The medical structure of a nursing home, or skilled nursing facility, differs significantly from a hospital’s acute care setting. Nursing homes provide 24-hour skilled nursing care for long-term support or short-term rehabilitation. While doctors are not typically full-time, physically present employees, federal regulations mandate physician oversight and availability. Medical care is managed through a system of external attending physicians, on-site nursing teams, and an administrative medical director.
The Attending Physician: Oversight and Visits
The primary medical relationship for a resident is with their Attending Physician, who acts as their personal doctor within the facility. This physician is usually not an employee of the nursing home but must be credentialed to practice there. Residents generally have the right to choose their own Attending Physician, who manages their overall medical condition.
The Attending Physician is responsible for writing admission orders, developing the initial comprehensive assessment, and overseeing the resident’s total program of care, including medications and treatments. Federal requirements specify a minimum schedule for visits. The physician must see the resident at least once every 30 days for the first 90 days after admission, and then at least once every 60 days thereafter. During these visits, the doctor must personally review the care plan and document progress notes to ensure the ongoing appropriateness of the medical regimen.
Round-the-Clock Medical Staffing
Although physicians are not physically present 24 hours a day, skilled nursing facilities must maintain round-the-clock licensed nursing coverage. Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are the frontline staff, providing direct care and monitoring residents’ conditions. Federal guidelines require an RN on duty for at least eight consecutive hours daily, and either an RN or an LPN must be present 24 hours per day.
Nurses communicate primarily with the Attending Physician regarding changes in a resident’s condition. Non-physician practitioners, such as Nurse Practitioners (NPs) or Physician Assistants (PAs), often visit the facility and may alternate required visits with the Attending Physician. When urgent medical issues arise, the nursing staff contacts the Attending Physician or the backup physician on call for immediate orders.
Administrative Medical Leadership
Every skilled nursing facility must designate a physician to serve as the Medical Director. This physician rarely provides direct care to individual residents; instead, their focus is on the overall quality of medical care and clinical policy within the facility. The Medical Director implements resident care policies and coordinates the medical care provided to all residents.
The role includes overseeing medical protocols, ensuring compliance with federal and state standards, and working with administration on quality assurance activities. The Medical Director acts as a resource for the nursing staff and helps resolve conflicts or issues that arise with Attending Physicians. The Medical Director ensures the environment supports appropriate medical practices for the facility’s complex population.
Accessing Specialized and Crisis Care
Beyond the routine primary care provided by the Attending Physician, nursing homes coordinate access to a variety of specialized medical and rehabilitation services. These services often include physical, occupational, and speech therapies provided on-site by licensed personnel. Facilities also arrange for specialized services such as:
- Podiatry
- Dental care
- Mental health counseling
- Hospice or palliative care
For medical emergencies or acute illnesses requiring a higher level of care, the nursing staff contacts the Attending Physician for orders. This often results in a transfer to a hospital Emergency Department. The facility coordinates the resident’s transfer and provides the hospital with the necessary medical history and treatment plan.