(Snippets from the frontline)
Improving Nursing Home Care
None of my seniors want to go to a nursing home. Being surrounded by screaming patients, the odor of incontinence, and the loss of dignity and independence make them cringe.
Primary care physicians (PCP) are reimbursed once-a-month for a visit, so the scope of medical care is minimal.
My suggestion: Develop public-private partnerships to fund for one year a recent PCP graduate who will serve in a nursing home seeing patients daily. These newly minted doctors can study for their Boards, have weekends off and set vacation time, but must round on patients and be on-call for problems. At the end of one year, an equal amount of salary will be awarded to pay back some of their medical school loans (which now can be greater than $200,000).
From this experience, young doctors will carry into their careers empathy for a vulnerable and growing group in society.
The odor may not change, but nursing home care could improve.
Gene Uzawa Dorio, M.D.
I think this is a fantastic idea! I have a friend who has been living in a nursing home for one year now. She mentions that a doctor visits about once a month. I wonder how long he stays and what he checks. If she says she’s OK, does he just move on. In the meantime I see both legs hard as a rock from edema and ask a nurse to look into it. So far nothing’s happened, but I don’t plan to just let it go. I think the part about new doctors developing empathy early on for this vast population of older people existing in such miserable conditions would — in the end — lead to better care as they mature in their profession — before the insurance companies and Big Pharma get their stranglehold!
The hired physician would be salaried, not paid by insurance companies or Medicare/Medicaid. Public-private financing would come from local government (city, country, state), with private fund donations by the community the nursing home serves.
Models will have to be developed to create this project. Hopefully, the Santa Clarita Valley where I live will play a role initiating a program like this. If others around the country get involved in this creation, spreading information back to the rest of us can allow molding of this important and complex issue.
Since public funding and insurance funding of rounds on nursing home patients is only monthly, where would the funds come from for daily rounds for new PCPs?