Easing the strain. The physician and the long-term care facility should work together to improve patient care.

Numerous regulations, inadequate reimbursement, and poor communication can strain the physician--long-term care facility relationship. Three major roles define the physician's responsibilities in the nursing home: care giver, communicator, and complier. Although the physician's roles in the nursing home may be similar to those in an office practice, they can be complicated by a number of factors. Many professionals, such as the nutritionist, social worker, and pharmacist, care for the nursing home resident. The physician thus loses some control over the patient's care. Communication barriers, such as the nursing home's misinterpretation of federal regulations, can frustrate both the physician and the facility's medical staff. This can lead to suboptimal patient care. Nursing homes must ensure that they keep physicians who treat residents abreast of facility regulations and federal and state guidelines. Although a physician may want to continue providing care to a patient who has entered a long-term care facility, he or she may find it necessary to transfer care to the medical director or house physician. Often the time and distance a physician must travel prohibit the physician from giving patients the high-quality care to which they are entitled.