How Medical Directors Shape Nursing Home Policies & Care
Who really sets the tone for care in a nursing home? Medical directors have a major role in shaping policies that impact every resident’s safety and health. Their decisions can influence staffing, treatment plans, and emergency protocols. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Ashley Moreau to talk about the influence of medical directors and how their leadership—or lack of it—affects the quality of care.
Moreau:
So if he’ll participate in that meeting and give input and provide interventions and guidance with policies and with the different interventions for each area. They have a high falls incident rate that month or wounds are developing on certain hall.
Intro
Schenk:
Hello out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I will be your host for this episode. Today we are talking about the role of the, I don’t know if you heard that noise or not. The role of the medical director in the nursing home, and of course the medical director is a position at that nursing home that is required under the Federal Code of Regulations facility must designate a physician to serve as a medical director. I have that memorized. I’m not just looking at it on my computer screen, but we’re not having that conversation alone. Absolutely not. We had the fantastic Ashley Moreau on to walk us through this process.
As I mentioned, we’re talking about medical directors and what they do. We’re not doing that alone. We have the fabulous Ashley Moreau. Ashley is a registered nurse with 19 years of experience, primarily in long-term care and nursing homes.
She advanced from bedside roles to leadership, mastering staff training, care planning, and infection control. Since 2018, Ashley has worked as a Certified Legal Nurse Consultant, offering expert reviews testimony and deposition support in nursing home litigation. She also provides onsite risk assessments and mock surveys, combining clinical expertise with a strong focus on quality and compliance.
For legal nurse consulting services focused on elder care litigation, visit Moreau Legal Nurse Consultants.
And we’re so happy to have her here today. Ashley, welcome to the show.
Moreau:
Thanks for having me.
Who is the medical director?
Schenk:
Everybody gets a softball question right up front, and so Ashley, your softball question is to lead off the show, what or who is the medical director in a nursing home?
Moreau:
The medical director is the chief healthcare professional of the facility. He is the primary care physician of the residents in that home.
Schenk:
So what’s the difference then between a medical director and the attending physician?
Moreau:
The attending physician is not usually a profession In the nursing home, the attending physician, that title would be covered by the medical director. So it’s not necessarily a separate person.
In Episode 210: Assisted Living Facilities – Understanding Long-Term Care Options, we help families navigate placement decisions.
Schenk:
Okay, so the medical director could be an attending physician?
Moreau:
Yes.
How do medical directors influence policies in nursing homes?
Schenk:
Okay. And let’s put the medical director hat on as opposed to attending physician or anything else. So what role does the medical director have with respect to perhaps policies and procedures as it pertains to nursing care or medical care in that nursing home?
Moreau:
The nursing home will provide their own policies. Usually it’s done by a corporate nurse. If it’s a chain nursing home, they have their policies already in place and they just tweak them to fit that individual nursing home. Where the medical director comes in is they use his expertise in healthcare to marginalize and set specific criteria for different areas like a fall.
He may want to or I think it’s warranted for every resident that is on an anticoagulant, if they fall, that they should go out to the hospital or if a resident falls and they have a head injury, that he wants neuro checks on a specific timetable, like every 15 minutes for one hour or two hours. So they’ll use his medical experience. Set certain criteria for those policies.
A new analysis explores interdisciplinary collaboration in long-term care on the impact of preventive health measures in elderly populations.
What role do medical directors play in reducing hospitalizations?
Schenk:
And how, I guess a question I would have logistically is is the medical director somebody that is on site every day? Is it once a month typically? And I know that it’s different from facility to facility. But in general, in your experience, is this an individual that’s nine to five every day in that nursing home?
Moreau:
Absolutely not. In fact, it’s the opposite. The medical director usually has a private practice. Or their own staff at a hospital, and this is something extra. However, he has his own practice, his own clinical team that he uses, and those medical professionals, whether it be a pa, another physician or nurse practitioners are in the facility. Much more than he’s.
This study reviews how discharge planning affects nursing home outcomes on the impact of preventive health measures in elderly populations.
How do they balance clinical care with administrative duties?
Schenk:
How is it that the policies or the kind of the interventions that the medical director wants to put in place in that nursing home trickles down to the nursing home? Is this is the in, is the medical director having CLEs or not? CLEs? That’s what we have. Ces like in services and things like that. How do we get from the brain of the medical director to boots on the ground in the nursing home?
Moreau:
Nursing homes are required to inservice staff every month in addition to specific topics that they have to cover. They can include these new policies. Say there’s a new policy about abuse. They’ll inservice all staff on that new policy at the time.
Review the federal requirement for facility administration in 42 CFR § 483.70 – Administration.
What are common ethical dilemmas medical directors face?
Schenk:
Are there any, in your experience, are there any kind of ethical dilemmas with respect to medical directors and being the medical director at a nursing home?
Moreau:
Not necessarily being the medical director, but the medical director has to attend to most of those ethical dilemmas. There is a lot in healthcare.
Nursing homes have unique dilemmas that you have. Are supposed to have advanced directives when they come into the facility. Some of them choose not to make a decision at the time, or they wanna talk to their family or discuss it. That needs to be taken care of immediately. So those healthcare directives are passed down to other staff, so staff know what to do in case of, so that can be an ethical dilemma.
