Attending Physician in a Nursing Home Setting

Personal Health Communication, Transfer of Care, Coordination of Care.

Licensed Physician, Licensed Nurses, Pharmacist, Social Worker, Dietician, Skilled Therapists, Restorative Nursing Staff, Activity Staff, Consultants - Wound Care Specialist, Psychiatrist

Dr. D has a case load of 20 residents at the local Nurisng Home. Some of these residents have been patients of his for a number of years and he is well versed in their medical condition(s). Others, are new to him at the NH. They have either relocated to the area to be closer to family, did not have a regular physician prior to admission or their regular primary care physician does not follow patients at this NH.

For residents not known to Dr. D, on admission he requests the health information department to access the patient's prior medical records from previous care providers, hospitals etc. Dr. D. also meets with the family to get a complete picture of the patient's prior health status and concerns.

Dr. D sees his residents at the nursing home on a regular basis (as required by State and Federal regulations) and as needed. Dr. D is required to coordinate the care of his residents at the NH, but relies heavily on the clinical staff to keep him apprised of changes in condition. The nursing staff monitor the resident for changes in physical condition, response to medications and report on accidents/incidents. The social work staff meet regularly with the resident to assess mood/behavior/mental status changes. The dietician follows the residents meal intake and makes recommendations for changes to diet and nutritional supplementation. Many other staff may be involved in the care and treatment of the residents at the NH depending on the individual resident's health condition (see Use Case Actors).

Dr. D. is responsible for overseeing all of the care and treatment that the resident receives at the NH.