What Happens When a Nursing Home has No Medical Director?

According to a recent study published in the Journal of the American Geriatrics Society, that’s exactly what’s happening in close to one-third of all nursing homes. Since medical directors are crucial for training and oversight in nursing facilities, the data shows an alarming trend.

Not only do medical directors oversee the training of staff in a nursing home, but they implement policies that minimize all types of nursing home abuse and neglect.

Summary of the Nursing Home Medical Director Study

This study aimed to show how many nursing homes meet federal standards by having a medical director present at their facility. It also analyzed differences in location and the particular type of nursing home.

The researchers obtained data from the federal Payroll Based Journal (PBJ) on staffing positions as well as federal nursing home ownership and deficiencies data.

The study examined key factors to determine whether medical directors were present or absent in facilities across the country.

These 4 factors were measured:

The amount of time medical directors spend at nursing homes
Presence of medical directors in various types of nursing homes
Variations in medical director presence across states
Overall deficiencies for director violations

By analyzing that data over a period of six years — from 2017 to 2023 — researchers were able to show a significant decrease in nursing home medical directors. They also showed that less than 70% of nursing homes even had a medical director.

Learn about the findings and how they may affect your loved one in a nursing home.

Differences Among Types of Nursing Homes

The researchers uncovered an interesting distinction between for-profit, government-owned, and nonprofit nursing homes.

Here are the key differences between the types of nursing homes:

For-profit facilities reported a director is on staff 61.4% of the time.
Government-owned facilities reported a director on staff 66.5% of the time.
Nonprofit facilities reported a director was on staff 71.3% of the time.

For-profit nursing homes reported the lowest rate of medical director presence. As businesses, these facilities may face financial pressures that could influence staffing decisions, including the presence of a medical director.

For those seeking a nursing home for a loved one, the data suggests that government-owned and nonprofit facilities are more likely to meet staffing requirements, including having a medical director on staff, compared to for-profit facilities.

The Reason for a Decrease in Directors

Despite federal and state regulations requiring nursing homes to have a medical director on staff, one-third of facilities still fail to comply with this mandate.

The most obvious reason is nursing homes can save significant money by not hiring a medical director, which is an executive position that generally earns a high salary.

Unfortunately, the lack of federal oversight mentioned in the study does little to address this problem. Until federal regulators take the issue seriously, some facilities will continue cutting corners to save money, leading to substandard care.

Limited Presence of Medical Directors in Nursing Homes

Another key finding involved the amount of time medical directors were present in a nursing home. In such cases where a director was present, most nursing homes reported that they were only at the facility for an average of 36 minutes per day.

Having a medical director present for such a short time suggests that nursing homes are trying to save money by barely meeting the federal requirement. While they do have a director, they aren’t on location long enough to make a substantial difference in the residents’ care.

Implications for the Future

The key takeaway of the study is that nursing home owners are cutting costs by neglecting to hire a medical director at their facility. What’s worse, the problem is not being enforced. Only 0.2% of nursing homes receive deficiencies for failing to meet requirements.

As for the low rate of regulatory enforcement, this problem will only improve in the future if the federal government follows through on its policies. Currently, nursing home owners know they can get by without meeting standards, so tightening down on enforcing this regulation is essential.

“Though medical directors have a critical role in overseeing clinical care, some nursing homes report no medical director time and those that do report about 4 h per week. Together, these findings may indicate the need for improvement.”

– Dr. Eric L. Goldwein MPH, author of study on medical director presence

What Does a Medical Director Do?

The medical director’s presence in a nursing home improves the standard of care and helps to prevent nursing home abuse.

In a nursing home, medical director job duties include:

Ensuring compliance with current medical standards
Establishing care protocols
Overseeing resident care

The medical director serves as the authority on all medical policies, training, and care that takes place within a nursing home. Without a qualified medical director, many problems that directly affect the residents can arise. This includes increases in errors, abuse, and neglect.

What Is the Impact of Having No Medical Director?

A nursing home medical director fills an indispensable role. Without their leadership, residents are more likely to experience inadequate care and other challenges.

Learn more about medical director duties in a nursing home and what issues can be caused by their absence.

Poor Quality of Staff Training

Training staff on the proper way to care for residents is one of the most critical responsibilities of a medical director. With high turnover rates and understaffing in most nursing homes, the absence of a director means many employees may lack consistent medical training.

A loved one in this type of facility may not receive even the most basic medical care. With poorly trained staff and no authority to oversee medical practices, the quality of resident care may suffer.

Staff that aren’t trained well are also likely to have a more difficult time identifying and reporting abuse and other problems in the nursing home.

Higher Risk of Medication Errors

One of the responsibilities of a medical director is to ensure all medication is handled and administered properly. It’s their job to implement policies on how to store medication and ensure that every resident receives their correct dosage at the exact time they need it.

A lack of a medical director means medications are being given by employees who don’t have the experience or knowledge to provide them properly. This is a huge liability issue for a nursing home and could be a matter of life and death for the residents who live there.

Residents Receive Substandard Care

Part of the value of having an authority figure in a nursing home is inspiring other employees to abide by their standards. The presence of a medical director typically makes employees strive to work toward their standard of care.

However, when there is no medical director, poorly trained employees are left to deal with residents in whichever way they see fit.

This results in a vastly diminished standard of care. With untrained workers left unsupervised, they will be that much less likely to spot signs of abuse or neglect.

Does Your Loved One’s Nursing Home Provide Quality Care?

In light of this study, anyone with a loved one in a nursing home should consider whether the facility provides high-quality care. Plus, for those looking for a nursing home, the study shows the importance of finding a facility that has a medical director on staff.

If your loved one is in immediate danger, call 911. For other concerns about possible abuse or neglect, the Nursing Home Abuse Center can help guide you on next steps.

Get a free case review right now. We may be able to help secure the compensation and justice your family deserves.