Medical Practice in Long-Term Care Facilities

Liang-Kung Chen, MD
Center for Geriatrics and Gerontology, Taipei Veterans General Hospital
National Yang Ming University School of Medicine

  Population aging is a global phenomenon. Both developed and developing countries are facing similar challenges from this phenomenon. In an aged society, long-term care services are of great importance. Long-term care is composed of various services to compensate the long-term care needs for older people with certain disabilities. Traditionally, long-term care services are mutually supported by health care sector and social care sector. Nevertheless, medical conditions occurred in the care homes (or so-called long-term care facilities) are extremely difficult to manage due to a number of possibilities: (1) the lack of on-site physicians (2) laws regulating health care practice in different settings (3) the lack of sufficient laboratory and imaging equipments (4) the lack of sufficient knowledge for physicians to properly look after care home residents, and (5) the lack of seamless service delivery from long-term care to acute care settings.

  Common challenges for physicians to practice in long-term care settings include (1) re-setting treatment goal for individual care home residents (2) effective and efficient diagnosis of disease (3) infectious control (4) chronic disease management (5) effectiveness of preventive services, (6) pain assessment and management for each resident, and (7) malnutrition. Most care home residents were treated by community general practitioners, but general practitioners lack appropriate geriatric medical training in the specialty training program. Moreover, physicians practice in the care homes need to provide accurate onsite clinical diagnosis and provide feasible treatment from the care home residents.

  To conclude, medical practice in the long-term care settings is completely different from traditional medical practice in the communities. More attentions should be paid and more continuing medical education should be provided.