Though all nursing homes must have a medical director under federal law, a new study shows that some nursing homes don’t meet the requirement. Facilities that do have a medical director report that the medical director spends just a few hours per week on site, according to the study.
Medical directors are charged with overseeing medical care. They manage resident care policies and procedures to align with current standards of practice, including infection control protocols, educational programs and performance reviews for healthcare workers.
The report was published on Monday in the Journal of the American Geriatrics Society. The authors reviewed the practices of nearly 15,000 nursing homes in the United States, using federal Payroll-Based Journal (PBJ) data on staffing positions for the period of 2017–2023, as well as federal nursing home ownership data and deficiencies data for 2023.
Of nursing homes reporting data, 36.1% didn’t have a medical director presence during the first quarter of 2023. (For reference, about 28% of nursing homes didn’t have a medical director in 2018.) Medical director presence fluctuated between 2017 and 2023, but steadily declined over the past four years. Nursing homes that did have a medical director in that time frame reported that the professional was on the payroll for an average of 36 minutes a day or 4.2 hours per week — that’s less than one minute per resident per day.
The presence of medical directors varied by the state the nursing home was in and who owned it. For example, 61.4% of for-profit nursing homes reported a medical director presence compared to 71.3% of nonprofit nursing homes and 66.5% of government facilities. In just 0.2% of cases, the nursing homes were cited for regulatory deficiencies for not meeting medical director requirements.
“It is unknown whether some nursing homes do not have medical directors, in violation of the regulations, or whether nursing homes are simply not reporting medical director time. Potential reasons for failure to report time include that nursing homes have not established mechanisms for obtaining and reporting the data from medical directors as required or that medical directors are not cooperating with the reporting requirements,” the authors wrote.
