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.
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References
Butler RN. Why survive? Being old in America. New York: Harper & Row; 1975.
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.
Committee on Nursing Home Regulation, Institute of Medicine. Improving the quality of care in nursing homes. Washington: National Academies Press; 1986.
Omnibus Budget Reconciliation Act of 1987. https://www.gpo.gov/fdsys/pkg/STATUTE-101/pdf/STATUTE-101-Pg1330.pdf. Accessed 15 Oct 2016.
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.
The Kaiser Commission on Medicaid and the Uninsured. Medicaid and long-term services and supports: a primer. Kaiser Family Foundation. 2015.
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.
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.
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.
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.
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.
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.
Williams C, Rosen J, O’Malley M. Profiles of nursing home residents on Medicaid. Washington: The Kaiser Commission on Medicaid and the Uninsured; 2006.
Kojima G. Prevalence of frailty in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2015;16:940–5.
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.
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.
Code of Federal Regulations, 42 CFR §483.30 Physician Services.
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.
Diamant J. Responsibilities of attending physicians in long-term care facilities. J Am Med Dir Assoc. 2002;3(4):254–8.
Diamant J. Roles and responsibilities of attending physicians in skilled nursing facilities. J Am Med Dir Assoc. 2003;4(4):231–43.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Newton PF, Levinson W, Masen D. The geriatric medication algorithm: a pilot study. J Gen Intern Med. 1994;9:164–7.
Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy. The process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.
Code of Federal Regulations, 42 CFR §483.75 Quality Assurance and Performance Improvement.
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.
Code of Maryland Regulations. Title 10 § 10.07.02.11 Medical Director Qualifications.
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.
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.
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.
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.
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.
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.
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.
Interventions to Reduce Acute Care Transfers (INTERACT). 2016. www.interact2.net/about.html. Accessed 3 Dec 2016.
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.
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.
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.
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.
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.
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.
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.
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.
Bakerjian D. Care of nursing home residents by advanced practice nurses. Res Gerontol Nurs. 2008;1:177–85.
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.
Kane RL, Huck S. The implementation of the EverCare demonstration project. J Am Geriatr Soc. 2000;48:218–23.
Kane RL, Flood S, Keckhafer G, Rockwood T. How EverCare nurse practitioners spend their time. J Am Geriatr Soc. 2001;49:1530–4.
Kane RL, Keckhafer G, Flood S, et al. The effect of EverCare on hospital use. J Am Geriatr Soc. 2003;51:1427–34.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Landow SM, DH O, Weinstock MA. Teledermatology within the Veterans Health Administration, 2002–2004. Telemed J E Health. 2015;21:769–73.
Volicer. Nursing home telepsychiatry. J Am Med Dir Assoc. 2015;16:7–8.
Morley JE. Telemedicine: coming to nursing homes in the near future. J Am Med Dir Assoc. 2016;17:1–3.
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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
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