A recent article in the Chicago Tribune examines the roles physicians play in nursing home care, particularly when it comes to medication management. When physicians or psychiatrists prescribe a drug for a patient, facilities must administer it as long as the order is consistent with state and federal nursing home regulations. If inspectors determine a violation occurred, they cite the nursing facility, not the doctor.

“There’s no downside for the physicians” who order inappropriate psychotropics, said Robert Hedges, a former regulator with the Illinois Department of Public Health who now co-owns five nursing facilities.

The Tribune found that inspectors documented many cases in which doctors prescribed powerful antipsychotic drugs without adequate justification or in doses that were too high.

It points to a larger issue that people do not often think of before and after a loved one is admitted to a facility – your physician choice. In most cases, your primary care doctor probably does not make house calls or visit long term care facilities. For residents unable to leave the facility for physician appointments that poses a dilemma as often they and their families must choose from a list provided by the nursing home. As the article points out that can often have dire consequences.

So if a loved one needs to enter a long-term care facility, add this issue to your list of things to investigate. How will your loved one access physician care? Who are these physicians? Do you have a choice? Can you find one on your own? Be sure to do your homework on the quality of physicians the facility offers. There are online tools to assess physician quality.