Abstract

Background: As long-term care is a responsibility of Länder governments in Austria, Länder are free to choose the mode of providing medical care in nursing homes, and different forms have been implmented in course of time.

Objectives: Across high-income countries, medical care in nursing homes is organized in different ways. I want to derive recommendations for Austria, how medical care in nursing homes could be organized in times of looming shortages of physicians, austerity and constant discussions about the quality of nursing care in care homes.

Methods: After a short summary of the literature, I compare organizational aspects of medical care in nursing homes in four countries: Austria, Germany, Netherlands, USA, and discuss these aspects in the respective national context.

Results: There is large international variation among nursing homes regarding morbidity of inhabitants, how their medical care is organized, and which education/specialization of physicians is required for practicing in nursing homes. Only the Netherlands introduced a specific nursing home specialist, but meanwhile replaced it with a more general specialist for medical needs of older people. Evaluations of medical care are rare and if available, mostly concentrate on avoided transfers to hospitals.

Conclusions: The literature does not support that nursing homes in general should provide medical care via employed nursing home physicians, a claim which also would be hard to support due to expected capacity shortages in the medical workforce. The literature does support, however, that physicians with sound geriatric background provide medical care for the inhabitants on a regular basis in a well-structured framework. Different forms are possible in exactly which way such care could be organized. Two forms existing already in Austria seem worth mentioning, äKo and GEKO, but considering rural capacities one should also think about the possibilities offered by telemedicine. Currently, however, general funding of telemedical doctor visits via health insurance has been implemented neither in Germany nor in Austria.