Annals of Long Term Care

Comprehensive Interdiscipilinary Geriatric Assessment has been shown to be associated with mixed outcomes in various clnical settings.1 However, studies evaluating Comprehensive Interdisciplinary Geriatric Assessment in the long-term care (LTC) setting are nonexistent. A very similar process in the nursing home (NH) setting involves the Interdisciplinary Care Plan process, which must be performed on admission, quarterly, and with acute change of condition of the patient. Federal regulations indicate that a facility must develop a comprehensive care plan for each resident. It must include measurable objectives and timetables to meet needs determined by the comprehensive assessment to achieve the resident’s highest practicable well-being.2

Traditionally, membership of the NH interdisciplinary team includes nursing, dietary/nutrition, social service/case manager, rehabilitation (physical, occupational, and speech therapy), wound care, and the care plan/MDS coordinator. The process of care plan development and specific issues addressed are based on the Minimum Data Set (MDS), a huge data set of demographic, physical, cognitive, functional, and nutritional parameters, as well as geriatric syndromes (falls, urinary incontinence, dementia, delirium) and the use of chemical and physical restraints.

The rationale or assumption for the use of care planning for the frail, advanced-age NH population includes the following: that this population is characteristically plagued with multiple chronic and comorbid illnesses and geriatric syndromes; that the provision of care is time-consuming when done in isolation; that these residents require the expertise of each member of the team—medical, nursing, social service, rehabilitation, dietary/nutrition, activities, and wound care; and that the best approach to care is an interdisciplinary one that will result in the highest quality of care possible.1,3

Medical directors and primary care physicians traditionally have not attended regular meetings of the interdisciplinary care team, in part due to the busy nature of physicians’ schedules, the time element involved, and the lack of reimbursement for this activity. They may also perceive the issue of care planning as mostly a nursing issue. Other possible reasons may be lack of expertise and training regarding geriatric syndromes and comprehensive geriatric assessment.4 Though a federal regulation indicates that nursing homes must have a designated medical director, there is no associated state regulation regarding reimbursement.

However, the role of the medical director in the NH setting has received increased attention in the last several years with the revision of the Medical Director F-Tag that expands the role. CFR §483.75(i).2 F-Tag 501 indicates that the medical director is responsible for implementation of resident care policies and the coordination of medical care in the facility.