The Nursing Home Physician IMPACT model at Ocean View Manor Society has positively affected satisfaction as residents and families report very high satisfaction with this model of care. Fee-for-service physician care does not always allow time for resident and family meetings. However, this new model assures that residents and families get one-on-one time with their physician on a regular basis. Clinical staff members were highly satisfied with working with only one physician versus several as is the case in a fee-for-service model. The physician was also satisfied with their quality of work life in terms of having consistent work hours, no overhead, and having the support of a team of health care providers on a regular basis. Ocean View Manor has involved the physician in planning and implementing best practices in areas such as the prevention of constipation, end of life care, promoting continence, oral care, managing osteoporosis, and addressing responsive behavior. Impact on the larger system has meant decreases in hospital transfers, lower lengths of stay in acute care (for Ocean View Manor residents), and the ability to work more collaboratively with physicians in discharge planning. Decreased costs per resident per year were also noted (versus a fee-for-service model). This practice is the first in Nova Scotia, if not the first in Canada. Ocean View Manor researched alternate medical practices in other countries to determine what model was required given the changing needs of residents coming into long term care coupled with a shortage of fee for service physicians. The Physician is salaried and a full time presence at OVM. The full time physician works differently than fee for service physicians in that: • The physician attends all care conferences for residents. • The physician is a regular team member of clinical committees. • The physician provides regular meetings with families. • The physician is an active participant in planning for end of life care (care pathways). • The physician provides education for staff in areas such as falls prevention, infection control, pain management, palliative care, etc.
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