What type of physician, such as a primary care physician (PCP) or geriatrician, fills out an assisted living facility resident health assessment?

Who Fills Out an Assisted Living Facility Resident Health Assessment

The initial clinical evaluation of an assisted living facility resident health assessment should be performed by a physician, physician assistant, or advanced-practice nurse, following a three-tiered approach that begins with certified nursing assistants (CNAs) and on-site nurses. 1

Recommended Assessment Hierarchy

The Infectious Diseases Society of America guidelines recommend a structured approach to resident assessment in long-term care facilities:

1. First Tier: Certified Nursing Assistants (CNAs)

   • Responsible for measuring vital signs (temperature, heart rate, blood pressure, respiratory rate)
   • Should immediately report suspected infections or abnormal vital signs to on-site nurses 1
   • Often have the first opportunity to assess residents but may not accurately identify infections 1

2. Second Tier: On-Site Nurses (RNs/LPNs)

   • Perform initial clinical evaluation regarding possible sites of infection
   • Communicate findings to the responsible clinician 1

3. Third Tier: Physician, Physician Assistant, or Advanced-Practice Nurse

   • Makes final assessment and decisions regarding further evaluation 1
   • Responsible for documenting the full extent of clinical evaluation 1
   • Should record reasons if specific diagnostic measures are withheld 1

Evidence Supporting This Approach

Guidelines from the Infectious Diseases Society of America clearly state that the initial clinical evaluation should involve this three-tiered approach 1. Studies have shown that geriatric nurse practitioners (GNPs) can enhance identification of acute medical problems and improve activities of daily living, nursing therapies, and drug treatments compared to facilities without GNPs 1.

Research has demonstrated that facilities with nurse practitioners/physician assistants (NP/PAs) were associated with lower hospitalization rates for ambulatory care-sensitive conditions (AOR=0.83) 2, suggesting their effectiveness in resident assessment and care.

Common Pitfalls in Resident Assessment

1. Inadequate Evaluation: Studies suggest that fever and infections are often inadequately evaluated or documented in long-term care facilities. In one study, only 21% of residents with infection were "appropriately" evaluated 1.

2. Lack of Physician Involvement: In some cases, 17% of residents were not examined before antibiotics were prescribed 1. Facilities with more physician involvement showed quicker response to residents with fever and more thorough assessment 1.

3. Failure to Document: The full extent of clinical evaluation should be documented as part of the medical record. If specific diagnostic measures are withheld, the reasons should be recorded 1.

Factors Affecting Assessment Quality

Several factors can influence the quality of resident health assessments:

• Facility Type: Hospital-based nursing homes (with more physician involvement) tend to have more thorough assessments than community-based nursing homes 1

• Resident Characteristics: Residents with dementia, those in larger facilities (>150 beds), and those in urban facilities are more likely to receive inadequate medical evaluations 1

• Advance Directives: These significantly impact the extent of evaluation, with "comfort care only" residents receiving less evaluation and treatment 1

By following this structured three-tiered approach with appropriate documentation, assisted living facilities can ensure proper assessment of residents while maintaining quality of care and potentially reducing unnecessary hospitalizations.