Do doctors see patients in the nursing home and assisted living facilities?

With so many opportunities available to physicians, it can be a challenge to determine which opportunity to pursue. Nursing homes and assisted living facilities have changed over time requiring more oversite of care.

So, do medical doctors work in nursing home facilities? The answer is yes. Medical doctors of all specialties work in skilled nursing homes. They also work in similar settings, such as assisted living facilities.

Doctors trained in internal medicine, family medicine, pulmonologists, cardiologist, and other specialist make rounds in nursing homes.

Medical Director

Doctors can act as medical directors for this setting. This means that they take on the added responsibility of a medical director to provide oversite of the care of the residents. This is usually with extra pay called a stipend.

Attending Physician

The doctor can focus on their patients in the nursing home as an attending physician. An attending doctor only takes on the responsibility of the patients assigned to them by the facility.

These patients can be attributed to them on a rotating basis or have a group assigned when they agree to join the home.

Level of Care

Physicians have been rounding in long term care facilities for years. They are a vital component in the care of the residents. Gone are the days of the little old mom and pop that require minimal medical care. Patients are sicker and frailer than ever.

The residents in Nursing homes require regular visits by medical staff. With the level of care increasing, the oversite required has increased. This increase in the complexity of residents has resulted in nursing homes becoming the new step-down unit for the hospital and require oversite by a trained medical provider.

How much responsibility do doctors take on while working in a nursing home?

It really depends on how much you want to take on as a medical provider. Do you want to get involved in the day to day operations as a director, or do you just want to come in and evaluate your patients?

The role of the medical director can be all-encompassing at times while working in a nursing home.

The medical director will be the one who looks over and assists in providing medical oversite for the facility and its residents. There can be a high level of responsibility involved in this position. If done correctly, the role of the medical director can be rewarding.

Some doctors pass on nursing homes and work in assisted living facilities, which is similar to the old-style nursing home.

Can Doctors make money working for nursing homes or assisted living facilities?

Nursing homes and Assisted living facilities are often overlooked as a viable source of revenue and patient visits to supplement their office work. 

These two settings are different, and you need to evaluate the pros and cons of each setting before deciding which setting you want to work in.

Medical doctors in Nursing homes usually receive a stipend to act as medical director.

Assisted living facilities usually do not pay their doctors a stipend. They will try to recruit doctors by offering them a panel of patients. The assisted living facility gains oversite by a doctor and the physician has a built-in group of elderly patients that are easily accessible.

Doctors in assisted living facilities will evaluate and treat residents, review and sign the paperwork, and review charts.

Types of doctors rounding in nursing home  

Many types of physicians rounding in nursing homes and assisted living facilities.

  1.  Internal medicine
  2. Family medicine
  3. Pulmonologist
  4. Cardiologists
  5. Dentist
  6. Podiatrist
  7. Wound care specialist
  8. Orthopedics
  9. Nephrology
  10. Basically, any specialty in medicine

Many types of specialists round in the nursing home. Specialist order and perform many of the same tests/procedures that they would in the office setting. 

The specialist usually rounds in this setting and then send them to their office when specific testing is required that cannot be completed. Most homes will pay a stipend to a specialist so that they can advertise specialty programs.

 Stipend for nursing home doctors

Most medical directors in this setting command a monetary stipend based on the size of the facility.

The size of the monthly stipend ranges from 1000 on the low end and 5000 per month for larger facilities requiring more medical oversite.

The stipend is usually paid every month after the facility is invoiced. Some facilities pay on time, but many can delay their payments. This can be frustrating to many providers, so be prepared for payment issues for some facilities.

Role of Medical Director

The medical director signs off on facility mandated forms, attending quarterly medical staff meetings, and covering for other attendings when not available.

APRN oversite by medical director in nursing home

 The medical director provides oversite of the advanced practice registered nurses that may be providing care in the facility. This collaboration care is mutually beneficial because the APRN can provide sick visits and alternate monthly visits.

When the APRN in the building needs to collaborate in the care of your residents, they will usually call. The APRN will usually be the first line in evaluating the resident because they are generally in the facility more often.

You can set the standard of care for your patients when it comes to APRN care. Do you want to be updated on all changes in care? How do you want them to communicate changes in care? Protocols that you would like to see followed? You can set the standard that you would like the APRN to follow and how they communicate with you.

