The Nursing Home Medical Director

ong-term care for the elderly and disabled poses a difficult and complex problem for the health care system. In 1985, although total Medicare L expenditures were over 71 billion dollars, only a small fraction of this was spent on nursing home costs.' The majority of the 35 billion dollars spent on nursing costs were paid by private sources (5 1 %), with Medicaid paying for 41.8% and Medicare 1.7%. By 1990, nursing home costs are projected to be 54.5 billion dollars and by the year 2000,129 billion dollars.2 The expanding need for long-term care can be attributed to several factors. These include the aging of our society with increasing life expectancy, as well as the chronic nature of disease states so commonplace in the elderly. Also, as Somers3 points out, the "shrinking American family" contributes to this problem. Factors leading to less available direct care include more women in the labor market, less children being born, and families being more mobile. The care of the nursing-home population presents a special challenge for physicians who are primary caretakers for these often-neglected patients. Because of this, physicians must energetically and effectively assume a leadership role in nursing homes as medical directors. This paper is intended to describe the physician's role as medical director of the nursing home.