One-Third of U.S. Nursing Homes Had No Medical Director in 2023: Study

On average, nursing homes across the country had a medical director on site for only about 30 minutes per day last year, which may increase the risk of medication errors and nursing home neglect for residents, according to a recent study.

In findings published in the Journal of the American Geriatrics Society earlier this month, researchers warn that about one-third of nursing homes did not even have a medical director on staff last year, and those who had medical directors frequently scheduled them for far fewer hours than required by federal law.

Federal regulations call for nursing homes to have a medical director on-site to help oversee patient care, develop resident care policies and implement procedures for residents’ physical and mental well-being.

However, medical directors can only do their job sufficiently if they spend a significant amount of time with the patients they are caring for on a daily basis, according to regulators.

Not having a medical director on staff or present at a facility on a consistent basis can cause serious issues, potentially resulting in severe injuries for residents. Therefore, researchers warn that additional studies are needed to evaluate the extent to which nursing home medical director regulations are being followed and enforced.

The new study was conducted by Dr. Eric L. Goldwein and a team of researchers from the Long Term Care Community Coalition in New York, who examined medical director presence time spent on-site, at nursing homes across the U.S. The researchers used federal payroll-based journal data on staffing positions for the period from 2017 to 2023, along with federal nursing home ownership data and deficiencies data for 2023.

According to the findings, more than one-third of nursing homes reported having no medical director on staff during the first quarter of 2023. In addition, over the past six years, the time a medical director spent on location at a nursing home has declined.

Among nursing homes that reported having a medical director on staff to guide patient care, medical directors were only on staff for an average of 36 minutes per day, or 4.2 hours per week, at each facility. That equates to less than one minute per day for each resident on average.

Some states reported only about 45% of nursing homes had a medical director on staff at any time during the study period. At for-profit nursing homes, medical directors were on staff roughly 60% of the time, compared to 71% at non-profit facilities, and 67% at government facilities.

However, the researchers discovered that the lack of medical director time did not result in most nursing homes being cited for regulatory deficiencies, even though they should have been.

Nursing Home Staffing Problems

The findings come amid continuing concerns about nursing home staffing shortages, which remain a major problem at facilities nationwide since the COVID-19 pandemic.

A lack of adequate staffing has been cited as one of the major issues contributing to an increase in nursing home resident deaths during the pandemic, and research published earlier this year indicates that many nursing homes still fail to meet the requirements for certified nursing assistants (CNAs).

In April 2024, the U.S. Centers for Medicare and Medicaid Services (CMS) proposed new rules calling  for minimum staffing requirements for nursing homes across the U.S., despite pushback from the industry and some Republican lawmakers.

Nursing home staff shortages make it difficult to provide optimal care, especially for residents who have recuperated enough from hospital visits to be sent back to their facilities, even though they might still need critical care. In these instances, residents often can’t be discharged due to understaffing issues at nursing homes.

These risks for facility residents may be further increased by a lack of medical directors to coordinate and oversee their care, a deficiency that researchers have found may require more government oversight.

“Together, these findings may indicate the need for improvement,” Goldwein’s team concluded. “More research is needed to understand these variations and the extent to which medical director regulations are being followed by nursing homes and enforced by regulators.”