What does a Medical doctor do in Nursing home?

 The doctor has many responsibilities when it comes to the care of their residents. When new patients come to the facility, the medical doctor will need to “admit the patient” within 48 hours. This is usually to keep the facility in compliance with Medicare rules and regulations.

The 48-hour rule can be a challenge for many medical providers who don’t want to come in to see a patient that was admitted on a Friday night and needs to be seen before Sunday.

There are requirements by Medicare for the care and frequency of visits by a doctor. These requirements are vastly different between the setting of a nursing home compared to assisted living facilities.

Do Doctors see Patients in an Assisted Living facility?

 Medical practitioners do provide care in assisted living facilities. Assisted living facilities are taking sicker patients than ever before. Many of these patients have CHF, COPD, diabetes, and multiple comorbidities.

With such ill patients in assisted living facilities, doctors willing to round in assisted living facilities are in demand more than ever before.

The only way the assisted living home makes money is if the patient is in the facility. This means if they are in the hospital, they usually don’t charge the resident. This can vary from homes, and some will still charge even if they are in the hospital or nursing home.

If they don’t return, then that means no more revenue for the facility.

Does assisted living facilities pay stipends to doctors?

Should you expect that an ALF will pay a stipend to have a doctor round in their facility? Unfortunately, most assisted living facilities will not pay stipends to doctors for becoming an attending in the assisted living facility.

Should you avoid rounding on patients in the assisted living facility? Most definitely not! You will get a higher rate of reimbursement for evaluating patients in the ALF compared to an office visit.

An established patient seen for an average level of complexity visit can collect 101 dollars from Medicare. Compare that to an office visit for the same level of care which can pay approximately 78 dollars.

Plus, the patients will be pleased that you are coming to their home to provide medical care. You will be in a relaxed environment and will be able to get a good understanding of how they live their lives.

What does a doctor do in an assisted living facility?

 A doctor will usually round twice per month, sometimes more depending on the size of the facility. You may need to go to the facility more when they get a new resident.

Rounding will entail “admitting the patient” and clearing them to stay in this setting. Many will have already been “cleared” by their PCP in the community before they arrived.

Why would a patient want to be seen at an assisted living vs. office setting?

 These residents are elderly and do not want to travel to an office if they can avoid it. Why would someone who has decreased muscle mass, or in a wheelchair want to come to a doctor’s office when they can have the doctor come to them? The answer is, they would prefer you to see them in their home setting.

The doctor will have access to their medication cabinet, list of providers, and will be able to ask questions of the nursing staff at the assisted living facility. If the patient is seen in an office, the provider would not have access to any of the above.

Cons and benefits of Nursing home and assisted living facilities:

 There can be liability risks for seeing patients in the nursing home and assisted living setting. However, there are risks for liability in all settings of medicine. Just make sure to follow guideline-based medicine and follow thru with care, and you should be fine.

There are also problems with paperwork, phone calls, and faxes. These problems will exist in all settings, but due to your mobile nature, it can be more challenging. With more apps and programs available to doctors, this is becoming less of a problem.

Commuting to the facility is a problem for some doctors. Therefore, we recommend covering facilities closer to home when possible or on the same route as your primary job.

Conclusion about doctors working in nursing homes

Doctors see patients in the nursing home and assisted living facility setting all the time. It is up to you to determine if this setting is right for you and your style of medicine. It can be a great way to supplement your income and change the pace from the office setting.

You need to determine if you want the responsibility of becoming a medical director for the nursing home (along with the stipends) or would you prefer to round on patients at nursing homes and assisted living facilities as an attending physician.

Having a doctor in the nursing home and assisted living facility is no longer an option for these facilities. They need to have a medical doctor that can provide the care that is required for these patients.

Keeping them out of the hospital is priority number two, and priority number one is maintaining the patient’s health.

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I am a Family Nurse Practitioner working in the post acute setting which includes Nursing homes, Assisted living facilities. I have worked for two other companies that provided APRNs to the nursing homes and now run a company providing APRNs in this setting. I have experience with clinical, operations, and general nursing home topics. This blog is a hobby that I use to relax after a long day working in the post acute world.

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