The Role of a Nursing Home Attending Physician explains how physicians impact care planning and continuity.
They also have antipsychotics that they need to deal with. CMS requires that nursing homes try to reduce. Sometimes it does not work. Sometimes that’s not in the best interest of that resident. It doesn’t provide quality of life. It actually has a negative outcome for them. So the medical director will deal with a lot of family issues as well as clinical dis issues.
This article discusses infection control procedures in skilled nursing environments on the impact of preventive health measures in elderly populations.
Schenk:
Typically, how does the medical director become aware of whether or not a policy needs to change or a policy needs to be made to begin with? Are they in, regular communication with the DON or with the attending physician? If there’s a, if it’s a different person, like how does that how do they know what to do?
Moreau:
They’re always in communication with the facility. And it can be a nurse on the floor. It can be the DON, it could be the administrator, it really can be anyone. Those problems will pop up and things will be communicated to the physician. And, the policies will need to be changed or tweaked or updated, and that happens a lot. But communication is a key factor. Everything should be documented and the. The medical director will have access to that at all times.
Explore the early evidence linking facility size and staffing to quality measures on the impact of preventive health measures in elderly populations.
How do medical directors handle end-of-life care decisions?
Schenk:
How do hand, how do medical directors go through whatever, however they, whatever the role calls for, whether it’s driving the policies or being at the facility, how do they handle end of life care decisions?
Moreau:
End of life care. Is guided by the residents wishes, their advanced directives, what they said in advance. I wanna be a full, I wanna be a d. The medical director is guided by the resident wishes in that form. So if a resident says, I wanna be a full code the medical director is more aggressive with his care.
Do Not Resuscitate: Facts in Nursing Homes outlines how DNR orders are implemented and sometimes ignored.
Okay? If a resident is doing poorly, they need to be sent out. They need more, more acute care than what we can provide here. They need more aggressive treatment. Now this resident that’s chosen to be a dnr, they don’t wanna go to the hospital. They don’t want aggressive treatment. They already have in the back of their mind, they don’t wanna peg to or things like that. They just want to be comfortable. So the medical director is led by what the wishes of that resident is.
Operators should consult our facility guide to meeting Georgia’s assisted living regulations.
What strategies help medical directors improve nursing home standards?
Schenk:
What are some strategies in your experience that can help the medical director improve the overall quality of care and standards at a particular nursing home?
Moreau:
The medical director can impact the facility by educating staff immensely. If he is, or she is an individual that is willing to communicate and educate staff each time they come into the building, it’s a fantastic win for that facility and for the residents there. They can also participate in quai, which is quality assurance performance improvement. It’s a meeting that the department has every quarter.
During COVID, a lot of things changed and they moved. Most facilities move that up to every month, and that’s fantastic because if you have a problem, you don’t wanna wait three months to make sure it’s, the interventions are working. You wanna make sure the interventions are working. Pretty quickly so you can change them if they’re not.
Episode 204: Who Are the Governing Body of a Nursing Home? explores the legal responsibilities of facility leadership.
So he’ll participate in that meeting and give input and provide interventions and guidance with policies and with the different interventions for each area, whether it be they have a high falls incident rate that month or wounds are developing on certain halls. It can help guide that those outcomes could be improved.
Legal concerns around COVID-19 outbreaks are discussed in this coronavirus nursing home liability article.
Schenk:
Any thoughts about communication between the medical director and the nursing home?
Moreau:
Sure. I wanna say that with communication and the medical director, if you have someone that is willing to educate staff and constantly stay in communication with staff, residents and their families, it’s a fantastic way to find residents.
Understanding Pressure Ulcer Staging – Episode 135 breaks down staging categories and legal implications in wound care claims.
Healthcare dramatically improves when there’s a good communication line between the physician. Staff and the residents’ families, and they all feel like they can communicate well together.
Families often ask who regulates nursing homes in Georgia? This blog breaks down federal and state oversight.
Schenk:
Very well said. Ashley, we really appreciate you coming on the show and sharing your knowledge with us today.
Moreau:
Thank you for having me,
Schenk:
Folks. I hope that you found this episode educational. If you did, please be sure to like and subscribe wherever you get your podcast from. If you have an idea for someone that you would want me to talk to, please let me know. If you have an idea for a subject that you would like for me to talk about.
Let me know that as well. New episodes of the Nursing Home Abuse Podcast. Come out every single Monday for now and be sure not to enter the contest to win. A Nursing Home Abuse Podcast, coffee mug. There aren’t a lot of how many, I’m trying to think about this. If you excluding Jason Statham and Bruce Willis, and to some extent Billy Zane, who are the other bald action stars?
I guess you have to go back a little bit further in time. Who was the guy? Was it Tony Sava? What was he? He was big in the seventies, I think. I don’t know that. That’s a little bit before my time, but I can’t think of any other, so really, it’s literally gonna be Bruce Willis or Jason Statham. Those are the only two options that you have, and I guess with that folks.
We’ll see you next time.
Ashley Moreau’s Contact Information: