Shot of a young male nurse treating an elderly patient in a nursing home
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The percentage of clinicians working full-time in nursing home settings has risen steadily as facility operators attempt to reduce care disruption and increase timely response to staff members’ medical questions, the authors of a new study say.

Investigators drew from a 20% sample of Medicare data on nursing home residents and the clinicians who submitted claims for their care. Based on these claims, the number of physicians, nurse practitioners and physician assistants working in nursing facilities increased from 26% in 2008 to 45% in 2017. Nurse practitioners topped the list, more than doubling their ranks to 4,479 during the study period. 

The trend is a boon for residents, the researchers say. Prior studies have shown that residents who receive care from full-time clinical staff have fewer avoidable hospitalizations and lower Medicare spending. Full-time providers also are better positioned to evaluate and intervene after a change in clinical status, they said.

“This has led some nursing homes to hire full-time nurse practitioners and to pay more for medical directors that are more present in the facility,” researcher James S. Goodwin, M.D., told the McKnight’s Clinical Daily. “In addition, nursing home residents and their families also prefer providers who are available,” said Goodwin, of the Sealy Center on Aging, The University of Texas Medical Branch at Galveston.

Vast care differences

But the trend is not universal. There were vast differences between facilities in the number of residents receiving care from full-time staff clinicians — from about 6% in the bottom fifth of facilities to more than 90% in the top fifth, Goodwin and colleagues reported. Residents in larger, urban, for-profit, and minority-serving nursing homes were more likely to have full-time providers. But these characteristics did not fully explain the discrepancies between facilities, they wrote.

Notably, residents whose primary care providers were nurse practitioners were 23 times more likely to have full-time healthcare providers than their peers who did not. Resident age, sex, Medicaid eligibility, and race and/or ethnicity had very little association with the odds of having a full-time provider. 

Team-based care

The results also revealed signs that facility operators may be moving toward a team-based care model, the researchers added. Residents who received care from both a physician and a nurse practitioner or physician assistant increased from 34% in 2008 to 63% in 2018. 

Although the study focused on clinicians who provided nursing home care only, one point to keep in mind is that these clinicians may be spreading their care between multiple facilities, Goodwin and colleagues noted.

“Thus, having a full-time nursing home provider should not necessarily imply that nursing home residents have immediate access to their providers,” they wrote.

Full findings were published in JAMDA.