Medical directors are important in nursing homes because they ensure that residents receive appropriate medical care and oversight. However, one recent study revealed something alarming about the lack of medical directors in nursing home facilities.
More than a third of nursing homes didn’t have an on-site medical director during the first quarter of 2023, despite regulations that require one. Researchers warn that this lack of medical oversight raises serious concerns about the quality of resident care.
What do nursing home medical directors do?
Medical directors are federally required to oversee resident health and ensure optimal physical, mental, and emotional well-being for everyone in the facility. They develop and implement care policies and evaluate procedures to meet quality care standards. However, these policies are effective only if a medical director is actively present in a facility, assessing residents and tailoring care plans.
The research also revealed notable differences regarding ownership type. For example, for-profit nursing homes (61.4%0 were more reluctant to report any medical director presence. That’s compared to non-profits (71.3%) and government-owned facilities (66.5%).
Some states reported that just 45% of nursing homes had any medical director time at all. Even worse, medical directors who were present averaged just 36 minutes on-site per day, or roughly 4.2 hours a week. In an average-sized nursing home, that equates to less than one minute of medical oversight per resident daily.
This study comes as many nursing homes are resisting new federal requirements from the Centers for Medicare & Medicaid Services (CMS) for minimum staffing levels, including having a registered nurse on duty 24/7. The nursing home industry and the American Hospital Association have strongly criticized these requirements, while many patient advocates argue that the changes still don’t go far enough.
Why do on-site medical directors matter?
Medical directors ensure that each resident receives high-quality care tailored to their health needs, preferences, and abilities. A lack of adequate oversight can lead to poorer outcomes, increased hospitalizations, and even premature death.
“Our findings highlight a significant gap in the presence and involvement of medical directors, particularly in for-profit facilities, which raises serious concerns about the adequacy of care provided to residents,” said Richard Mollot, executive director of the Long Term Care Community Coalition (LTCCC) and co-author of the study. The LTCCC is dedicated to advocacy, education, and policy work to improve resident care.
According to Mollot, medical directors are important for maintaining high care standards in nursing homes, from infection control to addressing unnecessary medication use. He points out that the study confirms what he’s been hearing anecdotally for years—many residents rarely see a doctor. This leads to avoidable infections, pressure ulcers, poor dementia care, and other issues.
Mollot (along with researchers from the University of California, San Francisco) and the California Association of Long Term Care Medicine reviewed staffing data from 2017 to 2023 for nursing homes across the United States. The analysis excluded other medical professionals, such as physician assistants and nurse practitioners. It focused specifically on the presence and role of medical directors.
The study examined the presence of medical directors, time spent on-site, variations by ownership type, and differences across states. It also assessed compliance with CMS requirements using Payroll-Based Journal (PBJ) data, ownership records, and deficiency data from 2023.
Pushback from industry leaders
Not everyone agrees with the study’s findings. Dr. Rajeev Kumar, head of the Post-Acute and Long-Term Care Medical Association, disagreed. He argued that discrepancies in data reporting led to skewed results. According to Kumar, the current reporting system is flawed because medical directors often split their time between administrative work, which gets reported, and clinical work, which may not.
Mollot, however, disagrees with Kumar’s interpretation. In response, Mollot expressed that critics may not have fully reviewed the details of the study. “It is disturbing to hear that they are drawing such conclusions,” said Mollot. “This is not an opinion piece.”
Seeking legal help for nursing home negligence
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