Grants fuel Center for Health Law and Policy study

A study at the SIU School of Law is examining causes of a nationwide shortage of physicians who care for nursing home patients.

The law school's Center for Health Law and Policy recently received grants from the Commonwealth Fund and The California Health Care Fund for the study.

Marshall B. Kapp, the law school's Garwin Distinguished Professor of Law and Medicine and co-director of the Center for Health Law and Policy, is the project's principal investigator.

The two foundations are finding "it's getting harder and harder for nursing homes to attract physicians to come into their nursing homes and care for their patients," Kapp said. "They are looking for reasons that doctors are reluctant to come into nursing homes to treat patients, and hopefully come up with some solutions for remedying the problem."

Kapp's background is health law and medical ethics, and much of his work focuses on legal and ethical aspects of health care for older people in acute care and long-term environments.

Malpractice litigation risks against physicians and nursing homes have "increased substantially" in the past decade, resulting in higher insurance premiums, if insurance coverage is even available, he said.

"Up until five to 10 years ago, doctors almost never got sued relating to their treatment of nursing home patients. Nursing home residents and their families almost never brought lawsuits," Kapp said. "In the last five to 10 years, that has changed to the point that a substantial number of lawsuits are being filed — not just against nursing homes but, we think, and this is what the study will look at, also against physicians who are caring for nursing home patients."

And even with advances in home- and community-based long-term care environments, there still are 1.5 million people in nursing homes nationwide. That is a "significant population that often gets overlooked in health policy discussions," he said.

"Even though we are doing a much better job of keeping even very disabled people in their homes a lot longer, there is still a significant number of people who are so disabled or who lack family support who need nursing homes," he said. "You cannot forget about the need to assure them access to good quality medical care."

The extent of the problem varies geographically, "but on the whole, it is a large problem," Kapp said. It is extensive in some states, including Florida, Texas and California. Anecdotally, the same problem exists in Illinois.

"If you talk with nursing home administrators, particularly the smaller nursing homes, they almost all complain about the problems of getting physicians to come in and follow their patients," he said.

The study will separate genuine issues from perceptions that are exaggerations and unrealistic fears, Kapp said.

The study will include relevant legal, medical, ethical, health policy and health services literature, along with legal cases, statutes and regulations. It also will include interviews with officials from relevant professional and trade organizations, such as American Medical Directors Association, American Geriatrics Society, American Medical Association, American Health Care Association, American Health Lawyers Association, and the American Association of Homes and Services for the Aging.

Kapp said there also will be structured telephone interviews with physicians involved in caring for nursing home residents, attorneys who represent and advise nursing homes, their residents/or families, and nursing home physicians. There are plans for a one-day invitational working meeting of 10 to 12 representatives of nursing home administrators, medical directors and others.

The study will also examine if it makes a difference whether a nursing home is a for-profit or not-for-profit facility, Kapp said. Between 75 and 80 percent of nursing homes are for-profit facilities.

Kapp expects to complete the study — funded with $40,000 in grants — next spring. The findings could result in recommendations for more professional education in law schools and medical schools, better risk management by nursing homes, and legislation, if needed.

"It's a valuable opportunity to look at an important and real issue that affects the quality of care and access to care for nursing home residents," he said.

- Pete Rosenbery