DAL: NH 11-13 -- Guidelines on Medical Direction and Medical Care in Nursing Homes

January 20, 2012

DAL: NH 11-13

RE: Guidelines on Medical Direction and Medical Care in Nursing Homes

Dear Administrator:

This letter announces a best practice: Guidelines on Medical Direction and Medical Care in Nursing Homes. These are process guidelines (they are not clinical guidelines) and incorporate federal and New York regulatory requirements. They lay out the roles, responsibilities and accountabilities of medical directors and attending medical practitioners (physicians, nurse practitioners and physician assistants) in nursing facilities. Implementation is voluntary and strongly encouraged. We offer these guidelines to you for several reasons. If appropriately implemented, they will:

  • Help you and your medical director, attending practitioners and nursing staff provide optimal medical care, leading to better health and quality of life outcomes for residents which in turn produces:
    • greater resident and family satisfaction;
    • greater staff satisfaction with and pride in the quality of care they provide;
    • an enhanced reputation in your community for providing high quality care; and
    • fewer emergency room visits and hospitalizations.
  • Help your facility to provide the quality care and positive health outcomes that all stakeholders demand.
  • Help your facility define performance expectations sought by the Medicare Advantage Plans that enroll your residents.
  • Strengthen your facility's capacity to function effectively and successfully in health care reform both in: (a) Medicaid's managed care environment, and (b) Medicaid's and Medicare's coordinated and integrated care environment.

We partnered with the NY Medical Directors Association, convening a stake holders group to develop the guidelines over the course of the year beginning June, 2010. This group included medical directors, attending practitioners and administrators, provider associations (LeadingAge NY (formerly NY Association of Homes and Services for the Aging), Healthcare Association of NYS, NY Health Facilities Association and Continuing Care Leadership Coalition), Board of Examiners of Nursing Home Administrators and Medical Society of the State of NY. A special effort was made to ensure that rural nursing homes and their unique circumstances were represented. The development work group, having met its charge, has been disbanded. A new work group has been created to plan the "roll out" of the guidelines, including training for your leadership team on the guidelines and related topics. Associations representing nursing homes are on this work group.

This initiative, like the Gold STAMP initiative, provides you with valuable tools and resources that can transform your nursing facility's response to the extraordinary forces that are reshaping the nation's and New York's health care environment. We urge you to share the guidelines with your leadership team and begin the discussion of how to implement them.

Yours truly,

Jackie Pappalardi, Director
Division of Residential Services