Teaching nursing homes: their impact on public policy, patient care, and medical education.

In summary, teaching nursing homes can be expected to have an impact on public policy development, patient care, and physician training. It is anticipated that research into the important public policy issues regarding relationships between costs and proprietary status and quality of care will be enhanced by developing teaching nursing homes. It will be important to coordinate efforts and evaluations between pilot projects with different funding bases in order to provide research projects with adequate controls. Many results regarding cost-quality comparisons may be of limited applicability to community institutions because of the higher costs inherent to teaching facilities. Nursing home patients living in teaching facilities can expect to be directly benefitted in terms of receiving increased medical attention. They will reside in model facilities providing what is hoped to be the optimal services in all aspects of nursing home care. Possible detrimental aspects for such patients include increased exposure to heroic interventions and possibly poorer care as a result of medical interference with established nursing home team approaches to patient care. As a result of living in a research environment, patients also may be pressured to participate in protocols to which they are not normally exposed. In addition, because many of the geriatric fellowships are based in Veterans Administration facilities (with their predominantly male patient population), it will be important to ensure that current research adequately studies the common problems of elderly women, who represent 70 per cent of those who are in nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)