More specialized nurses, physician assistants providing nursing home care

The number of specialized nurses and physician assistants in the US classified as “skilled nursing facility specialists” providing nursing home care services has almost doubled to accommodate more aging patients while the number of doctors in nursing homes has dropped, a recent study shows.

The benefit of this trend is not clear, according to the authors.

“Medicare was created more than 40 years ago around farmers who had problems with access to hernia care. Now our focus is on frail older women with chronic illnesses,” said lead author Dr. Joan Teno of the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle.

“The patients often have functional impairments and need skilled help,” she told Reuters Health by phone. Patients also need coordinated care because for each new chronic illness, they often meet new doctors and specialists, which can lead to medical errors, lack of coordination and inefficiency, Teno explained.

“Our current system supports silos of care,” she said. But now healthcare policy experts are pushing for programs that coordinate care, provide consistent staffing for older patients and train nurses for geriatric care.

“What we’re seeing is an emerging set of programs targeting this older cohort. It’s important to start asking what’s best for the patient and family instead of the system.”

Teno and colleagues used national Medicare Part B claims from 2007, 2010 and 2014 to identify trends in the numbers of physicians, nurse practitioners and physician assistants working in nursing homes or skilled nursing facilities.

The research team found that the proportion of physicians who had ever billed for care delivered in these facilities fell from 13.7% to 9.8%. Although the number of physicians classified as skilled nursing facility specialists rose from 1,496 to 2,225, that represented an increase from just 0.3% of all physicians to 0.5%.

Nursing facility specialists nearly doubled in number from 1,678 to 3,074 during the study period, but because more people entered these professions in general, that did not represent an increase in the proportions specializing in nursing home care.

The proportion of total billing for care at skilled nursing facilities by non-doctor specialists rose from 22% to 31.5%, though this varied by state, the authors note. It reached nearly 50% in Delaware, Hawaii, Tennessee, Connecticut and Massachusetts.

Teno said the need for geriatrics or palliative care today would still not be met even if the training in medical schools was ramped up by several factors.

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