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Why isn’t there a doctor in the house?

Naturally, as residents of nursing care facilities age, they become more frail and are more likely to suffer from health events. To reduce the wait time, inconvenience, and discomfort of long and repeated ER waits, many facilities are now having doctors come directly to their facilities instead of placing calls to 911 unless there is imminent danger. 

 

Why should facilities consider house calls instead of ER visits?

One example, where this type of house call proved beneficial was a patient was that of a 73-year-old resident whose daughter placed her in the facility after a series of falls at home. The woman's visits to the ER became almost a monthly event. The falls could not easily be explained as she claimed to never feel dizzy or light-headed and would simply wind up on the floor. 

Once at the facility, the falls continued and the nursing home followed their regular protocol of calling an ambulance to take her to the emergency room, if the paramedics deemed necessary. Each trip to the ER would follow the same pattern of services, generally a CT scan and blood work, which always came back clean. The ER visits were costly, both in terms of real cost to Medicare and the family, as well as the emotional traumatic cost to the resident.  

The downside to repeated ER visits

No one likes to go to the ER, but for most people it is a rare occurrence. Yet, when dealing with elderly patients and residents, many communities would rather err on the side of caution and make sure that residents are properly checked out after any type of incident. 

Even though many nursing facilities have a lot of staff, very few have doctors on-site or on-call and only about half of the facilities will have trained nurses either in the facility or easily available. 

How nursing facilities have evolved in the past couple of decades

When the boom in nursing facilities began, they were designed with the anticipation of housing fairly healthy retirees who would be there to enjoy meal service, a multitude of social activities, and have their maintenance and housekeeping issues addressed. The original model was basically of long-term hospitality. Today, however, many of these assisted living facilities house residents who are older and sicker than expected, as many retirees will try to stay in their home for as long as possible. A large percentage will require help with bathing, and some will even need feeding assistance.  

On top of that, many residents will have multiple prescription medications that need to be managed, and the facilities have now become primarily a residential setting for people suffering from dementia. It is estimated that 70 percent of residents in these care facilities have some form of cognitive impairment which can make it difficult for them to keep regular appointments, attend testing, and travel in general to help keep their health on track. 

Why there are some opponents to having medical staff in assisted living facilities

Trying to persuade assisted living facility operators to provide medical care in-house has been met with some resistance. One of the first issues is that they are trying to differentiate themselves from a nursing home, so "medicalizing" their communities would affect their overall marketing strategy. Other problems facilities might face by adding medical care include:

  • A higher risk of liability
  • More heavy-handed federal regulation
  • Lead to higher fees for residents

While some facilities may be hesitant, it seems like many are moving towards some type of medical care available to residents to avoid costly and disruptive trips to the ER. Some facilities have decided to employ a doctor in-house, who can assist patients with everything from colds to aches and pains. Others are relying on the services of house call doctors. As residents in assisted living facilities continue to age and enter into these facilities with more ailments, facilities will need to address the issue of medical services and how best to use it to help their residents stay healthier.

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