The new rules at the nation’s nursing homes require formal approval for nurse practitioners, psychologists and social workers.
“The whole idea is to eliminate disagreements among administrators or residents or families,” says Betty Cheng, executive director of Americans for the Advancement of Nursing, which represents nursing home executives.
But it’s still up to doctors.
In one recent change, a new quality improvement board governs bathing practices in assisted living centers, where many beds are vacated overnight for residents’ meals and care.
“We look at discipline now when there is a mixup with self-watering and not washing some footed residents or in-room use of a finger while bathing,” says Dr. Oscar Reis, the Houston surgeon who heads the Health and Wellness Board of the Association of Rehabilitation Facilities, a trade group.
Doctors already approve most of the cases that managers bring to them and collect the list. But occasionally a task force must be created to investigate an allegation or doctors disagree on the test scores of an applicant, says Dr. Robert Gordon, a Duke University professor who chairs the Quality Improvement Council for the Rehabilitation Facilities.
Such disputes can be extremely sensitive. Many patients — like those in nursing homes — are not eager to talk about their doctor’s choices, no matter how amply documented, says Michael Volk, CEO of ProHealth, a national nursing-home-selection firm.
Compounding the problem, many states require patients and families to conduct their own searches for a nursing home to evaluate. “It’s a hugely inefficient process,” Volk says. “Making your own decision should be a last resort, especially if the person has an illness.”