTERACT)—compatible order sets for common conditions associated with potentially avoidable hospitalizations. J Am Med Dir Assoc. 2015;16:524–6.

    Article  PubMed  Google Scholar 

  51. Bakerjian D. Care of nursing home residents by advanced practice nurses. Res Gerontol Nurs. 2008;1:177–85.

    Article  PubMed  Google Scholar 

  52. Bayard J, Jacobson R. How two NPs changed managed care: the birth of Evercare. Interview by Jill Rollet. Adv Nurse Pract. 2007;15(5):73–5.

    PubMed  Google Scholar 

  53. Kane RL, Huck S. The implementation of the EverCare demonstration project. J Am Geriatr Soc. 2000;48:218–23.

    Article  CAS  PubMed  Google Scholar 

  54. Kane RL, Flood S, Keckhafer G, Rockwood T. How EverCare nurse practitioners spend their time. J Am Geriatr Soc. 2001;49:1530–4.

    Article  CAS  PubMed  Google Scholar 

  55. Kane RL, Keckhafer G, Flood S, et al. The effect of EverCare on hospital use. J Am Geriatr Soc. 2003;51:1427–34.

    Article  PubMed  Google Scholar 

  56. Kane RL, Flood S, Keckhafer BA, et al. Nursing home residents covered by Medicare risk contracts: early findings from the EverCare evaluation project. J Am Geriatr Soc. 2002;50:719–27.

    Article  PubMed  Google Scholar 

  57. Kane RL, Keckhafer G, Robst J. Evaluation of the Evercare demonstration program final report. Minneapolis: Division of Health Service Research and Policy, School of Public Health, University of Minnesota; 2002.

    Google Scholar 

  58. Lawrence JF. The advance directive prevalence in long-term care: a comparison of relationships between a nurse practitioner healthcare model and a traditional healthcare model. J Am Acad Nurse Pract. 2009;21(3):179–85.

    Article  PubMed  Google Scholar 

  59. Wenger NS, Roth CP, Martin D, et al. Quality of care provided in a special needs plan using a nurse care manager model. J Am Geriatr Soc. 2011;59:1810–22.

    Article  PubMed  Google Scholar 

  60. Goldfeld KS, Grabowski DC, Caudry DJ, Mitchell SL. Health insurance status and the care of nursing home residents with advanced dementia. JAMA Intern Med. 2013;173(22):2047–53.

    Article  PubMed  Google Scholar 

  61. Centers for Medicare & Medicaid Services. Initiative to reduce avoidable hospitalization among nursing facility residents. CMS Web Site. 2016. http://go.cms.gov/1QNwsfG. Accessed 10 Dec 2016.

  62. Centers for Medicare & Medicaid Services. State operations manual. Appendix PP—guidance to surveyors for long term care facilities. (Rev 157, 06-10-16). 2016. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed 25 Nov 2016.

  63. Holtz LR, Maurer H, Nazir A, et al. OPTIMISTIC: a program to improve nursing home care and reduce avoidable hospitalizations. In: Malone ML, Capezuti EA, Palmer RM, editors. Geriatrics models of care: bringing ‘best practice’ to an aging America. Cham: Springer International Publishing; 2015. p. 287–92.

    Chapter  Google Scholar 

  64. Unroe KT, Nazir A, Holtz L, et al. The optimizing patient transfers, impacting medical quality, and improving symptoms: transforming institutional care approach: preliminary data from the implementation of a centers for Medicare and Medicaid services nursing facility demonstration project. J Am Geriatr Soc. 2015;63:165–9.

    Article  PubMed  Google Scholar 

  65. Hickman SE, Unroe KT, Ersek MT, et al. An interim analysis of an advance care planning intervention in the nursing home setting. J Am Geriatr Soc. 2016;64:2385–92.

    Article  PubMed  Google Scholar 

  66. Nazir A, Unroe KT, Buente B, et al. OPTIMISTIC transition visits: a model to improve hospital to nursing facility transfers. Ann Long-Term Care: Clin Care Aging. 2016;24(7):31–6.

    Google Scholar 

  67. LaMantia MA, Scheunemann LP, Viera AJ, et al. Interventions to improve transitional care between nursing homes and hospitals: a systematic review. J Am Geriatr Soc. 2010;58(4):777–82.

    Article  PubMed  PubMed Central  Google Scholar 

  68. AMDA—The Society for Post-Acute and Long-Term Care. Know-it-all before you call: data collection system. Columbia: AMDA—The Society for Post-Acute and Long-Term Care; 2015.

    Google Scholar 

  69. AMDA—Society for Post-Acute and Long-Term Care. Know-it-all when you’re called: diagnosing system. Columbia: AMDA—The Society for Post-Acute and Long-Term Care; 2015.

    Google Scholar 

  70. Driessen J, Bonhomme A, Chang W, et al. Nursing home provider perceptions of telemedicine for reducing potentially avoidable hospitalizations. J Am Med Dir Assoc. 2016;17:519–24.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Grabowski DC, O’Malley AJ. The use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare. Health Aff. 2014;33(2):244–50.

    Article  Google Scholar 

  72. Landow SM, DH O, Weinstock MA. Teledermatology within the Veterans Health Administration, 2002–2004. Telemed J E Health. 2015;21:769–73.

    Article  PubMed  Google Scholar 

  73. Volicer. Nursing home telepsychiatry. J Am Med Dir Assoc. 2015;16:7–8.

    Article  PubMed  Google Scholar 

  74. Morley JE. Telemedicine: coming to nursing homes in the near future. J Am Med Dir Assoc. 2016;17:1–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Optum, Inc., New York, NY, USA

    Robert A. Zorowitz MD, MBA, FACP, AGSF, CMD

Authors
  1. Robert A. Zorowitz MD, MBA, FACP, AGSF, CMD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. Zorowitz MD, MBA, FACP, AGSF, CMD .

Editor information

Editors and Affiliations

  1. Rockport Healthcare Services, Los Angeles, California, USA

    Michael Wasserman

  2. Physician Consultant Institute, Denver, Colorado, USA

    James Riopelle

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Zorowitz, R.A. (2018). Primary Care in the Nursing Home. In: Wasserman, M., Riopelle, J. (eds) Primary Care for Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-61329-1_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61329-1_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61327-7

  • Online ISBN: 978-3-319-61329-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation