Once the red headed step child of the care giving continuum, nursing homes are playing a more significant role in today's health care environment. The aging of the population, the rise in hospital as well as outpatient acuity, and the focus on rehospitalization rates are driving forces shaping the need and quality of such institutions.
The modern nursing home is nothing like the barren images of the past. Ornate buildings with state of the art rehab facilities, parlors, and resident amenities are now the rule. The beautified facilities, however, hide a more technical and intensive milieu of clinical care. Total parenteral nutrition, patient controlled anesthesia, and the placement of central venous catheters all take place in extended care facilities on any given day. Acute care, chronic disease management, and end of life palliation are now the expectation.
While the capabilities and quality have increased, the future of the nursing home as a soft landing place from acute hospitalization depends on an ever increasing clinical skill set. Once the purview of administrators and directors of nursing, to create centers of excellence a new breed of physicians must rise to meet these challenges.
I propose the extended care facilitator. These are physicians schooled both in intensive hospital care as well as outpatient medicine. Leaders who are willing to spend hours a day rounding and problem solving. The nursing home doctor of tomorrow needs to be agile at acute diagnosis, chronic disease management, as well as understand hospice and palliative care.
These facilitators will have innumerable benefits. Nursing homes will deliver higher quality care and their numbers will swell as unexpected discharges fall. Hospitals will experience better integration and lower rehospitalization rates. Patients will receive state of the art care in comfortable surroundings. And lastly, physicians will administer advanced medicine to a ready supply of patients without worrying about having enough to support their small businesses.
Its a win, win, win, win situation.
1 comment:
This seems a superb idea. What is the likelyhood of such a thing coming to pass? For my part, I've got fingers crossed, both for my aging mother and, eventually of course, for wife and myself (not too soon, mind you).
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